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PubMed2005

Standing balance in persistent whiplash: a comparison between subjects with and without dizziness.

OBJECTIVE: Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes. DESIGN: A prospective, 3 group, observational design. SUBJECTS: 100 subjects with persistent whiplash associated disorders, 50 complaining of dizziness, 50 not complaining of dizziness and 50 healthy controls. METHODS: The Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance. The sway trace was analysed using wavelet analysis. CONCLUSION: The results indicated that the energy of the sway signal for comfortable stance tests was significantly greater in the group with dizziness compared with the group without dizziness. In the group without dizziness the energy was greater than controls for all tests, but significantly different on selected tests. In selected tandem stance tests, subjects with dizziness were significantly less able to complete the test than subjects without dizziness and controls. These deficits could not be attributed to medications, compensation, anxiety or age and are likely to be due to disturbances to the postural control system possibly originating from abnormal cervical afferent input.

Adult↗
PubMed2002

Exertional dizziness and autonomic dysregulation.

OBJECTIVES: To define the clinical characteristics and treatment of dizziness induced by physical exertion and to investigate autonomic nervous system function in exertional dizziness. STUDY DESIGN: Retrospective case series from a review of 1400 patients evaluated for dizziness at a neurotology referral center, identifying those with predominantly exertional symptoms. METHODS: Records of patients with exertional dizziness were screened to eliminate those with known vestibular deficits, cardiopulmonary illnesses, and psychiatric disorders. The clinical characteristics, evaluation results, and treatment of nine patients with purely exertional dizziness were described. RESULTS: The cohort included 4 male and 5 female patients (age range, 13-53 y) with symptoms for 1 to 8 years. Only one patient had a history of autonomic symptoms: phlebotomy-induced syncope in childhood. No patient was taking medications that caused dizziness or orthostasis. All patients experienced "spacey" or "foggy" head sensations without vertigo during exertion. Provocative activities ranged from standing upright for extended periods to running and swimming. On examination, voluntary hyperventilation provoked moderate symptoms in all patients (without nystagmus or anxiety), although no patient had spontaneously occurring, hyperventilation-related complaints. Seven patients underwent autonomic testing. Tilt table tests (n = 5) produced severe symptoms in one patient and mild symptoms in two patients. Sodium lactate infusions (n = 6) provoked marked symptoms in four patients and moderate symptoms in one patient. All were treated for autonomic dysregulation. Seven patients improved substantially and resumed all of their premorbid activities. Two improved slightly. CONCLUSIONS: In nine patients with exertional dizziness, autonomic challenges were provocative, and medications for autonomic dysregulation were effective. Exertional dizziness may be a clinical manifestation of autonomic nervous system dysregulation.

Adolescent↗
PubMed2005

Dizziness is associated with decreased vasoreactivity in right cerebral hemisphere for head-down manoeuvre--near-infrared spectroscopy study.

To investigate the vasoreactivity of cerebral hemisphere in patients with dizziness and syncope, we compared changes in total haemoglobin (THbl) and regional oxygen saturation (rSO2) of the right and left frontal lobes in response to head-down manoeuvre. Ninety-six right-handed subjects (aged 59 +/- 19 years) were asked to perform a head-down or a standing manoeuvre. Head-down manoeuvre produced a greater increase in right side THbl in subjects under 70 years of age (8.5 +/- 3.1) when compared with subjects older than 70 years (0.40 +/- 0.08). In contrast, the head-down manoeuvre had no effects on left side THbl, irrespective of patient age. Similarly, the head-down manoeuvre resulted in a greater decrease of right side rSO2 in subjects under 70 years of age (-5.2 +/- 2.1%) when compared with subjects older than 70 years (0.31 +/- 0.9%). In contrast, the head-down manoeuvre had no effects on left side rSO2, irrespective of patient age. The head-down manoeuvre produced a smaller increase in right side THbl in subjects with dizziness (0.38 +/- 0.19) than in those without dizziness (9.4 +/- 3.5). A standing manoeuvre produced a smaller increase in right side THbl in subjects with syncope (-0.057 +/- 0.047) than in those without syncope (0.063 +/- 0.028). The head-down manoeuvre produced a decrease in right side rSO2 in subjects without dizziness (-6.4 +/- 2.4%) and a slight increase in right side rSO2 in subjects with dizziness (1.1 +/- 0.4%). Subjects with dizziness (67 +/- 2.1 years) were significantly older than those without dizziness (53 +/- 2.7 years) or those with syncope (44 +/- 4.2 years). These data indicate that reduced vasoreactivity to right hemispheric pressure changes is associated with dizziness in older subjects. Further, decreases in right hemispheric THbl during a standing manoeuvre are associated with syncope in relatively younger subjects.

