Posttraumatic Dizziness
A patient presents with posttraumatic dizziness including lightheadedness, giddiness and mild nausea.
-
List five possible differential diagnoses and the most salient sign or symptom that would suggest that diagnosis
-
Post Concussion Syndrome (Posttraumatic Head Injury Syndrome)
- Usually type 2 rather than type 1 dizziness
- History of loss of memory and/or being knocked unconscious together with headache, non-progressive intellectual impairment, mood swings, lethargy.
-
Intracranial Hemorrage
- Usually type 2 dizziness
- Progressive often atypical headaches for reference from the neck with progressive drowsiness with or without intellectual impairment.
-
Medication (NSAIDs, steroids, muscle relaxants)
- Usually type 2 rather than type 1 dizziness
- Increased dizziness just after ingestion and tailing off before next dose.
-
Brainstem Petechial Hemorrhaging
- May be type 1 or 2 dizziness
- Disorganized minor cranial nerve signs
-
Labyrinthine Concussion
- Usually type 1 dizziness
- Paroxysmal positional vertigo (cupulolithiasis or canalolithiasis), vertigo on head movements rather than neck movements (if the head is held still while the neck is moved under it, no dizziness is reproduced).
-
Cervicogenic (craniovertebral or less commonly lower cervical joint)
- Usually type 2 rather than type 1 dizziness
- Compression or gentle posteroanterior pressures may reproduce the symptoms and the dizziness eases as ROM increases.
-
Vertebrobasilar Injury
- May be type 1 or 2 dizziness
- Neighbourhood cranial nerve signs and/ or symptoms are present when the patient is dizzy. For example, diplopia, dysphagia, dysarthria, ataxia, clumsiness.
References:
Adams, RD. Victory, M. Ropper. Principles of neurology. 6th ed, (CD-ROM). McGraw-Hill. NY 1998
Brenner, CT. et al. Posttraumatic Headache. Ann Neurosurg 1:379 1944
Calliet, R. Head and face pain syndromes. 1st. ed. FA Davis Philadelphia, 1992
de Jong, PTVM et al. Ataxia induced by local injection of anesthetics in the neck. Ann Neurol 1:240-246 1977
George, B. Laurian, C. The vertebral artery: pathology and surger. Springer-Verlag, NY 1987
Disclaimer:
The assessment and treatment techniques depicted or described in this site are not intended to replace formal instruction in orthopedic manual or any other type of physical therapy. They are intended to review, augment and facilitate the knowledge and skills previously gained on manual therapy or other course and to stimulate the untrained or trainee physical therapist to increase the bounds of his or her knowledge and skill base.
|
