A guideline to Giddiness examination

A guideline to Giddiness examination
The sequence may be varied according to the stem but the following is the possible approach to a patient complaint of dizziness.

Differential diagnoses of vertigo (Tally O’conner)
Persistent vertigo without hearing loss – vestibular neuronitis
Intermittent vertigo without hearing loss – benign positional vertigo
Persistent vertigo with hearing loss – Labryinthitis
Intermittent vertigo and tinnitus with hearing loss – Meniere’s disease

Differential diagnoses of Giddiness Vertigo, Syncope (John Murtagh)
Probability diagnosis
Anxiety hyperventilation (G)
Postural hypotension (G/S)
Simple faint – vasovagal (S)
Acute vestibulopathy (V)
Benign paroxysmal positional vertigo (V)
Motion sickness (V)
Vestibular migraine (V)
Cervical dysfunction/ spondylosis
(note : S for syncope, V for vertigo, G for giddiness)
Serious disorders not to be missed
Neoplasia (acoustic neuroma, posterior fossa tumour, other brain tumours)
Intracerebral infections
Cardiovascular (arrhythmias, myocardial infarction, aortic stenosis)
Cerebrovascular (vertibrobasilar insufficiency, brain stem infarct)
Multiple sclerosis
Carbon monoxide poisoning
Pitfalls
Ear wax – Otosclerosis
Arrhythmias
Hyperventilation
Alcohol and other drugs
Cough and micturition syncope
Vestibular migraine/ Migrainous vertigo
Parkinson’s disease
Meniere syndrome

Checklist for examination
General appearance – age, sex, comfortability
Vitals – BP (lying, standing for postural hypotension), Pulse rate, SPO2, respiration
Eyes – anaemia, face – parotidis for alcoholics
Hands – polycythaemia, anaemia
Neck – cervical spine tenderness
Cranial nerves – 2nd, 3rd,4th,6th,7th
-Corneal reflex for 5th

  • 8th in very focused and detailed
  1. CVS – auscultation for arrhythmias, carotid bruits
  2. Cerebellar – gait, reflexes, Romberg’s, Finger-nose (ask for tingling and numbness, if present go for sensation test in upper and lower limb to exclude vertebrobasilar insufficiency)
  3. Special tests

Special tests

  1. Halllpike manoeuvre

  2. Forced hyperventilation (20 to 25 breaths per min for 2 min) (just mention, don’t do it to save time in AMC)

Bedside test – ECG