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Clinical examination of the dizzy patient

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • The 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
          • fundoscopy 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 vertigo (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 patient 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

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