Adult↗
PubMed1991

The relation of dizziness to functional decline.

OBJECTIVE: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not-dizzy older people in order to assist clinicians who diagnose and treat these patients. DESIGN: a prospective study of a representative sample of elderly (70+) non-institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986. OUTCOME MEASURE: transition from functional ability to disability after 2 years. RESULTS: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled. CONCLUSION: Elderly people who are dizzy should be evaluated for the presence of these related conditions.

Aged↗
PubMed1999

Diagnosis of geriatric patients with severe dizziness.

OBJECTIVE: To identify the causes of dizziness in older patients presenting to the general practitioner and the clinical characteristics at presentation that might guide the general practitioner to the likely cause of dizziness and the most appropriate specialty for subsequent referral if referral is required. DESIGN: A prospective case control study of older patients presenting with dizziness. SETTING: The initial assessment was made in four general practices, three urban practices and one inner city practice (Newcastle). Subsequent investigations were conducted randomly in the Neurocardiovascular Investigation Unit and the Otolaryngology (ENT) Unit at local University hospitals (Newcastle). PARTICIPANTS: Fifty consecutive patients more than 60 years of age presented with dizziness. Twenty-two age- and sex-matched case controls were recruited from the same general practices. MEASUREMENTS: Measurements were of diagnoses attributable to symptoms. RESULTS: Symptoms were of long duration (median 1 year). Forty-six percent of patients had syncope and/or falls in addition to dizziness. Twenty-eight percent had a cardiovascular diagnosis, 18% had a peripheral vestibular disorder, 14% had a central neurological disorder, 18% had more than one diagnosis, and 22% had no attributable cause of symptoms identified. A cardiovascular diagnosis was predicted by the presence of syncope (P < .001), dizziness described as lightheadedness (P < .001), the need to sit or lie down during symptoms (P < .001), pallor with symptoms (P < .001), symptom precipitation by prolonged standing (P < .05), and whether patients had coexisting cardiovascular disease (P < .05). The description of dizziness as "vertigo" predicted a peripheral vestibular disorder (P < .001). The predictive strength of these prognostic indicators was then validated on a separate sample of 50 additional older patients. CONCLUSIONS: Clinical characteristics can predict an attributable cause of dizziness in most older patients and thus guide general practitioners in treatment and appropriate specialist referral. The presence of syncope, falls, or cardiovascular comorbidity increases the likelihood of a cardiovascular diagnosis. Otolaryngological investigations are rarely diagnostic, but vertiginous symptoms do predict peripheral vestibular disorders.

Accidental Falls↗
PubMed1988

Should echocardiography be used to screen dizzy patients?

The value of echocardiography in the evaluation of dizziness was studied in 151 consecutive patients. Twenty-two patients, on further review, were found to have related complaints, seizures and syncope mainly, but not dizziness. Twenty-four patients had vertigo, 67 had nonvertiginous dizziness, and in 38 patients, there was insufficient information to categorize the dizziness as being vertigo or nonvertiginous dizziness. When the 22 nondizzy patients were compared with the 129 dizzy patients, the only statistically significant differences were that there were more blacks in the nondizzy group and that the aortic root dimension was, on average, 0.4 cm larger in the nondizzy group. These findings, although statistically significant, appeared to be clinically insignificant. There was, however, a high prevalence of valvular heart disease in both the nondizzy and two of the three dizzy subgroups. In most cases, the valvular abnormality had not been suspected clinically. But in no case was significant information added by echocardiography that helped in patient management. Thus, in the dizzy patient, echocardiography should be reserved for specific cardiac indications and not used as a routine screening test.

Adult↗
PubMed2005

Assessment of dizziness among older patients at a family practice clinic: a chart audit study.

