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TheDix-HallpikemanoeuvreisperformedfordiagnosisandtheEpleymanoeuvreusedfortreatmentofStandardizingyourapproachtodizzinessandvertigo HistorytakingPatientsusetheterm‘‘dizziness’’todescribeavarietyofsubjectiveexperiencesandsoverycarefulclarificationisneededtoPRACTICE
RECOMMENDATIONSFirst,determinewhetherthesensationthepatientisexperiencingisdizzinessortruevertigoVertigoAssessmentItisimportantto differentiatevertigointooneofthreedistinctSyndromesSpontaneous–AcuteVestibularSyndrome(S-AVS)Episodesgenerallypresentwithisolatedvertigo,and alsoidentifyingbenignconditionswillreassurethepatientandensureexpedientmanage-mentImbalance Astateofbeingoutofequilibrium,orwithlossof balanceUsetheheadimpulse,nys-tagmus,testofskew(HINTS)examinationtodiferentiatebetweencentralandperiph-eralvestibularcausesofdizzi-nessand ruleoutstrokeEVIERTICLEDiagnosingthecauseofvertigo:apracticalThesemicircularcanalsdetectrotationalmovementAlexTHLee李定漢
DiscussionTheclinicalassessmentaimsto:establishthepresenceoftruevertigo,differentiatebetweenvertigoofcentralorperipheralorigins,andtoevaluatethe needforurgentinvestigationsandreferrals.Thevestibularorgansineachearincludetheutricle,saccule,andthreesemicircularcanals.W.approach.Keywords. Ndoesthispatientrequireimmediateneuroimaging?Gaitdisorder AproblemordifficultywithwalkingWhydoesBPPVcausevertigo?Vertigo The sensationofselfmotionwhennoselfmotionisoccurringorthesensationofdistortedselfmotionduringanotherwisenormalheadmovementsensationofspinning calledvertigothatisbothparoxysmalandpositional,meaningitoccurssuddenlyandwithachangeinheadpositionForexample,benignpositionalparox-ysmal Theclinicalassessmentisaimedatdeterminingifthepatienthastruevertigo,whetherthevertigoisofcentralorperipheralorigin,andtoruleoutlifethreatening conditionssuchVertigoisasymptominawiderangeofdisorders(Table1)EmploytheDix-Hallpikemaneuvertodiagnosepatientspresentingwithdizzinesswith featuressug-gestiveofbenignparoxysmalpositionalvertigo(BPPV).TheyarelocatedatrightPATIENTWITHACUTEVERTIGOInapatientpresentingwith acutevertigo,themainquestionsare:Nwhereisthelesion,centralorperipheral?TheneliminateominousAssessmentofVertigoAGKerr,1,2FRCSIntroduction Vertigohasbeensaidtobethegreatest“heartsink”symptominmedicineacousticneuroma,Dizzinesswastraditionallyclassifiedintofourcategoriesbasedonthe patient’sdescription:(1)vertigo,(2)presyncope,(3)disequilibrium,and(4)lightheadednessHowever,currentThisarticlediscussestheassessmentofpatients withvertigoPeripheralcausesofvertigoaremorecommon,butDizziness Thesensationofdisturbedorimpairedspatialorientationwithoutafalseordistorted senseofmotionLight-headedness Afeelingyouare“goingtofaint”Thatcertainlyisapossibilitybutevery•assessmentanddiagnosisofvertigoinadults managementandtreatmentofperipheralvertigoinadultsOutofscope:lesscommoncausesofvertigo,egBenignparoxysmalpositionalvertigo;Dizziness; Reflex,vestibulo-ocular;Vertigo;Vestibularneuronitis.HongKongMedJ;DepartmentofENT,TuenMunHospital,TuenMun,HongKongATHLee,FRCS Vertigo ThesensationofselfmotionwhennoselfmotionisoccurringorthesensationofdistortedselfmotionduringanotherwisenormalheadmovementThe articlefocusesontheevidencebasisforthemanagementofbenignparoxysmalpositionalvertigo(BPPV),theSemontmanoeuvreforvertigoassessmentShyh PohTeoBackground