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Sore Throat Differential Diagnosis
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WoS Paediatric Drooling and Aspiration Guideline
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Dizziness Differential Diagnosis
Last updated 12th October 2023
Is the Dizzy Sensation Actually Vertigo?
- Vertigo is a symptom – the sensation that you, or the world around you is moving or spinning.
- Vertigo can be a symptom of the vestibular system, but it can also be a central nervous symptom.
- Dizziness, light-headedness, giddiness, ‘feeling wrapped in cotton wool’ are usually symptoms of the central nervous system.
- Dizziness can be a symptom of cardiac problems, stroke, TIA, polypharmacy, alcohol intake etc.
If the Dizziness is True Vertigo How Long Does it Last and What Brings it on?
- Episodic, lasts seconds, usually on turning head a particular way or turning over in bed: might be benign paroxysmal positional vertigo (BPPV)
- Episodic, lasts minutes to hours, sometimes aggravated on standing, no focal neurology or postural hypotension etc., associated with increased age: might be a type of generalised age-related dysequilibrium
- Episodic, warning aura, headache, photophobia, post-headache ‘fuzziness’, lasts a few hours to one day: might be vestibular (or vertiginous) migraine
- Episodic, without warning, typically unilateral hearing loss, tinnitus and sensation of aural pressure, lasts a few hours, commonly in 40-60 year olds: might be Ménière’s disease; if no aural pressure, then rarely it might be a bleed inside an acoustic neuroma
- Constant, lasts days or longer, reduction in mobility, nausea, vomiting, hearing loss , tinnitus etc.: might be some sort of labyrinthine disorder/viral infection, commonly labelled as ‘labyrinthitis’
- If lasting days with no hearing loss or tinnitus -> vestibular neuronitis
- Remember that a stroke can give you vertigo: when in doubt, rule out the more serious pathology first.
Is the Patient Unwell, Unable to Mobilise Safely or Vomiting, or is There any Focal Neurology etc.?
- Yes – Refer patient for general medical or neurological management.
Do you Think this is BPPV, Ménière’s, an Acoustic Neuroma etc.?
- Yes – Refer patient to ENT clinic; a fuller assessment of the vestibulocochlear system can be made in clinic as there is access to vestibular testing and audiology.
Distinguishing Characteristics of Peripheral vs. Central Causes of Vertigo
Feature | Peripheral Vertigo | Central Vertigo |
---|---|---|
Nystagmus | Combined horizontal and torsional: inhibited by fixation of eyes onto object; fades after a few days; does not change direction with gaze to either side | Purely vertical, horizontal or torsional; not inhibited by fixation of eyes onto object; may last weeks to months; may change direction with gaze towards fast phase of nystagmus |
Imbalance | Mild to moderate; able to walk | Severe; unable to stand still or walk |
Nausea, vomiting | May be severe | Varies |
Hearing loss, tinnitus | Common | Rare |
Nonauditory neurologic symptoms | Rare | Common |
Latency following provocative diagnostic manoeuvre | Longer (up to 20 seconds) | Shorter (up to 5 seconds) |
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Content by Alexandra Barabas and Marissa Botma