BACKGROUND: Dizziness is a common complaint among the elderly with a prevalence of over 30% in people over the age of 65. Although it is a common problem the assessment and management of dizziness in the elderly is challenging for family physicians. There is little published research which assesses the quality of dizziness assessment and management by family physicians. METHODS: We conducted a retrospective, chart audit study of patients with dizziness attending the Sunnybrook Family Practice Center of Sunnybrook and Women's College Health Sciences Center (SWCHSC) in Toronto. We audited a random sample of 50 charts of patients from 310 eligible charts. Quality indicators across all dizziness subtypes were assessed. These quality indicators included: onset and course of symptoms; symptoms in patients' own words; number of medications used; postural blood pressure changes; symptoms of depression or anxiety; falls; syncope; diagnosis; outcome; specialty referrals. Quality indicators specific to each dizziness subtype were also audited. RESULTS: 310 charts satisfied inclusion criteria with 20 charts excluded and 50 charts were randomly generated. Documentation of key quality indicators in the management of dizziness was sub-optimal. Charts documenting patients' dizziness symptoms in their own words were more likely to have a clinical diagnosis compared to charts without (P = 0.002). CONCLUSIONS: Documentation of selected key quality indicators could be improved, especially that of patients' symptoms in their own words.

Aged↗
PubMed1992

Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care.

OBJECTIVE: To determine the causes of persistent dizziness in outpatients. DESIGN: Consecutive adult outpatients presenting with a chief complaint of dizziness. SETTING: Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. PATIENTS: Of 185 patients presenting during the 10-month study period, 51 (28%) had minimal or no dizziness at 2-week follow-up. Of the remaining 134 patients, 100 completed the study protocol (mean age, 62 years; range, 20 to 85 years). MEASUREMENTS: Evaluation included a detailed study questionnaire, standardized physical examination, vestibular testing by a neuro-ophthalmologist, laboratory tests, audiometry, and a structured psychiatric interview. Data were abstracted onto a standard form and reviewed by three raters. Raters independently assigned diagnoses using explicit criteria, with the final cause determined by consensus. RESULTS: Primary causes of dizziness included vestibular disorders (54 patients), psychiatric disorders (16 patients), presyncope (6 patients), dysequilibrium (2 patients), and hyperventilation (1 patient); dizziness was multicausal in 13 patients and of unknown cause in 8 patients. Many of those with a single primary cause, however, had at least one other condition contributing to their dizziness; only 52% of patients had a single "pure" cause. Thirty patients had a potentially treatable primary cause, the most common being benign positional vertigo (BPV) (16%) and psychiatric disorders (6%). Central vestibulopathies detected in 10 patients were presumably vascular or idiopathic in origin. No brain tumors or cardiac arrhythmias were found. CONCLUSIONS: Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.

Adult↗
PubMed2004

Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness.

BACKGROUND: Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined. OBJECTIVE: To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness. DESIGN: Single-blind randomized, controlled trial. SETTING: 20 general practices in southern England. PATIENTS: 170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87). INTERVENTION: Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet. MEASUREMENTS: Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed. RESULTS: At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]). LIMITATIONS: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients. CONCLUSIONS: Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.

Chronic Disease↗
PubMed2005

Vestibular rehabilitation for migraine-associated dizziness.

The purpose of this study was to investigate the effects of a vestibular rehabilitation program on patients with the diagnosis of migraine-associated dizziness. Subjects were placed in four groups as follows: idiopathic migraine-associated dizziness; idiopathic migraine-associated dizziness and associated benign positional vertigo; posttraumatic migraine-associated dizziness; and posttraumatic migraine-associated dizziness and benign positional vertigo. Vestibular rehabilitation therapy was administered to all patients. Criterion measurements included the dizziness handicap inventory, activities-specific balance confidence scale, computerized dynamic posturography performance, and dynamic gait index. After vestibular physical therapy, all subjects showed significant improvement in the dizziness handicap, activities-specific balance confidence, dynamic gait, and computerized dynamic posturography measures. Patients with migraine-associated dizziness can benefit from physical therapy intervention. The results of this study are important in considering the approach to vertiginous migraine patients with and without head injury.

Adolescent↗
PubMed1989

Dizziness in primary care. Results from the National Ambulatory Medical Care Survey.

