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Dizziness - Coggle Diagram

- - - - Head impulse
        
        Move head briskly to look for catch up saccade
      - Nystagmus
        
        Primary gaze and lateral gaze
      - Test of Skew
        
        Cover and uncover test with each eye individually
- - - - Occurs hours to days to weeks,a nd resolves wtihin 1 week
      - Most important causes
        
        Vestibular neuritis
        
        Diagnosis that is presumed to be viral or post-viral inflammatory
        
        Idiopathic
        
        Posterior circulation stroke
        
        Can mimic vestibular neuritis or labyrinthitis
    - - Brief episodes of dizziness lasting seconds to minute
      - Has a specific trigger that consistently causes dizziness
      - Etiologies
        
        BPPV
        
        Most common cause of vestibular dizziness from cystalline debris in 1+ semicircular canals
        
        Displaced otoliths causing dizziness
        
        Symptoms
        
        Repetitive brief triggered episodes of rotational vertigo lasting less than a minute
        
        Diagnosis
        
        Confirmed by reproducing symptoms using Dix-hall pike test, and using the Epley maneuver
        
        Orthostatic Hypotension
        
        Accounts for 24% of acute syncopal presentations, classical symptom is lightheadedness or presyncope
        
        Compensatory Tachycardia
        
        Deconditioning
        
        Dysfunctional Heart: Myocardium (Low left ventricular ejection fraction, aortic stenosis)
        
        Dehydration: Disease, dialysis, drugs
        
        Drugs: ANtihypertensives, antianginals, anti-parkinsons, antidepressants, antipsyhcotics, anti-BPH
        
        Wiithout Compensatory Tachycardia
        
        Autonomic dysfunction
        
        Idiopathic, depletion of NE
        
        Drugs: Beta Blockers
        
        Approach
        
        Sustained reduction in systolic BP at least 20 mmHG or diastolic of 10 mmHG within 3 minutes of standing
        
        Failure of HR increase in setting of BP drop may be sign of underlying autonomic pathology
        
        Other causes (MUMP)
        
        Medication (Antihistamines, benzos, antidepressants, anticonvulsants, antipsychotics, toxicity)
        
        Unsteady gait (Parkinsons)
        
        Metabolic (ANemia, hypoglycemia, hyponatremia)
        
        Psychiatric (Anxiety, mood disorders, hyperventilation/emotional stress
        
        Dangerous causes
        
        Central neurologic mimics
    - - REcurrent, spntaenous episodes of dizziness thar range in duration from seconds to days
      - Most common cause is vestibular migraine
        
        at least 5 episodes of dizziness/vertigo lasting from minutes to days, half the episodes have 1+ migrainous feature
      - Can be caused by posterior circulation TIA
      - Meniere's disease can also present but is less common
      - Other important causes
        
        Reflex syncome, Cardiac arrhythmias, Strucutral heart disease