Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination (Page 9 of 30) in pdf

last for up to 72 hours in patients with vertebrobasilar

peak incidence of onset for BPPV is in the sixth decade

migraine

. Symptoms in patients with VBI and subcla-

of life

. Orthostatic hypotension is most common in

vian steal syndrome are progressive and non-accom-

people in the sixth and seventh decades

. Parkinsonism

10,12

modating until the precipitating postures or activities

is most prevalent in older adults

. Vasovagal syncope

10,12

are discontinued

. One could assume that based on

as a cause of dizziness can occur in all age groups

43,45

10,12

the pathophysiology, the other types of presyncopal

Onset of dizziness and ataxia in childhood is a strong

dizziness will behave similarly. The duration of symp-

indicator for referral.

toms in patients with cervicogenic dizziness is usually

Men are more often affected by Meniere’s disease,

brief after assuming the provoking position, although

alcoholic cerebellar degeneration, orthostatic hypoten-

symptoms have been reported as lasting minutes to

sion, carotid sinus syndrome, and cough syncope

10,12

hours

. Dizziness and other symptoms in patients

Women are more often affected by hypothyroidism,

26,45

with panic disorder have an abrupt onset and peak in

migraine, vertebrobasilar migraine, and hyperventila-

about 10 minutes

. Symptom duration of >60 seconds

tion-induced presyncope

. Takayasu’s disease affects

10,11

and especially non-accommodating forms of dizziness

only women while micturition syncope occurs almost

indicate the need for referral.

exclusively in men

Takayasu’s disease only affects women of Asian descent

Symptom Frequency

Parkinsonism affects all ethnic groups equally

Dizziness associated with precipitating factors is, of

Medical History

course, recurrent in nature depending on exposure to

those factors, as discussed above. Dizziness and other

Past and concurrent medical history may provide

symptoms are episodic in patients with Meniere’s disease,

diagnostic or screening clues in patients with com-

otosclerosis, perilymphatic fistulae with low-volume

plaints of dizziness. A medical history of head trauma,

leaks, migraine, vertebrobasilar migraine, panic disorder,

labyrinthine infection, surgical stapedectomy, chronic

and phobic postural vertigo

. We have already

suppurative otitis media, and degenerative changes to

10,12,19,23,38

discussed the constant symptoms in patients with central

the inner ear may indicate non-idiopathic BPPV

22,25,45

vestibular lesions

. Episodic bouts of dizziness indicate

An upper respiratory infection precedes acute peripheral

1,10

a likely need for referral.

vestibulopathy in 50% of patients

. Acoustic neuromas

are more common in patients with neurofibromatosis

Symptom Fatigability

Vestibulocochlear nerve compression can be the result

Fatigability of symptoms refers to the decrease

of bacterial, syphilitic, and tuberculous infection or

in symptoms of vertigo and nystagmus with repeated

sarcoidosis

. Barotrauma due to diving or flying, a

positioning

. It is characteristic for cervicogenic diz-

forceful Valsalva maneuver, or head trauma can produce

ziness and BPPV

. Non-fatigable dizziness indicates a

a perilymphatic fistula

. Head trauma can also cause

12,19

likely need for referral (even though few patients will

occult skull fractures; a petrosal bone fracture can cause

willingly provoke dizziness repeatedly to find out about

vertigo and hearing loss

. Autoimmune diseases such as

this characteristic).

rheumatoid arthritis, Crohn’s disease, and polyarteritis

are often concurrently present in patients with autoim-

mune disease of the inner ear

. AIDS, varicella, mumps,

Pertinent Past and Present Medical History

poliomyelitis, infectious mononucleosis, and lymphocytic

Patient Demographics

choriomeningitis (a virus borne by rodents) can all provide

Ataxia-telangiectasia has its onset before the age of

the viral agent responsible for viral cerebellar infections

four

. Friedreich’s ataxia also starts in childhood

. Mi-

Acute cerebellar ataxia of childhood is often preceded by

graine and vertebrobasilar migraine too usually have their

a viral infection or inoculation

. Vertigo is a common

onset early in life

. Takayasu’s disease affects mainly

symptom in patients with multiple sclerosis, albeit not

10,11

women between the ages of 15 and 30

. Panic disorder

often the presenting symptom

. Epilepsy in the medical

often first occurs in young adulthood

. Hyperventilation

history should prompt questions about phenytoin: Long-

most commonly affects patients between 20 and 40

term treatment with phenytoin may produce cerebellar

The age of onset in Meniere’s disease is usually between

degeneration

. Patients with lung cancer, ovarian can-

20 and 50

. Hearing loss associated with otosclerosis

cer, Hodgkin’s disease, and breast cancer are at risk for

generally starts before age 30

. Cerebellopontine angle

paraneoplastic cerebellar degeneration

. Breast and lung

tumors have an age of onset between 30 and 60

. The

cancer are also apt to metastasize to the posterior fossa

age of onset for alcoholic cerebellar degeneration is 40

in adults

. A medical history positive for heart disease

to 60

. Cough syncope is most prevalent in middle-aged

could imply a cardiovascular origin for presyncopal

men

. Hypothyroidism is most common in middle-aged

dizziness complaints

. Chronic obstructive pulmonary

or elderly women

. BPPV generally occurs in people over

disease is frequent in patients with cough-related pre-

age 40; it rarely occurs in people under 20

; however,

syncopal dizziness

. Atherosclerosis, thrombo-embolic

230 / The Journal of Manual & Manipulative Therapy, 2005

Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 9

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