Diagnosis of Vertigo
Diagnosis of Vertigo? A doctor will carry out a physical examination, and they will ask the patient how their dizziness makes them feel. This will enable the doctor to find out what kind of dizziness a patient has.
During an evaluation for vertigo, the health care professional may obtain a full history of the events and symptoms. This includes medications that have been taken (even over-the-counter medications), recent illnesses, and prior medical problems (if any). Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.
After the history is obtained, a physical examination is performed. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. New symptoms of vertigo should be worked up to rule out stroke as the primary cause. History, physical exam, and imaging as needed are critical to insure any life-threatening conditions are ruled out. vertigo treatment, Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem.
The Dix-Hallpike test is done to try to recreate symptoms of vertigo; this test involves abruptly repositioning the patient’s head and monitoring the symptoms which might then occur. However, not every patient is a good candidate for this type of assessment, and a physician might instead perform a “roll test,” during which a patient lies flat and the head is rapidly moved from side to side. Like the Dix-Hallpike test, this may recreate vertigo symptoms and may be quite helpful in determining the underlying cause of the vertigo.
If indicated, some cases of vertigo may require an MRI or CT scan of the brain or inner ears to exclude a structural problem like stroke. If hearing loss is suspected, audiometry may be ordered. Hearing loss is not seen with BPPV or other common causes of vertigo. Electronystagmography, or electrical evaluation of vertigo, can help distinguish between peripheral and central vertigo, but is not routinely performed.
The doctor may also try to provoke nystagmus, as this can occur with vertigo.
Similar eye movement happens when you try to fix your eyes on one position while looking at something that is passing quickly by, for example, when looking out from a train window.
To check for nystagmus, the doctor may carry out the following exercise:
The doctor rapidly moves the patient from a sitting position to lying down on the examination bench.
The head is turned and held 45 degrees toward the affected side before this quick maneuver, and moved 30 degrees down at the end of it, over the end of the bench, below the horizontal position of the rest of the body.
If the patient experiences vertigo shortly after, and if the doctor observes specific eye movements, those of nystagmus, this can indicate that the patient has vertigo.
This is achieved through a number of tests, including:
- Electronystagmography (ENG): This can electronically record the nystagmus. The patient wears a headset that places electrodes around the eyes. The device measures eye movements.
- Videonystagmography (VNG): This is a newer technology can provide a video recording of the nystagmus.
The person with vertigo puts on a pair of special glasses that contain video cameras. These record horizontal, vertical and torsional eye movements using infrared light. Computer processing can analyze the data collected. vertigo treatment
The Head impulse Test
The patient is asked to fix their gaze on the tip of the doctor’s nose while the head is moved quickly to one side.
If the patient can keep their eyes on the nose of the examiner during this movement, the test is negative. The cause is not an inner ear problem, so the doctor may then carry out tests to see if the symptoms are due to a central nervous system issue, such as blood vessel narrowing or blood clots in the brain.
The test gives a positive result if the patient cannot keep the eyes on the examiner’s nose during the quick head movement and quickly moves their eyes back to look at the nose.
By determining if this effect is seen when the head is moved to the left or the right, this may assist the doctor in finding out which side’s inner ear is affected, should the patient have vestibular dysfunction. However, a positive test could be due to a central nervous system problem.
A person who is steady standing in place with arms at the sides and feet together when they have their eyes open is asked to shut their eyes. If they become unsteady, this could be a sign of an inner ear problem. The side they fall toward is typically the side on which the inner ear is affected.
The Romberg test is a simple and commonly used method of quantifying balance. It is also very flexible because its difficulty can be adjusted to fit most patient situations. The Romberg test is probably most commonly used by police officers — who use it to detect imbalance due to alcohol intoxication.
The Romberg test can be performed with no equipment at all, making it very suitable for large scale deployment. vertigo treatment
The examiner chooses the most difficult variant that the subject might be able to perform, asks the examinee to assume the position, and times their ability to stay in that position for at least 6 seconds. If the examinee has to take a step, then the examiner has them try again, using an easier variant.
The Romberg test is thought to be more reliable if footware is removed — as larger shoes make the test easier. One would also not want to do Romberg testing on someone wearing spike heels. Socks are generally retained.
The patient marches on the spot for 30 seconds with their eyes closed. If peripheral vertigo is present, there may be sideways rotation, toward the affected side.
This is used to identify damage to one of the labyrinths:
- The patient should march on the spot for 30 seconds with their eyes closed; observe them for lateral rotation:
- If there is no rotation, there is symmetrical labyrinthine function.
- If there is labyrinthine damage, the person will rotate to the side of the affected labyrinth.