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The occurrence of associated symptoms may help localise the origin of the vertigo. Both the clinician and the patient want to rule out a serious cause, but localising the source of vertigo may be difficult. Central vestibular disorders include brainstem lesions and multiple sclerosis. If the patient has vertigo, is it peripheral or central in origin?Īlthough recurrent isolated vertigo is usually peripheral and benign, this is not always the case. The dizziness occurs either through postural hypotension or direct effects on the central or peripheral vestibular system. Dizziness which precedes a blackout or near blackout will usually indicate a syncopal/presyncopal disorder which requires a different approach.ĭrugs which can cause dizziness include antihypertensives, anticonvulsants, antidepressants and sedatives.
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The dizziness of benign positional vertigo may be provoked by specific positional manoeuvres while dizziness which is unaltered between resting and moving about is usually non-vestibular in origin. Its many causes (Table 1) may be central or peripheral. Is the dizziness of vestibular origin or non-vestibular origin?ĭizziness of vestibular origin (vertigo) is usually provoked or aggravated by movement and improved or relieved by rest (sitting or lying down).
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A framework of questions in the clinician's mind will serve as a guide in analysing the patient's complaint.
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