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4 results

  • Balance testing: does it make a difference?

  • E Watts, K Lindley, R Irving, L Dalton
  • Journal:
    The Journal of Laryngology & Otology / Volume 137 / Issue 5 / May 2023
    Published online by Cambridge University Press:
    23 August 2022, pp. 506-514
    Print publication:
    May 2023
    • Article
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  • Objective

    This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness.

    Method

    This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018.

    Results

    A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary ‘pre-vestibular function testing balance diagnosis’, which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients.

    Conclusion

    Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing.

  • Chapter 5 - Spinal cord injury

  • Edited by Todd Crocco, West Virginia University, Michael Sayre, University of Washington
  • Book:
    Prehospital Care of Neurologic Emergencies
    Published online:
    05 August 2014
    Print publication:
    24 July 2014, pp 97-139

  • Summary

    Evaluation of the dizzy patient in the prehospital setting is a challenging task. A chief complaint of feeling lightheaded or dizzy is extremely common. Traditionally, dizziness is often subdivided into four different categories: lightheadedness, presyncope, disequilibrium and vertigo. It can be further subdivided into orthostatic dizziness and positional dizziness. This chapter discusses the physiology, categories, and key challenges of dizziness. In order to successfully approach patients who are complaining of dizziness, the EMS professional needs to understand how the brain perceives orientation in space and processes the signals to maintain an upright posture. He should focus on identifying life-threatening entities, including serious cardiac dysrhythmias or cardiac syncope; centrally mediated causes of vertigo; and life-threatening metabolic/electrolyte derangements. Obtaining a blood glucose level, acquiring a 12 lead ECG and performing a focused physical exam may help identify a subgroup of patients with immediately life-threatening conditions.

  • Chapter 10 - Cramps, spasms, startles and related symptoms

  • Edited by Bettina Schmitz, Barbara Tettenborn, Johannes Gutenberg Universität Mainz, Germany, Donald L. Schomer, Harvard University, Massachusetts
  • Book:
    The Paroxysmal Disorders
    Published online:
    06 December 2010
    Print publication:
    09 September 2010, pp 130-144

  • Summary

    This chapter describes the clinical characteristics of syncope and its distinction from generalized tonic-clonic seizures, which cause the most difficulties in daily clinical practice. The high variability of frequencies at which convulsions in syncope were observed is explained by their highly variable presentation. The most important criterion to differentiate syncopal and epileptic convulsions is their specific phenomenology. Presyncope is the prodromal stage of syncope in which there is only a less pronounced hypoperfusion of the brain and therefore no complete loss of consciousness. Syncope can also appear after eating a carbohydrate-rich meal, particularly in elderly patients. Syncope associated with migraine is particularly frequent in basilar migraine. This form of migraine occurs mostly in adolescent girls and young women. The initial evaluation of a patient presenting after loss of consciousness includes a thorough history, a physical examination, supine and upright measurement of blood pressure and pulse rate, and an electrocardiogram (ECG).