Differential diagnosis and mini-cases - headache, confusion&memory loss, loss of vision, depressed mood, psychosis, dizziness Flashcards Preview

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Flashcards in Differential diagnosis and mini-cases - headache, confusion&memory loss, loss of vision, depressed mood, psychosis, dizziness Deck (46):
1

Headache - key history ?

  1. Onset : acute or chronic ?
  2. Location : unilateral vs. bilateral ?
  3. Quality : dull vs. stabbing ? 
  4. Intensity : is it the “worst headache of their life” ?
  5. Duration, timing : does it disturb sleep?)
  6. Presence of associated neurologic symptoms : paresthesias, visual stigmata, weakness, numbness, ataxia, photophobia, dizziness, auras, neck stiffness;
  7. Nausea/vomiting ?
  8. Jaw claudication ?
  9. Recent trauma, dental surgeries ?
  10. Sinusitis symptoms : frontal pain, pain over sinuses ?
  11. Exacerbating factors : stress, fatigue, menses, exercise, certain foods ? 
  12. Alleviating factors : rest, medications ?
  13. Patient and family history of headache ?

2

Headache : Key Physical Exam ?

  1. Vital signs;
  2. Inspection and palpation of entire head;
  3. ENT inspection;
  4. Complete neurologic exam, including fundu- scopic exam

3

What is your differential diagnosis and workup plan ?

21 yo F presents with several episodes of throbbing left temporal pain that last for 2–3 hours. Before onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Her headaches are often associated with nausea and vomiting. She has a family history of migraine. 

 

  • Differential diagnosis :
    • Migraine headaches - complicated 
    • Tension headaches
    • Cluster headaches 
    • Pseudotumor cerebri
    • CNS vasculitis
    • Partial seizure
    • IC neoplasm
  • Workup plan : 
    • CBC, ESR
    • CT-head, MRI-brain
    • LP : CSF analysis

4

What is your differential diagnosis and workup plan ?

26 yo M presents with severe right temporal head- aches associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes.

  • Differetntial diagnosis :
    • Cluster headaches
    • Migraine headaches - complicated
    • Tension headches 
    • Intracranial neoplasm 
    • Pseudotumor cerebri
  • Workup : 
    • CBC, ESR
    • CT - head, MRI - brain 
    • LP - CSF analysis

5

What is your differential diagnosis and workup plan ?

65 yo F presents with severe, intermittent right tem- poral headache, fever, blurred vision in her right eye, and pain in her jaw when chewing.

  • Differential diagnosis :
    • Temporal arteritis - giant cell arteritis
    • Migraine hedache
    • Cluster headache
    • Tension headache
    • Meningitis
    • Carotid artery dissection
    • Pseudotumor cerebri 
    • Temporomandibular joint disorder
    • Trigeminal neuralgia  
    • Intracranial neoplasm
  • Workup :
    • CBC with differential, ESR, CRP
    • Temporal artery biopsy 
    • Fundoscopic exam and visual field testing
    • MRI - brain, CT - head
    • Doppler U/S - carotid 
    • LP - opening pressure and CSF analysis 

6

What is your differential diagnosis and workup plan ?

"30 yo F presents with frontal headache, fever, and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. She has a history of allergies"

  • Differential diagnosis :
    • Allergic sinusitis
    • Bacterial/viral (infectious) sinusitis 
    • Common cold
    • Migraine
    • Tension headache
    • Meningitis
  • Workup : 
    • CBC with differential, ESR, CRP
    • XR - sinuses; CT - sinuses

7

What is your differential diagnosis and workup plan ?

"50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3–4 times a week, typically toward the end of her work day. She is ex- periencing significant stress in her life and recently decreased her intake of caffeine"

  • Differential diagnosis :
    • Tension-type headaches 
    • Caffein-withdrawal associated headaches
    • Migraine 
    • Depression
    • Hypertension
    • Cluster headaches 
    • Pseudotumor cerebri
    • Intracranial neoplasm 
  • Workup :
    • CBC with differential, CRP, ESR
    • CT-head, MRI-brain, electrolytes

8

What is your differential diagnosis and workup plan ?

