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Examination Protocol in a Dizzy Patient

Sandeep Sharma

A practical easy to do examination protocol while approaching a patient of vertigo to clarify - Type of Dizziness. Dizziness is a term to describe a number of different sensations, especially uncertainty of a position or motion. Dizziness is derived from "Dysig" meaning stupid. Dizziness is categorized into 5 types: Vertigo, disequilibrium, lightheadedness, floating (psychogenic) and motion sickness and is illusion of motion or spinning sensation. Vertigo is of two types: Subjective in which person feels the motion and Objective in which surroundings revolve and patient sees the motion. Imbalance is wobbling on your feet-loss of balance without abnormal sensation. Patient usually complains of feeling of unsteadiness/imbalance when standing/walking/ turning - increased by uneven ground or turning. Fainting (Blackouts/ Presyncope) Usually due to cardiovascular e.g Postural Hypotension, Metabolic e.g. Hypoglycemia. Light headedness - Vague symptoms due to psychological cause, multisensory deficit etc. Motion Sickness - This is a mismatch between the visual and vestibular system. Commonly occurs with cars, boats and aero planes etc. When a patient approaches to vertigo clinic, for assessment First and foremost is to understand what patient means by dizziness-whether it is true vertigo or dizziness, type of Vertigo -- Central or Peripheral, then start ruling out the causes of dizziness and vertigo with special emphasis on examination of Vestibulo-occular and Vestibulospinal reflexes - their relevance and their usefulness.