Subjective Examination Purpose:
develop clinical hypothesis
Patient Information
age fall history occupation referral source medical records medical diagnosis
Stage of Dizziness
(Tempo) acute: = 3 days or less than chronic: is more than 3 days. constant spells: seconds/minutes/hours
Type of Dizziness
Vertigo: Light headedness: Disequilibrium: Oscillopsia: Pre-syncope
Vertigo:
false sense of movement or spinning (defined as the illusion of environmental movement or a spinning/twisting/turning sensation)
Disequilibrium:
the feeling of being unsteady in balance or coordination
Intensity of Dizziness
Modified Visual Analog Scale (mVAS) 0-10/10 verbal scale 0/10 = no dizziness 10/10 = most dizziness possible obtain verbal range and current number
Impact of Dizziness
Dizziness Handicap Inventory (DHI)
-0-100 scale
-dizziness psychological impact
Activities-specific Balance Confidence scale (ABC)
-0-100% scale
-dizziness functional confidence impact
Past Medical History:
(potentiallydrivingdizziness) trauma infection metabolic disorders vascular disorders degenerative disorders tumors congenital disorders neurogenic psychogenic
Ototoxic Drugs
(destructive to sterocilia and kinocilium)
- aminoglycoside antibiotics (gentamycin)
- antineoplastics(cisplatin)
- diuretics (mannitol)
- environmental toxins (carbon monoxide)
Antihistamines
improves dizziness by decreasing fluid in ears
- antivert
- dramamine
- benadryl
- phenergan
Benzodiazepines
improves dizziness by decreasing CNS response
- valium
- ativan
Anticholinergics
(improves dizziness by decreasing acetylcholine)
-scopolamine
Social History
home environment
smoking and drinking
sleeping pattern
Patient History
tempo
symptoms
circumstances
Tempo=acute
labrynthitis
vestibular neuritis
Wallenberg infarct
Tempo=chronic constant
unilateral vestibular hypofunction (UVH)
bilateral vestibular hypofunction (BVH)
mal de debarquement
anxiety/depression
Tempo=chronic spells last seconds
benign paroxysmal positional vertigo (BPPV) orthostatic hypotension perilymphatic fistula (PLF)
Tempo=chronic spells last minutes
migraine
panic attack
transient ischemic attack
Tempo=chronic spells last hours
motion sickness
Meniere’s disease
Oscillopsia:
blurred vision
Pre-syncope
is a more extreme form of lightheadedness. The patient senses a looming loss of consciousness or a feeling as if your are about to faint