"35 yo M presents with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity"

  • Differential diagnosis : 
    • Subarachnoid hemorrhage
    • Stroke - hemorrhagic/ischemic 
    • Meningitis
    • Encephalitis
    • Migraine - complicated
    • Vertebral artery dissection
    • Intracranial venous thrombosis
    • Acute hypertension
    • Intracranial neoplasm
  • Workup 
    • CT - head, no-contrast
    • MRI - brain, MR venography
    • CBC with differential
    • INR, PT, aPTT
    • Glucose, U&E, BUN
    • Urinalysis, urine toxicology
    • LP - CSF analysis

9

What is your differential diagnosis and workup plan ?

"25 yo M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity"

  • Differential diagnosis :
    • Meningitis 
    • Encephalitis 
    • Migraine
    • Subarachnoid hemorrhage 
    • Sinusitis
    • Intracranial/epidural abscess
  • Workup :
    • MRI - brain, CT - head, no contrast 
    • CBC with differential, CRP
    • Blood culture, Urinalysis and culture
    • LP - CSF analysis (cell count, protein count, glucose) and culture, opening pressure measurement

10

What is your differential diagnosis and workup plan ?

"18 yo obese F presents with a pulsatile headache, vomiting, and blurred vision for the past 2–3 weeks. She is taking OCPs"

  • Differential diagnosis :
    • Pseudotumor cerebri
    • Migraine 
    • Tension headaches
    • Cerebral venous thrombosis
    • Stroke 
    • Subarachnoid hemorrhage 
  • Workup :
    • LP - opening pressure, xanthochromia
    • CBC with differential, CRP
    • INR, PT, aPTT, BT

11

What is your differential diagnosis and workup plan ?

"57 yo M c/o daily pain in the right cheek for the past month. The pain is electric and stabbing in character and occurs while he is shaving. Each episode lasts 2–4 minutes."

  • Differential diagnosis : 
    • Trigeminal neuralgia
    • Cluster headaches 
    • Tension headache 
    • Migraine 
    • TMJ disorder 
    • Intracranial neoplasm 
  • Workup : 
    • CBC 
    • ESR
    • MRI - brain

12

What are some useful tips for a good "headache-interview" ?

  1. Let the patient tell the headache story in his or her own words before asking more directed and focused questions;
  2. Patients often seek medical care due to concern about a brain tumor or other serious diagnosis => PEARLS;
  3. First, correctly classify whether the headache is old or new.
  4. Cardinal symptom features: onset, duration, frequency, pain character, location, radiation, associated features, precipitating and alleviating factors;
  5. Always ask about change in frequency or character of chronic headache ! 
  6. Remember about alarm syptoms; 

13

What are the alarming symptoms that always indicate serious diagnosis ?

  1. Visual loss => acute-angle closure glaucoma, giant cell arteritis; 
  2. Prolonged visual aura => arterio-venous malformation; 
  3. Dysequilibrium => stroke, brain tumor;
  4. Confusion or lethargy => meningitis, encephalitis, brain tumor, brain abscess;
  5. New-onset seizure => stroke, encephalitis, brain tumor; 

14

Confusion/Memory loss - key history ?

  • Must include history from family members/caregivers when available;
  • Detailed time course of cognitive deficits (acute vs. chronic/gradual onset);
  • Associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression);
  • Screen for delirium (waxing/waning level of alertness);
  • Falls, medications (and recent medication changes); 
  • History of stroke or other atherosclerotic vascular disease, syphilis, HIV risk factors, alcohol use, vitamin B12 deficiency;
  • Family history of Alzheimer’s disease or other neurologic disorders;

15

Confusion/Memory loss - physical examination

  1. Vital signs;
  2. Complete neurologic exam, including mini-mental status exam and gait;
  3. General physical exam, including ENT, heart, lungs, abdomen, extremities; 

16

What is your differential diagnosis and workup plan ?

