Vertigo

摘要

A 58 year old woman presented to her general practitioner stating that she woke that day feeling that the room was moving. She had vomited twice. She seemed anxious, was slightly unsteady on her feet, and was hyperventilating. She did not have fever but had a sore throat, slight difficulty swallowing, slight hoarseness, and a red throat. The Hallpike test induced vertigo and nystagmus; the nystagmus was sustained. The general practitioner thought the likely diagnosis was either viral labyrinthitis with pharyngitis, or benign paroxysmal positional vertigo.The diagnostic dilemmaIn the 1970s a classification of dizziness was developed, based on an analysis of 125 patients attending a dizziness clinic.12 Vertigo was defined as the illusory sense of movement or orientation, and indicates disorders of the labyrinth or brainstem; presyncope was defined as a sense of near faint, typically due to transient hypotension. Disequilibrium of the elderly is often described as a non-specific slight "unsteadiness," particularly on turning, and indicates poor balance and strength,3 4 and lightheadedness is often associated with dysfunctional breathing or anxiety.