Approach to Dizziness

DESCRIPTION:
IMPORTANT: For use by qualified healthcare professionals only.

Approach to Dizziness is a comprehensive evidence-based clinical reference for dizziness, vertigo, and balance disorders. Built for neurologists, stroke physicians, ENT surgeons, emergency physicians, audiologists, and vestibular physiotherapists. Midnight blue with amber accents -- Dementia Pro Guide design style.

DIAGNOSIS FRAMEWORK
TiTrATE algorithm (Timing, Triggers, Targeted examination). Full HINTS exam guide -- Head Impulse Test technique, nystagmus (unidirectional vs direction-changing), Test of Skew. INFARCT pattern vs peripheral pattern. HINTS PLUS -- acute hearing loss as fourth alarming feature. Peripheral vs central comparison table. Acute vestibular syndrome management algorithm.

BPPV AND MANOEUVRES
Canal variants table. Dix-Hallpike technique. Epley manoeuvre (80-90% single treatment success). Semont manoeuvre. Supine roll test -- geotropic vs apogeotropic. Gufoni manoeuvre for horizontal canal. Brandt-Daroff home exercise prescription.

VESTIBULAR NEURITIS AND LABYRINTHITIS
Diagnostic criteria. Neuritis vs labyrinthitis comparison. AICA infarct -- the dangerous mimic. Corticosteroid evidence (Strupp 2004). Vestibular suppressants -- 3-day maximum rule. VRT -- when to start, gaze stabilisation, habituation, balance training.

MENIERE DISEASE
Barany Society 2015 criteria -- definite and probable. Low-sodium diet, betahistine (BEMED trial 2016 discussed), diuretics, acute rescue medications. Intratympanic gentamicin (90%+ vertigo control, hearing risk). Intratympanic dexamethasone (no hearing risk). Endolymphatic sac surgery. Vestibular neurectomy and labyrinthectomy.

CENTRAL CAUSES
PICA infarct -- Wallenberg syndrome. AICA infarct. Basilar TIA -- the 5 Ds. ABCD2 score. Cerebellar infarct -- the cannot-walk rule. Cerebellar haemorrhage. MS vestibular syndromes. Superior canal dehiscence (Tullio phenomenon). PPPD -- Barany 2017 criteria, SSRIs plus VRT plus CBT.

VESTIBULAR MIGRAINE
2022 Barany/IHS criteria -- definite and probable. VM vs Meniere comparison (10 features). Acute treatment (triptans, aspirin, antiemetics). Prevention: amitriptyline, propranolol, venlafaxine (specific VM evidence), CGRP monoclonal antibodies.

ORTHOSTATIC HYPOTENSION
Definition and causes (neurogenic, volume depletion, drug-induced, cardiac). Non-pharmacological management. Fludrocortisone and midodrine (last dose before 6pm rule explained).

DRUG-INDUCED DIZZINESS
Ototoxic drug table: aminoglycosides (permanent), cisplatin, loop diuretics, quinine. Critical warning: aminoglycoside plus loop diuretic combination. Drug-induced parkinsonism (metoclopramide, prochlorperazine, cinnarizine). Monitoring protocol.

INVESTIGATIONS
VNG caloric testing. vHIT -- all 6 canals. VEMP -- cervical and ocular, superior canal dehiscence pattern. Audiometry patterns. MRI indications: urgent vs elective vs CT temporal bones. Blood test guide.

REHABILITATION
VRT evidence by condition (Level A/B). Gaze stabilisation exercises. Cawthorne-Cooksey -- all 4 levels. VRT for PPPD with psychoeducation, SSRIs, and CBT.

INTERACTIVE FEATURES
40+ searchable entries. 10-question scenario-based quiz with expert explanations. My Notes. 20 tappable sources (Barany Society, AAN, NICE, BEMED, HINTS, Strupp 2004, Cochrane VRT review). Font size adjustment. No login. No patient data stored.

DISCLAIMER
For use by qualified healthcare professionals only. Does not replace individual clinical assessment or official guidelines.

Dr Atif Elnil MBBS MRCP Neurology Department St George's Hospital London