Persistent postural-perceptual dizziness
diagnosis of exclusion characterized by at least 3 months of nonvertiginous, persistent dizziness or imbalance that occurs on most days and is often provoked by patient motion and upright positioning as well as moving objects in the environment. Patients often have comorbid anxiety or other psychiatric disease. PPPD is often preceded by central nervous system (CNS) trauma, infection, or other vestibular disorders. Vestibular rehabilitation, reassurance, cognitive behavioral therapy, and treatment of comorbid psychiatric conditions are the mainstays of treatment.
two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
audiometrically documented sensorineural hearing loss in the affected ear
fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
not accounted for by another vestibular diagnosis
common cause of acute vestibular syndrome with preserved hearing
Reactivation of type 1 herpes simplex virus is thought to be the primary etiology, but antivirals (e.g., valacyclovir) have not been shown to have a benefit
Vestibular labyrinthitis refers to acute vestibular syndrome with hearing loss. It is thought to be closely related to vestibular neuritis; however, some experts advise caution with this diagnosis because the clinical picture can be a dangerous mimic of anterior inferior cerebellar artery ischemia.
Key History for dizziness
Categorize the patient’s symptoms using their report of the timing (comes and goes vs. continuous) and known triggers (precipitated by a certain movement or event).
triggered episodic vestibular syndrome: lasting seconds to minutesspontaneous episodic vestibular syndrome: lasting minutes to hoursacute vestibular syndrome: spontaneous onset and constant vertiginous symptoms lasting hours to days
Take a complete social history including substance use.Review medications (especially antiepileptics, sedatives, antihypertensives, and analgesics, which are common causes of dizziness in the elderly).
Most common causes of dizziness
most common causes were vasovagal syncope, fluid and electrolyte disorders, vestibular neuritis/labyrinthitis, arrhythmia, anemia, transient ischemic attack, hypoglycemia, and migraine