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Dizziness
Published in Henry J. Woodford, Essential Geriatrics, 2022
‘Dizziness' is a very vague term that is used to describe the symptoms of a wide range of conditions. For simplicity, here it will be divided into ‘vertigo' and ‘lightheadedness' because these can usually be distinguished by a careful history. Vertigo is a sensation of movement, usually the room spinning. Lightheadedness is a sensation of pre-syncope that is often described as a giddiness, wooziness or drunkenness sensation. Sometimes people report dysequilibrium – a sense of reduced balance and unsteadiness while walking. This is typically due to a combination of gait and balance disorders, sensory loss and sometimes medication effects. It can be viewed as a precursor to falls and should be evaluated in a similar way (see Chapter 14). Vertigo, lightheadedness and dysequilibrium may coexist within individuals. In a study of older people in primary care who reported dizziness for at least two weeks, presyncope was judged to be the commonest type affecting 69% but 44% had more than one subtype.3 Vertigo was present in 41%, dysequilibrium in 40% and a small number of cases were deemed unclassifiable.
Therapeutic Pheresis: Precautions and Nursing Intervention
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
Jeane E. Blust, Judith Parrish
The patient who is very anxious may also begin to experience symptoms of hyperventilation. Patients will begin to become very restless and often experience increased sighing and gasping for air. Rapid breathing and lightheadedness may occur. If hyperventilation is suspected, the patient may require rebreathing with a paper bag. The nurse must take care not to increase the level of fear by placing the bag over the nose and mouth without an explanation. Additional steps that may be necessary include decreasing the blood flow, increasing the infusing replacement fluid and/or changing the patient’s position.
Exercise testing patients with pulmonary hypertension
Published in Robert B. Schoene, H. Thomas Robertson, Making Sense of Exercise Testing, 2018
Robert B. Schoene, H. Thomas Robertson
The classic presentation for a patient with Group 1 PAH is a progressive increase in exertional dyspnea over time, with an associated loss of overall exercise tolerance and generalized fatigue. With progression, patients may note chest pain and exertional lightheadedness. The latter symptom may advance to frank exertional syncope, an ominous symptom suggestive of advanced disease. As the response to drug treatment is better in early-stage disease, the diagnostic use of CPET to identify disease in patients with unexplained dyspnea can lead to an earlier correct diagnosis. Unfortunately, many patients are not identified for over two years, by which time the pulmonary vascular pathology has progressed to a point in which drug treatment is less effective.
Adults are not older adolescents: comparing physical therapy findings among adolescents, young adults and older adults with persistent post-concussive symptoms
Published in Brain Injury, 2023
Jacob I. McPherson, Mohammad N. Haider, Theresa Miyashita, Lacey Bromley, Benjamin Mazur, Barry Willer, John Leddy
Interestingly, younger and older adults in our sample were more likely to report dizziness as a presenting complaint when compared with adolescents (80–81% versus 66%). Dizziness is a common symptom after concussion but research describing its prevalence in those with PPCS is limited. Physical findings related to the vestibular system supported this observation as adolescents demonstrated fewer impairments during horizontal and vertical VOR screening (43% vs. 65–66%). The Head Impulse Test and DVA also assess VOR integrity but were performed less consistently than the less provocative VOR screen. A higher proportion of adolescents (30%) described their dizziness as ‘lightheadedness’ (a sensation of faintness) as opposed to ‘vertigo’ (a sensation of spinning or motion) when compared with the older groups (12–14%). Lightheadedness with position change is suspected to be due to orthostatic intolerance from reduced cerebral perfusion whereas vertigo is more suggestive of an impairment in the vestibular system (18). Lightheadedness upon positional change acutely after concussion is thought to be due to the inability of the brain to regulate its blood flow (11), which may relate to several orthostatic intolerance syndromes that have been described in children after concussion, including postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (11). Additional research on orthostasis as a cause of dizziness in patients with PPCS is warranted.
Studying subjective hearing loss in older adults measured by speech, spatial, and quality of hearing scale within the framework of the ICF core set for hearing loss
Published in Hearing, Balance and Communication, 2022
The International Society for Neuro-otology, known as the Barany Society, highlighted that dizziness is a subjective perception of disorientation or involuntary motion that occurs during head or body movement or when head or body is still. Dizziness can be further characterized as light-headedness, which is the sensation of the impending loss of consciousness associated with transient diffuse cerebral hypoperfusion, or as vertigo, which is the false sensation that the body of the environment is spinning. While the causal factors for light-headedness typically include cardiovascular disease or neurovascular disease, the causal factors for vertigo typically include otologic/neurologic diseases such as benign paroxysmal positional vertigo and Meniere’s disease [34,35]. Dizzy patients usually have motor-related activities such as imbalance and walking difficulty. Imbalance connotes disequilibrium which occurs either while walking or standing [36]. The causal factors may include muscle weakness, arthritis, and/or reduced sensory input leading to impaired postural control or instability [34–36]. Hence, dizziness, even mild, is a potentially disabling condition that has a distinct impact on physical activity, participation, psychosocial interaction, and quality of life. This impact can sustain a higher burden of neurobehavioral features of dementia, especially that related to spatial memory, other cognitive functions, and depression [34–36]. Therefore, there is certainly a need for further studies controlling dizziness since HL and vestibular (balance) loss are considered contributors to cognitive dysfunction [37].
Nose blowing-induced biphasic nystagmus of unknown origin
Published in Acta Oto-Laryngologica Case Reports, 2021
Munetaka Ushio, Manabu Kataoka, Kenji Iyama, Ayami Shimizu, Mitsuya Suzuki
On electronystagmography, no spontaneous nystagmus, including periodic alternating nystagmus, was observed. There were no abnormalities in eye tracking, saccades, and optokinetic nystagmus tests. No head positional or positioning nystagmus was observed. No periodic alternating nystagmus (PAN) were observed in the ENG records. The caloric test results were normal, with no difference between the left and right sides. A right-beating nystagmus was observed approximately 22 s after nose blowing (Figure 2(a)), and the patient became aware of spinning vertigo 25 s after nose blowing. Once the nystagmus disappeared (Figure 2(b)), a left-beating nystagmus appeared approximately 45 s after nose blowing (Figure 2(c)), and the direction of rotation of the spinning vertigo was reversed. The nystagmus disappeared approximately 95 s after nose blowing (Figure 2(d)), and the patient was no longer aware of vertigo. Lightheadedness, however, persisted for approximately 30 s. Spinning vertigo and biphasic nystagmus caused by nose blowing were observed in both the sitting and supine positions, and were reproducible upon re-examination.