Dizziness 9.56.15 PM

Dizziness 9.56.15 PM - Approach to Dizziness December 4,...

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Approach to Dizziness December 4, 2001 Swedish Family Medicine Dobrina Okorn, MD
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Clinical Scenario It’s 2:50pm and your 2:45 is being placed in a room. Your next patient is scheduled at 3:00pm and you’ve given up trying to dictate between patients. Your nurse hands you the chart, on the front of which the chief complaint and blood pressure are written: “Dizziness”, 148/86. You emit an almost-silent groan and gather your thoughts before entering the room.
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Differential 40% Peripheral vestibular dysfunction 10% Central brainstem vestibular lesion 25% Presyncope or disequilibrium 15% Psychiatric disorder 10% Unknown cause
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Case continues. .. You quickly review the chart and see that the pt is a 47 yo gentleman with no significant PMH (he was last seen one year ago for a mole removal) and is on no medications; you enter the room. He tells you that last week, all of a sudden, he was attacked by episodes of dizziness -- yeah, the room was spinning around him, how did you know? -- sometimes just while standing still, sometimes when he turned over in bed. Each lasted less than a minute or two and then he’d
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Vestibular dysfunction. .. Peripheral causes canalithiasis (BPPV) -- 50% vestibular neuronitis (labyrinthitis) -- 25% Meniere’s disease -- 10% trauma drugs (aminoglycosides) Central causes vascular
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Dizziness 9.56.15 PM - Approach to Dizziness December 4,...

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