368 Ch 367. Dizziness and Vertigo

Dizziness = nonspecific term — clinically distinguish 4 types: vertigo (illusion of spinning/motion), presyncope (near-faint, cardiovascular), disequilibrium (off-balance without rotation, often gait), lightheadedness/anxiety；vertigo further divided into peripheral (vestibular labyrinth or nerve) vs central (brainstem/cerebellum)；peripheral causes (more common, less dangerous): BPPV (most common, brief positional), vestibular neuritis (acute prolonged), Meniere disease (recurrent + tinnitus + hearing loss + fullness), labyrinthitis (with hearing loss), vestibular migraine；central causes (dangerous!): brainstem/cerebellar stroke or hemorrhage, MS, posterior fossa tumor, vertebrobasilar insufficiency；HINTS exam (Head Impulse + Nystagmus + Test of Skew) — for acute vestibular syndrome distinguishes peripheral from central (more sensitive than early MRI for stroke!)；treatment: Epley maneuver (BPPV), vestibular suppressants short-term, steroids for vestibular neuritis, diet + diuretics for Meniere, betahistine。