"81 yo M presents with progressive confusion for the past several years accompanied by forgetfulness and clumsiness. He has a history of hypertension, diabe- tes mellitus, and 2 strokes with residual left hemi- paresis. His mental status has worsened after each stroke (stepwise decline in cognitive function)"

  • Differential diagnosis :
    • Vascular dementia - multiinfarct dementia or diffuse white matter disease 
    • Alzheimer's disease
    • Normal pressure hydrocephalus
    • Chronic subdural hematoma
    • Intracranial neoplasm
    • Depression
    • Vitamin B12 defficiency 
    • Hypothyroidism
    • Neurosyphilis
  • Workup plan :
    • MRI - brain, CT - head
    • Doppler US - carotid 
    • Beck's depression 
    • Vitamin B12 serum level 
    • TSH, T4 
    • VDRL, RPR 
    • LP - CSF analysis

17

What is your differential diagnosis and workup plan ?

"84 yo F brought by her son c/o forgetfulness (eg, forgets phone numbers, loses her way back home) and difficulty performing some of her daily activities (eg, bathing, dressing, managing money, using the phone). The problem has progressed gradually over the past few years"

  • Differential diagnosis :
    • Alzheimer's disease 
    • Vascular dementia
    • Depression
    • Hypothyroidism 
    • Chronic subdural hematoma
    • Normal pressure hydrocephalus
    • Intracranial neoplasm
    • Vitamin B12 defficiency 
    • Neurosyphilis 
  • Workup : 
    • CBC with differential 
    • MRI - brain, CT - head
    • TSH, T4
    • Vitamin B12 serum level
    • VDRL, RPR 
    • Beck's depression inventory
    • LP - CSF analysis 

18

What is your differential diagnosis and workup plan ?

"72 yo M presents with memory loss, gait disturbance, and urinary incontinence for the past 6 months"

  • Differential diagnosis :
    • Normal pressure hydrocephalus
    • Alzheimer’s disease
    • Vascular dementia
    • Chronic subdural hematoma
    • Intracranial neoplasm
    • Depression
    • B12 deficiency
    • Neurosyphilis
    • Hypothyroidism
  • Workup : 
    • CT—head
    • MRI—brain
    • LP—opening pressure and CSF analysis
    • Serum B12
    • VDRL/RPR
    • TSH 

19

What is your differential diagnosis and workup plan ?

"55 yo M presents with a rapidly progressive change in mental status, inability to concentrate, and memory impairment for the past 2 months. His symptoms are associated with myoclonus, ataxia, and a startle response"

  • Differential diagnosis :
    • Creutzfeldt-Jakob disease
    • Vascular dementia
    • Lewy body dementia
    • Wernicke’s encephalopathy
    • Normal pressure hydrocephalus
    • Chronic subdural hematoma
    • Intracranial neoplasm
    • Depression
    • Delirium
    • B12 deficiency
    • Neurosyphilis
  • Workup : 
    • CBC
    • Electrolytes, calcium
    • Serum B12
    • VDRL/RPR
    • MRI—brain (preferred), CT—head
    • EEG
    • LP—CSF analysis
    • Brain biopsy 

20

What is your differential diagnosis and workup plan ?

70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitations, dia- phoresis, and weakness. 

  • Differential diagnosis :
    • Hypoglycemia
    • Hyperosmolar hyperglycemic state 
    • Trancient ischemic attack 
    • Arrythmia
    • Delirium 
    • Angina
    • Intoxication
    • Hyperthyroidism - thyroid storm 
  • Workup : 
    •  

21

What is your differential diagnosis and workup plan ?

"55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for 2 minutes"

  • Differential diagnosis :
    • Subdural hematoma
    • SIADH (causing hyponatremia)
    • Creutzfeldt-Jakob disease
    • Intracranial neoplasm 
  • Workup : 
    • CT—head
    • CBC
    • Electrolytes
    • MRI—brain
    • LP—CSF analysis 

22

What are some points to consider when having a confused patient ?

  • Obtain information from other caregivers;
  • Evaluate the patient at different times;
  • Differnitiate delirium and dementia;
  • Delirium and dementia often coexist;

23

Loss of vision - key history ?

  • Acute vs. chronic, progression; 
  • Ability to see light;
  • Associated symptoms : eye pain, discharge, itching, tearing, photophobia, redness, headache, weakness, numbness, floaters, sparks;
  • History of cardiac, rheumatic, thrombotic, autoim- mune, neurologic disorders;
  • Jaw claudication;
  • Medications, trauma; 

24

What are the key physical exam points in case of vision loss symptom ?