This study utilized data from the 1981 and 1985 National Ambulatory Medical Care Surveys to study dizziness, a frequently troublesome patient problem in family practice. These data indicate that family physicians and general practitioners see nearly 45% of all outpatients with dizziness. In primary care practices (family physicians, general practitioners, and general internists) the frequency of dizziness as a presenting complaint rises steadily with age, so that nearly 7% of patients aged 85 years and older present with that symptom. Women complain of dizziness more frequently than men, with this relationship being particularly prominent in older age categories. According to primary care physicians who gathered data for the 1981 and 1985 surveys, dizziness was the principal reason for visit (chief complaint) of 2.61% of patients aged 25 years and older (531 recorded encounters). Of these patients, 66.7% were women; 1.5% were hospitalized; 4.4% were referred to specialists; and 89.3% left with a drug prescription. Hypertension was the most frequent diagnosis recorded among these patients who complained of dizziness. Several of the most common diagnoses recorded for these visits (hypertension, diabetes, unspecified dizziness, and coronary arteriosclerosis) differ from common causes of dizziness reported by specialty clinics.

Adolescent↗
PubMed1995

The dizzy patient: a review of etiology, differential diagnosis, and management.

BACKGROUND: Dizziness is a lay term used to describe a variety of sensations. Unfortunately, the term "dizziness" does not have a precise medical definition, and additional information is typically required to further define the patient's problem. METHODS: When dizziness is a presenting complaint, distinctions must be made between vertigo (a sense of false movement), near-syncope (a feeling of impending faint), disequilibrium (loss of balance), and ill-defined lightheadedness (an inability to concentrate or focus the mind). Possible causes of dizziness include conflicts between visual and vestibular information, vascular problems, adverse reactions to medication, psychological difficulties, systemic disease, and the effects of aging. RESULTS: Dizziness is a symptom of a physiological or psychological illness, and therefore management is typically directed toward treatment of the underlying illness. In some cases the cause of the dizziness cannot be found, however, or is untreatable. In these cases, management is directed toward symptom reduction. CONCLUSIONS: Dizziness is a relatively common problem that arises from a variety of causes. In many cases, optometrists can participate in the diagnosis and management of patients with complaints of dizziness.

Diagnosis, Differential↗
PubMed2002

Serotonin reuptake inhibitors for dizziness with psychiatric symptoms.

OBJECTIVE: To investigate the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and major or minor psychiatric symptoms, with or without neurotologic illnesses. DESIGN: Review of 60 consecutive cases of patients with dizziness who were treated with an SSRI for at least 20 weeks during the 30-month period from July 1998 to December 2000. SETTING: Tertiary care, multidisciplinary referral center. PATIENTS: Sixty men and women, aged 13 to 81 years, with (1) psychogenic dizziness, (2) dizziness due to a neurotologic condition, as well as significant psychiatric symptoms, or (3) idiopathic dizziness. INTERVENTIONS: Open-label treatment with an SSRI titrated to 1 of 3 end points: optimal clinical benefit, intolerable adverse effects, or no therapeutic response. MAIN OUTCOME MEASURE: Change in dizziness and psychiatric symptoms measured by the 7-point, clinician-rated, Clinical Global Impressions-Improvement Scale. RESULTS: Thirty-eight (63%) of 60 patients in the intent-to-treat sample and 32 (84%) of 38 patients who completed treatment improved substantially. The response rates did not differ between patients with major psychiatric disorders and those with lesser psychiatric symptoms. Patients whose only diagnosis was a psychiatric disorder and those with coexisting peripheral vestibular conditions or migraine headaches fared better than patients with central nervous system deficits. Before being treated with an SSRI, two thirds of the study patients took meclizine hydrochloride and/or benzodiazepines, with minimal benefit. CONCLUSIONS: Treatment with SSRIs relieved dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches. Patients fared far better with SSRI treatment than with treatment with vestibular suppressants or benzodiazepines.

Adolescent↗
PubMed2005

Muscle weakness and imbalance in older dizzy patients.

BACKGROUND AND AIMS: Dizziness is common in older adults, and may be associated with limitations in physical performance. The purpose of this study was to investigate if leg muscle weakness and imbalance exist in older dizzy patients. METHODS: Twenty-three older dizzy patients and an age-matched group of 16 healthy non-dizzy older adults participated in the study. Isometric strength of leg muscles, center of pressure (COP) during quiet standing, and maximal distance of reaching forward in standing were tested. All patients answered the Dizziness Handicap Inventory (DHI). RESULTS: Most patients reported that they were handicapped by dizziness (DHI mean 31.8, SD 22.1). Compared with the healthy group, they showed significantly weaker strength in hip extension, knee extension and ankle dorsiflexion (all p < 0.000). Imbalance, indicated by greater COP trajectory (p = 0.008) and anteroposterior range of displacement (p = 0.001) during quiet standing, and a smaller forward reach distance (p < 0.000), was also found in patients. CONCLUSIONS: Leg muscle weakness and imbalance were more common in older dizzy patients than in healthy subjects. Clinical management should include assessment and therapy for these problems.

