Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination (Page 10 of 30) in pdf

disease, and cervical spine trauma and degeneration may

artery disease and peripheral vascular disease with a

predispose patients to VBI

. Atherosclerosis can also

possible role in producing presyncopal dizziness have

25,27,49-51

lead to subclavian steal syndrome

. Recurrent episodes

a strong family history

. Some of the spinocerebellar

of VBI predispose patients to vertebrobasilar infarction

ataxias are hereditary autosomal dominant diseases,

Cervical spine trauma and degeneration may also be at the

while Friedreich’s ataxia and ataxia-telangiectasia are

basis of cervicogenic dizziness

. A recent optometry or

autosomal recessive diseases

. A positive family history

26,52

ophthalmology report may reveal the visual impairments

linked to relevant pathognomonic signs and symptoms

associated with complaints of dysequilibrium

. A recent

constitutes a reason for referral.

lower extremity joint replacement or other orthopaedic

Medication History

surgery may be the cause for dysequilibrium in the elderly

patient. A history of migraine or migraine-related disorders

Table 3 lists prescription, over-the-counter, and

has been associated with vestibular dysfunction

; in

recreational drugs associated with the various subtypes

54,55

fact, vertigo is three times more common in patients with

of dizziness, allowing the therapist to establish whether

migraine and there is a 30-50% prevalence of migraine in

symptom description matches the possibly causative

patients with vertigo

. With the exception of neck trauma

medication use reported. A strong relationship has been

and degeneration and recent lower extremity joint replace-

established between the number of medications taken

ment or other orthopaedic procedure, a positive medical

(>5) and dizziness symptoms

. Careful questioning

history in the absence of signs and symptoms indicative

may implicate such overmedication as a cause of dizzi-

of the three conditions amenable to sole PT management

ness. Non-compliance with medication may also be an

discussed above may indicate the need for referral.

issue, for example, the failure to take antidepressants

in a patient with panic disorder. Additionally, the use

Family History

of a particular medication may signal to the therapist

Familial paroxysmal ataxia is a hereditary recurrent

a medical condition that the patient failed to report. A

form of ataxia

. Also, 20% of patients with Meniere’s

positive medication history with symptoms indicative of

disease have a positive family history

. Patients with

a relevant dizziness subtype (see Table 3), poly-pharmacy,

otosclerosis, migraine, and vertebrobasilar migraine also

and non-compliance with prescribed medication may all

commonly have a positive family history

. Coronary

constitute reason for referral.

10,11

Table 3. Medications associated with subtypes of dizziness.

Vertigo

Presyncope

Dysequilibrium

Other dizziness

Alcohol

Digitalis

Phenothiazines

Alcohol

Aminoglycoside antibiotics

Quinidine

Butyrophenones

Aminoglycoside

•

Streptomycin

Procainamide

Metoclopramide

antibiotics

•

Gentamicin

Propranolol

Reserpine

•

Streptomycin

•

Tobramycin

Phenothiazines

Tetrabenazine

•

Gentamicin

•

Amikacin

Tricyclic

Angel Dust

•

Tobramycin

•

Kanamycin

antidepressants

Cis-platinum

•

Amikacin

Salicylates

Potassium

Isoniazid

•

Kanamycin

Quinine and quinidine

Methyldopa

Pyridoxine

Salicylates

Cis-platinum

Antidepressants

Taxol

Quinine and quinidine

Sedative hypnotics

Antihypertensives

Cis-platinum

•

Barbiturates

Bromocriptine

•

Benzodiazepines

Diuretics

•

Meprobamate

Levodopa

•

Ethchlorvynol

Monoamine oxidase

•

Methaqualone

(MOA) inhibitors

Anti-convulsants

Nitroglycerin

•

Phenytoin

Phenothiazines

Hallucinogens

•

Phencyclidine

Street drugs

•

Heroin

Mercuric and

organophosphoric compounds

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