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Dizziness and Vertigo

The term dizziness is used for lightheadedness, faintness, spinning, giddiness, confusion and blackouts. Dizziness is classified in three categories: (1) faintness (syncope and presyncopal symptoms), (2) vertigo and (3) miscellaneous head sensation. The common causes of vertigo include benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, chronic suppurative otitis media, Meniere’s disease, cervical spondylosis, drug-induced vertigo due to administration of aminoglycosides, furosemide, etc. Systemic problems such as long-standing diabetes, hypertension may also be a causative factor. Vertigo as a psychosomatic manifestation should be ruled out. If the entire list of common causes is excluded by clinical examination and investigations, the vertigo may be termed as idiopathic.

SALIENT FEATURES

Sensation of patient spinning or the environment spinning around him in a specific and fixed direction.

Spontaneous nystagmus (most important physical sign) in primary position with eyes looking straightforward.

Important notes

Axioms for defining a dizzy spell as vestibular: If the patient in a significant spell does not have spontaneous labyrinthine nystagmus, and also if the dizziness has been non-episodic and continuous for two or three months, then this dizziness cannot be vestibular.

Treatment

Nonpharmacological

Reassure the patient and in cases where positional vertigo cannot be ruled out, advise the patient to take complete rest with minimal movements only.

Pharmacological

Tab. Cinnarizine 25 mg three times a day till resolution of symptoms. Or

Tab. Betahistine 8 mg three times a day. Or

Tab. Prochlorperazine 25 mg three times a day.

The duration of drug administration depends on the disease entity as well as the persistence of symptoms.

If patient has acute, severe nausea and vomiting:

Inj. Prochlorperazine 25 mg by deep IM injection stat, may be repeated after eight hours, if required. If there is no response to medical treatment:

Refer to ENT specialist for Canthrone-Cooksey exercises. These are special exercises which facilitate the process of adaptation of the vestibule.

Refer patients with Meniere’s disease for surgery to eliminate the offending labyrinth. Patient education

Explain that the antivertigo drugs are likely to cause sedation, therefore, patient should avoid tasks requiring alertness.

#Vomiting #Prochlorperazine #Dizziness #Cinnarizine #Betahistine #Vertigo

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