- examination of the 'dizzy' patient is directed by the history. Components include: (1)
- neurological examination
- head and neck examination
- examination of the cardiovascular system
- neurological examination (1)
- cranial nerves should be examined for :
- signs of palsies and sensorineural hearing loss
- this includes particularly
- funduscopy for papilloedema or optic atrophy (II)
- eye movements (III, IV, and VI)
- corneal reflex (V)
- facial movement (VII)
- tuning folk tests for hearing loss(VIII)
- special attention is paid to those that pass through the cerebellopontine angle - the fifth to the seventh.
- nystagmus
- common in acute virtigo (2)
- vertical nystagmus (1)
- is commonly seen in vestibular nuclear or cerebellar vermis lesions
- horizontal nystagmus
- is present in acute vestibular neuronitis
- cerebellar function is tested via the finger-nose test
- Romberg's sign (1)
- not very useful in the diagnosis of vertigo
- Dix-Hallpike maneuver (1)
- the most helpful test to perform for vertigo
- Unterberger's stepping test
- head and neck examination (1)
- Hennebert's sign
- pushing on the tragus and external auditory meatus of the affected side causes vertigo or nystagmus
- indicates the presence of a perilymphatic fistula
- peripheral auditory system
- pneumatic otoscopy
- examine tympanic membranes for
- vesicles (Ramsay Hunt syndrome)
- cholesteatoma
- tuning fork tests (also mentioned above)
- assess neck movements - an arthritic cervical spine may be the source of abnormal proprioceptive signals
- auscultation of the neck for bruits
- cardiovascular examination
- the following orthostatic changes systolic in blood pressure and pulse when the patientg is made to stand suggests autonomic dysfunction
- systolic blood pressure-drop of 20 mm Hg or more
- pulse - rise of 10 beats per minute
- arrhythmias
- check for postural hypotension
Reference:
(1) Ronald H. Labuguen, Initial Evaluation of Vertigo, American Family Physician ,Vol. 73/No. 2 (January 15, 2006)
(2) J Kanagalingam ,et al, Vertigo, BMJ, Mar 2005; 330:523