Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination (Page 7 of 30) in pdf

problem indicates a need for referral.

ety and depression may be indicative of dizziness due to

panic disorder

. In one study, depression and panic

23,24

Visual Abnormalities

disorder were present in 50% of patients with initially

Quinine and quinidine toxicity may cause vision

organic vestibular hypofunction three to five years after

deficits, including the loss of color vision

. Visual

onset, leading Tusa

to suggest that psychological dis-

dysfunction is often one of the presenting symptoms

turbances that develop due to vestibular disorders may

in children with primary cerebellar tumors

. Visual

become the primary cause of dizziness, replacing the

field deficits may indicate vertebrobasilar infarction

initial organic cause. Eckhardt-Henn et al

reported that

Blurred vision may be a prodromal symptom for vasovagal

15.8% of 190 patients complaining of dizziness fell into

syncope

. Visual instability with head movement or

this category of psychosomatic dizziness. Standardized

10,12

oscillopsia suggests an impaired vestibulo-ocular reflex

measures with established reliability and validity, such

(VOR) and is indicative of vestibular system involve-

as the Mini-Mental Status Examination

and the Beck

ment

. A tilt illusion or deviation of the subjective visual

Depression Inventory

, may facilitate communication

vertical axis may indicate otolith dysfunction; however,

with a physician when referring a patient for further

it can also be caused by ischaemia or infarction in the

medical evaluation. Any noted mental or psychological

vertebrobasilar system and its branches, unilaterally

abnormality indicates the need for referral.

affecting the vestibular nuclei, the medial longitudinal

Other Symptoms

fascicle, and other nuclei involved in the vestibular

mechanism, or the thalamus

. Non-vestibular disorders

Diaphoresis is a symptom in patients with acute

can also cause a tilt illusion: third and fourth cranial

labyrinthitis, quinine or quinidine toxicity, and panic

nerve palsies may be responsible for monocular tilts of

disorder

. Patients with quinine or quinidine toxicity

10,12,23,24

the subjective visual vertical

. In general, non-vestibular

may indicate hot and flushed skin

. Fever is a symptom

causes for a tilt of the subjective visual vertical result in

of familial paroxysmal ataxia

. Myoclonus may occur in

minor and unpredictable changes as compared to ves-

patients with Creutzfeldt-Jakob disease; hyperventila-

tibular disorders

. Otolith dysfunction or pathological

tion is associated with muscular twitching

. A spastic

processes in the otolith-ocular reflex pathways involving

bladder can be caused by myelopathy

. Patients with

15-17

central processes can result in patients complaining

undiagnosed skull fractures may note discharge from the

of vertical diplopia or sometimes diplopia, where one

ear

. (Extra) pyramidal signs and symptoms may occur

image is tilted in relation to another

. Diplopia is also

in Creutzfeldt-Jakob disease

. Carpal tunnel syndrome,

a symptom in patients with paroxysmal familial ataxia,

myelopathy, and neuropathy may raise suspicion of hypo-

VBI, and subclavian steal syndrome

. Visual auras

thyroidism in undiagnosed patients

. The clinician may

10,11,13

can precede vertebrobasilar migraine; 10% of patients

suspect multiple sclerosis with a history of remitting

with migraine experience a visual or other neurological

and relapsing dysfunctions in multiple locations in the

aura

. Photophobia is another symptom in patients

nervous system

. Salicylate toxicity and diabetes mel-

10,11

with migraine

. Any report of visual abnormality (with

litus may cause excessive thirst

. The clinician may

10,32

the possible exception of oscillopsia) indicates a need

also suspect undiagnosed diabetes in case of polyuria,

for referral.

polyphagia, and unexplained weight loss

. Palpitation and

shortness of breath are symptoms in both patients with

Mental and Psychological Status

cardiovascular disease and panic disorder

. Patients

23,24,28

Changes in mental and psychological status may be

with cardiovascular disease may also note coughing,

noted by the patient or by people close to the patient.

cyanosis, edema in the legs, and claudication

, whereas

Dementia is a state in which there is a significant loss

patients with panic disorder may complain of a feeling

of intellectual capacity and cognitive functioning lead-

of choking, a feeling of unreality, fear of losing control

ing to impairment in social or occupational functioning

or dying, insomnia, and gastro-esophageal reflux

23,24

or both

. Wilson’s disease, Creutzfeldt-Jakob disease,

Buckling of the legs in response to neck movements

hypothyroidism, paraneoplastic syndromes, and some

without loss of consciousness (i.e., drop attacks) may

spinocerebellar degenerations may cause dementia in

indicate VBI

. A patient report of any of the symptoms

association with ataxia. Dementia with sensory ataxia

above indicates the need for referral.

may indicate neurosyphilis or vitamin B

deficiency.

An acute confusional state with ataxia may occur with

Symptom Behavior

alcohol, sedative, salicylate, or hallucinogen intoxica-

tion or in patients with Wernicke’s encephalopathy.

Symptom Onset

Korsakoff’s anamnestic syndrome and cerebellar ataxia

are associated with chronic alcohol abuse

. Lassitude

The initial episode of Meniere’s disease has an insidi-

is common in patients with migraine

. Confusion and

ous onset with the patient first noticing tinnitus, hear-

stupor can result from vertebrobasilar migraine

. Anxi-

ing loss, and a sensation of fullness in the ear

. Most

228 / The Journal of Manual & Manipulative Therapy, 2005

Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 7

Related Articles

Related forms

Related Categories