November 2002 • Volume 8 • Number
11 |
Dizziness is a wonderful thing, lecturer concludes
BY DENNIS CONNAUGHTON
"I
love dizzy people," said lecturer Martin Samuels, M.D., in opening his humorous
and insightful Assembly lecture, "Differential Diagnosis of the Dizzy Patient."
Samuels closed by saying, "Dizziness is a wonderful thing, isn't it? It's
common. It spans all medicine -- psychiatry, neurology and otolaryngology.
It does not yield to technology. It is comprehensible. It is treatable. And
I'll bet you can't wait to get back to your offices to see your next dizzy
patient."
In between those comments, Samuels, who is neurologist-in-chief at Brigham
and Women's Hospital in Boston and professor of neurology at Harvard Medical
School, Boston, told his audience how best to diagnose and manage dizzy patients.
History is key
Dizziness is one of the five most common complaints patients have when they
see a doctor. But to the layperson, the term can mean a variety of things,
such as feeling woozy, light-headed or on the verge of fainting. The very
fuzziness of the terminology presents a major diagnostic challenge to family
physicians, said Samuels.
Taking a thorough history is key to the proper diagnosis of dizziness. "If
you do not know the diagnosis at the end of the history, you will probably
never know the diagnosis," Samuels said. He gave tips for taking a dizzy history:
- Don't suggest symptoms to the patient. Rather than asking patients if
they are lightheaded or feel like the room is spinning, ask patients what
they mean by being dizzy or to describe their dizziness. Then listen and
don't interrupt.
- Listen for neighborhood symptoms in what the patient says, such as hearing
loss or seeing double. Symptoms of hearing loss suggest a peripheral nervous
system cause for the dizziness. Diplopia and dysarthria suggest a central
nervous system cause.
Types of dizziness
Samuels defined four types of dizziness and suggested treatments:
- Vertigo (illusion or hallucination of motion). About
half of all complaints of dizziness are cases of vertigo, he said. For some
cases of vertigo, physicians may prescribe anticholinergic drugs that penetrate
the blood-brain barrier, such as meclizine or diphenhydramine. In rare cases,
the patient may have a perilymphatic fistula that will either go away in
time or require surgery if it doesn't.
- Near-syncope (feeling of impending faint). About one-sixth
of all cases are near-syncope dizziness. Near-syncope may be caused by antihypertension
or antidepressant medications or ACE inhibitors. The treatment is beta-blockade.
- Dysequilibrium (gait disorder). Another one-sixth of
all cases involve a feeling of falling or staggering. The causes may be
an extrapyramidal disorder, such as Parkinson's disease; cervical spondylosis;
or vitamin B12 deficiency.
- Ill-defined lightheadedness (anxiety). The final one-sixth
of all cases can be attributed to anxiety or a combination of depression
and anxiety, Samuels said.
FP Report is published by the AAFP
News Department.
Copyright © 2002 by American Academy of Family Physicians.