Aged↗
PubMed1996

Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin.

OBJECTIVE: To assess postural performance in patients with dizziness of suspected cervical origin in whom extracervical causes had been excluded, and to assess the effects of physiotherapy on postural performance and subjective complaints of neck pain and dizziness. DESIGN: Prospective, randomized, controlled trial. SETTING: Primary care centers and a tertiary referral center. PATIENTS AND SUBJECTS: Of 65 referrals, 43 patients were excluded because extracervical etiology was suspected. Of the remaining 22 patients, 17 completed the study (15 women, 2 men, x age 37 yr, range 26-49). The controls were 17 healthy subjects (15 women, 2 men, x age 36 yr, range 25-55). INTERVENTION: Physiotherapy based on analysis of symptoms and findings, and aimed to reduce cervical discomfort. Patients were randomized either to receive immediate physiotherapy (n = 9), or to wait 2 months, undergo repeat measurements, and then receive physiotherapy (n = 8). MAIN OUTCOME MEASURES: Posturography, measuring velocity and variance of vibration-induced body sway and variance of galvanically induced body sway. Subjective intensity of neck pain (Visual Analog Scale ratings, 0-100), intensity and frequency of dizziness (subjective score 0-4). RESULTS: The patients manifested significantly poorer postural performance than did healthy subjects (.05 > p > .0001). Physiotherapy significantly reduced neck pain and intensity and the frequency of dizziness (p < .01), and significantly improved postural performance (.05 > p > .0007). CONCLUSIONS: Patients with dizziness of suspected cervical origin are characterized by impaired postural performance. Physiotherapy reduces neck pain and dizziness and improves postural performance. Neck disorders should be considered when assessing patients complaining of dizziness, but alternative diagnoses are common.

Adult↗
PubMed2002

Dizziness and panic in China: associated sensations of zang fu organ disequilibrium.

In China, distress is commonly experienced as dizziness that can develop into acute episodes resembling Western panic attacks. These distressing sensations occur in a unique cultural context with a distinctive set of associated symptoms, beliefs and purported etiologies. The experience of illness is informed by traditional Chinese medicine (TCM), an indigenous theory that elaborates a system of organ functioning called zang fi. Depending on the implicated zang fi organ disequilibrium, dizziness and panic present with a specific constellation of associated physical and mental symptoms. This paper presents a clinical survey of psychiatric disorders that demonstrates dizziness to be characteristic of Chinese anxiety states, most particularly panic. Three specific cases of dizziness-focused panic ascribed to different states of zangfu disequilibrium are described. In a typical pattern, initial dizziness and associated symptoms intensify until they generalize into panic attacks. The degree of dizziness and panic corresponds to the state of disequilibrium of the zang fu organ system as well as instability of the social, interpersonal and environmental context of the patient. This paper elucidates the dynamic interpretants of dizziness in the Chinese context to contribute to a medical anthropology of this sensation.

Adult↗
PubMed2006

Dizziness after traumatic brain injury: overview and measurement in the clinical setting.

Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.

Activities of Daily Living↗
PubMed2001

Panic disorder with agoraphobia associated with dizziness: characteristic symptoms and psychosocial sequelae.

The aim of this study was to assess the prevalence of symptoms of panic disorder in a representative community sample of people with dizziness and to compare the profile of those whose panic was consistently linked to attacks of dizziness with those in whom dizziness was just one of many, variable somatic symptoms of panic. Validated questionnaires assessing physical and psychological symptoms, occupational disability, and handicap were administered to 128 people reporting dizziness in an epidemiological survey. Nearly two thirds of the sample reported having panic attacks, and one in four met key criteria for panic disorder. People whose panic symptoms were consistently associated with dizziness reported higher rates of vertigo than those with panic unrelated to dizziness, and higher rates of fainting, agoraphobic behavior, and occupational disability than either comparison group. Explanation of perceptual-motor triggers for disorientation may increase the predictability of attacks, thus reducing vulnerability to dizziness-provoked panic.

Adult↗