Dizziness-1 9.56.15 PM

Dizziness-1 9.56.15 PM - Dizziness in the Elderly Steven...

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Dizziness in the Elderly Steven Zweig, MD Family and Community Medicine MU School of Medicine
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Objectives Learn the definitions of dizziness. Use acute or chronic course, continuous or episodic nature, and key elements in PE for differential diagnosis. Recognize value or lack of value in testing. Make diagnosis specific treatment recommendations.
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Epidemiology Over one year 18% of 65+ complained to a physician or had loss of usual activities due to dizziness 30% prevalence in community survey Most common complaint over age 75 Risk factor for functional decline
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Types of Dizziness Vertigo - spinning or motion Presyncopal lightheadedness - impending faint Dysequilibrium - unsteadiness, off balance Other dizziness - vague, difficult to describe, “floating”
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Vertigo Due to an imbalance in vestibular system, arising from inner or middle ear, brainstem or cerebellum Common causes include benign paroxysmal positional vertigo, cerebrovascular dx, and acute labyrinthitis and vestibular neuronitis
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Presyncopal lightheadedness Due to diffuse cerebral ischemia typically arising from vascular or cardiac causes Common causes include vasovagal episodes, postural hypotension, cardiac dx (such as arrhythmia, CHF, low output), and carotid sinus sensitivity
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Dysequilibrium Perceived as body rather than head sensation arising from motor control system (vision, vestibulospinal, proprioceptive, sensory, cerebellar or motor function) Common causes include stroke, sensory deficits, severe vestibular loss, peripheral neuropathy, and cerebellar disease
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Other causes of dizziness These are vaguely described and may be associated with anxiety and other psychological disorders Less common cause of dizziness in older than younger persons
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Multiple Causes Subtyping may be useful in only about half the cases Older persons often describe several subtypes Most have dysequilibrium along with some other type of dizziness - vertigo or presyncope
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Temporal Pattern of Symptoms Continuous - psychological, medications, permanent structural damage (e.g. stroke, cerebellar atrophy, vestibular damage, peripheral neuropathy, deconditioning) Episodic - BPPV, recurrent vestibulopathy, TIAs, Meniere’s dx, migraine
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This note was uploaded on 01/06/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Dizziness-1 9.56.15 PM - Dizziness in the Elderly Steven...

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