  • Vital signs;
  • Cardiovascular exam;
  • HEENT - Head, Ears, Eyes, Nose, Throat; 
  • Funduscopic exam; 
  • Neurologic exam; 

25

What is your differential diagnosis and workup plan ?

"73 yo M presents with acute loss of vision in his left eye, palpitations, and shortness of breath. He has a history of atrial fibrillation and cataracts in his right eye. He has no eye pain, discharge, redness, or pho- tophobia. He has not experienced headache, weak- ness, or numbness"

  • Differential diagnosis :
    • Retinal artery occlusion, CRAO - Central Retinal Artery Occlusion
    • Retinal vein thrombosis
    • Acute angle-closure glaucoma 
    • Retinal detachment
    • Temporal arteritis - giant cell arteritis
  • Workup : 
    • Fluorescein angiogram
    • Echocardiography
    • Doppler U/S—carotid
    • Intraocular tonometry
    • ESR, CBC
    • Temporal artery biopsy 

26

Depressed mood - key history ?

SIGME CAPT

  1. Suicidal/Stress/Sleep/Support/Social
  2. Interest - anhedonia ?
  3. Guilt
  4. Memory, Mood
  5. Energy level
  6. Concentration
  7. Apathy/Appetite & weight, Alcohol&drug use
  8. Psychomotor - agitation or retardation/Psychiatric/Prior episodes 
  9. Thyroid - hypothyroidism ? other medical conditions => kidney failure, liver failure ?

27

Depressed mood - key physical exam ?

  1. Vital signs;
  2. Head and neck exam;
  3. Neurologic exam;
  4. Mental status exam, including documentation of:
    1. appearance : gait, posture, clothes, grooming;
    2. behavior : mannerisms, gestures, psychomotor activity, expression, eye contact, ability to follow commands/requests, compulsions; 
    3. attitude : cooperative, hostile, open, secretive, evasive, suspicious, apathetic, easily distracted, focused, defensive; 
    4. speech :
      1. quantity : talkative, spontaneous, expansive, paucity, poverty;
      2. rate : fast, slow, normal, pressured; 
      3. volume : loud, quite, monotone, weak;
      4. fluency and rythm : slurred, clear, hesitant;
    5. mood,
    6. affect : broad (normal), restricted (constricted), blunted, flat, normal;
    7. thought process : linear, goal-directed, circumstantial, tangential, loose associations, incoherent, evasive, racing, blocking, perseveration, neologisms; 
    8. thought content;
    9. cognition (measured by the 30-point mini-mental status exam);
    10. insight;
    11. judgment; 

28

What is your differential diagnosis and workup ?

"68 yo M presents with a 2-month history of crying spells, excessive sleep, poor hygiene, and a 15-lb (6.8-kg) weight loss, all following his wife’s death. He cannot enjoy time with his grandchildren and admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner"

  • Differential diagnosis :
    • Normal grief 
    • Complicated grief
    • Adjustment disorder with depressed mood
    • Major depressive disorder with psychotic features
    • Schizoaffective disorder 
    • Underlying medical condition : hypothyroidism, anemia 
  • Workup : 
    • Physical exam
    • Beck's depression inventory 
    • TSH, T3, T4 
    • CBC with differential 
    • Urinalysis and toxicology screen 

29

What is your differential diagnosis and workup ?

"42 yo F presents with a 4-week history of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered 5 similar episodes in the past, the first in her 20s, and has made 2 previous suicide attempts. She further admits to increased alcohol use in the past month"

  • Differential diagnosis :
    • Major depressive disorder
    • Persistent depressive disorder = Dysthymia
    • Substance-induced mood disorder
    • Borderline personality 
  • Workup :
    • Beck's depression inventory
    • CBC with differential 
    • TSH, T4 
    • Blood alcohol 
    • Urinalysis and toxicology screen 
    • Mental status exam
  • Persistent depressive disorder (dysthymia) = depressed mood for ≥2yrs + ≥2 : decreased or increased appetite, insomnia/hypersomnia, low energy, poor self-esteem, poor concentration, hopelessness;

 

30

What is your differential diagnosis and workup ?

"26 yo F presents with a 6.5-lb (2.9-kg) weight loss in the past 2 months, accompanied by early-morning awakening, excessive guilt, and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing thoughts approximately 6 months before her presentation"

  • Differential diagnosis :
    • Bipolar I disorder
    • Bipolar II disorder
    • Cyclothymic disorder
    • Major depressive disorder
    • Schizoaffective disorder 
  • Workup :
    • Physical exam
    • Mental status exam
    • Urine toxicology 

 

31

What are the medications associated with depressive mood ?

  1. High dose reserpine
  2. High dose GCS 
  3. Anabolic steroids 
  4. Cocaine or amphetamine withdrawal 
  5. Isotretinoin 
  6. Alcohol 
  7. Interferon
  8. OCPs 
  9. Carbamazepine 
  10. Phenobarbital

32

What are the key history findings in case of psychosis ?

  1. Positive symptoms (delusions, hallucinations, disorganized thoughts, disorganized or catatonic behavior);
  2. Negative symptoms (blunted affect, social withdrawal, decreased motivation, decreased speech/thought);
  3. Cognitive symptoms (disorganized speech or thought patterns, paranoia);
  4. Age at first symptoms and/or hospitalization;
  5. Previous psychiatric medications;
  6. Alcohol and substance use. 

33

What are the key physical findings in case of psychotic patient ?

  • Vital signs;
  • Mental status exam;
  • During physical exam, pay particular attention to general appearance (eg, poor grooming, odd or poorly fitting clothing);

 

34

Differnitiate btw schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, schizotypal personality disorder and schizoid personality disorder.

  1. Schizophrenia : positive/negative symptoms lasting >1 yr; 
  2. Schizophreniform disorder all the criteria for schizophrenia are met, but the total duration of the disorder is <6 months; 
  3. Brief psychotic disorder => presence of one or more psychotic symptoms with a sudden onset, absence of a mood or substance-induced disorder, and remission within one month;
  4. Schizoaffective disorder is essentially schizophrenia with manic episodes or a significant depressive component;
  5. Schizotypal personality disorder is a long-standing pattern of odd or eccentric beliefs and/orperceptual disturbances that do not rise to the level of delusions or hallucinations;
  6. Schizoid personality disorder is a long-standing pattern of little interest in social relationships or intimacy. There is overlap with the negative symptoms seen in schizoid personality disorder and schizophrenia, but schizoid personality disorder does not present with psychosis.

35

What is your differential diagnosis and workup ?

"19 yo M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. He stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to “guard against the evil empire""

  • Differential diagnosis :
    • Schizophrenia
    • Schizophreniform disorder
    • Brief psychotic disorder
    • Schizoid personality
    • Schizotypal personality
    • Psychotic disorder due to a general medical condition
    • Substance-induced psychosis 
    • Depression with psychotic features 
  • Workup :
    • Mental status exam
    • Urine toxicology
    • TSH
    • CBC
    • Electrolytes 

36

What is your differential diagnosis and workup ?

"28 yo F c/o seeing bugs crawling on her bed for the past 2 days and hearing loud voices when she is alone in her room. She has never experienced anything similar in the past. She recently ingested an unknown substance"

  • Differential diagnosis :
    • Substance induced psychosis
    • Brief psychotic disorder 
    • Schizophreniform disorder 
    • Schizophrenia
    • Psychotic disorder due to a general medical condition 
  • Workup :
    • Urine toxicology
    • Mental status exam
    • TSH
    • CBC
    • Electrolytes, BUN/Cr
    • AST/ALT

37

What is your differential diagnosis and workup ?

"48 yo F presents with a 1-week history of auditory hallucinations that state, “I am worthless” and “I should kill myself.” She also reports a 2-week history of weight loss, early-morning awakening, decreased motivation, and overwhelming feelings of guilt. "

  • Differential diagnosis :
    • Schizoaffective disorder
    • Mood disorder with psychotic features
    • Schizophrenia
    • Schizophreniform disorder
    • Psychotic disorder due to a general medical condition 
  • Workup :
    • Mental status exam
    • Beck Depression Inventory
    • TSH, CBC, Electrolytes 

 

38

Key history : dizziness ?

  • Lightheadedness vs. vertigo ?
  • ± auditory symptoms (hearing loss, tinnitus) ?
  • Duration of episodes ?
  • Context (occurs with positioning, following head trauma) ?
  • Other associated symptoms (visual disturbance, URI, nausea) ?
  • Neck pain or injury ?
  • Medications ?
  • History of atherosclerotic vascular disease ? 

 

39

Key physical exam : dizziness ?

  • Vital signs;
  • Complete neurologic exam, including Romberg test, nystagmus, tilt test (eg, Dix-Hallpike maneuver);
  • Gait;
  • Hearing;
  • Weber and Rinne tests;
  • ENT exam;
  • Vardiovascular exam; 

 

40

What is your differential diagnosis and workup ?

"35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, hearing loss within the past week"

  • Differential diagnosis :
    • Ménière’s disease
    • Vestibular neuronitis
    • Labyrinthitis
    • Benign positional vertigo
    • Acoustic neuroma 
  • Workup : 
    • CBC
    • VDRL/RPR (syphilis can be a cause of Ménière’s disease)
    • MRI—brain
    • Dix-Hallpike maneuver

41

What is your differential diagnosis and workup ?

"55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She takes furosemide for hypertension"

  • Differential diagnosis :
    • Orthostatic hypotension due to dehydration (diarrhea, diuretic use)
    • Vestibular neuronitis
    • Labyrinthitis
    • Benign positional vertigo
    • Vertebrobasilar insufficiency 
  • Workup :
    • Orthostatic vital signs
    • CBC
    • Electrolytes
    • Rectal exam, stool for occult blood
    • Stool leukocytes 

42

What is your differential diagnosis and workup ?

"65 yo M presents with postural dizziness and unsteadiness. He has hypertension and was started on hydrochlorothiazide 2 days ago"

  • Differential diagnosis :
    • Drug-induced orthostatic hypotension
    • Vestibular neuronitis
    • Labyrinthitis
    • Benign positional vertigo
    • Brain stem or cerebellar tumor
    • Acute renal failure 
  • Workup : 
    • Orthostatic vital signs
    • CBC
    • Electrolytes
    • Echocardiography
    • MRI—brain 

43

What is your differential diagnosis and workup ?

"4 yo F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. A tilt test results in nystagmus and nausea"

  • Differential diagnosis :
    • Benign positional vertigo
    • Vestibular neuronitis
    • Labyrinthitis
    • Ménière’s disease 
  • Workup : 
    • Dix-Hallpike maneuver
    • MRI—brain
    • Audiogram

44

What is your differential diagnosis and workup ?

"55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss."

  • Differential diagnosis :
    • Vestibular neuronitis
    • Labyrinthitis
    • Ménière’s disease
    • Benign positional vertigo
    • Vertigo associated with cervical spine disease or injury
    • Vertebrobasilar insufficiency 
  • Workup : 
    • CBC, Electrolytes
    • Electronystagmography
    • MRI/MRA—brain

45

What is your differential diagnosis and workup ?

"55 yo F c/o dizziness that started this morning and of “not hearing well.” She feels nauseated and has vomited once in the past day. She had a URI 2 days ago."

  • Differential diagnosis :
    • Labyrinthitis
    • Vestibular neuronitis
    • Ménière’s disease
    • Acoustic neuroma
    • Vertebrobasilar insufficiency 
  • Workup : 
    • Audiogram
    • Electronystagmography
    • MRI/MRA—brain

46

What are some common causes of dizziness ?

  1. Vertigo :
    1. BPPV : Benign Paroxysmal Positional Vertigo 
    2. Vestibular neuronitis 
    3. Menieres disease
    4. Migraine
    5. Vertebrobasilar stroke
  2. Presyncope
    1. Cardiac arrythmias
    2. Aortic stenosis
    3. Orthostasis
    4. Vasovagal event
  3. Dysequilibrium 
    1. Peripheral neuropathy
    2. Sensory disturbances
    3. Neuromuscular disorder
    4. Cervical spondylosis
    5. CNS disorders
  4. Miscallenous  
    1. Anxiety and other psychiatric disorders
    2. Medications, substance abuse
    3. Metabolic disorders