Differentiate between vertigo and lightheadedness. Include the possible causes of vertigo and lightheadedness and the treatment plan for both. Describe when referral is needed for further workup or management. Include in-text citations and APA format.

Respond to your classmate

1. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
2. The peer postings should be at least one paragraph (approximately 100 words) and include references as indicated by the instructor.
3. References and citations should conform to the APA 6th edition.

Stephen Response;

Vertigo and lightheadedness are two similar symptoms that patients present with that may be difficult to differentiate and require different treatment modalities. According to the University of Michigan, lightheadedness is a feeling that an individual is about to pass out, is often accompanied by nausea, is not accompanied by the sense that your surroundings are moving, and is often alleviated by lying down. Lightheadedness can be caused by serious conditions like bleeding and arrythmia which cause hypotension and poor perfusion or less serious conditions like allergies, mild dehydration, and the flu. Vertigo on the other hand is the sensation that the patient or their environment is moving. It may be accompanied with nausea, loss of balance, and difficulty walking. Vertigo may be caused by inner ear disorders, migraines, and brain tumors (Michigan Medicine, 2017). Evaluation of patients with these symptoms involve a detailed history focusing symptom characteristics and triggers, a detailed physical focused on neurological evaluation with tests eye movement testing, head movement testing, posturography, and rotary chair testing (Mayo Clinic, 2018). Further diagnostic testing includes laboratory evaluation of blood glucose, electrolytes, and hemoglobin and hematocrit. Patients also may be assessed through CT scans of the head neck and brain, and MRI. Treatment in both cases depends on the underlying causes. Electrolytes and glucose would need to be corrected by IV or PO supplementation. Bleeding would need to be stopped through possible surgery and blood may need to be replaced depending on severity. Vestibular neuritis can be treated with antihistamines, antiemetics and benzodiazepines. Meniere disease can be treated with diuretics. Benign paroxysmal positional vertigo treatment often involves a referral to physical therapy (Munice & James, 2017). Positive MRIs or CT scans may also require referral to neurology. If the cause is bleeding and the source is intestinal or stomach, a GI consult is indicated. Lastly, some inner ear causes may require evaluation by an ENT.

References

Mayo Clinic. (2018, September 6). Dizziness. Retrieved from https://www.mayoclinic.org/diseases-conditions/dizziness/diagnosis-treatment/drc-20371792.

Michigan Medicine. (2017, November 20). Dizziness: lightheadedness and vertigo. Retrieved from https://www.uofmhealth.org/health-library/dizzi.

Munice, H. & James, E. (2017). Dizziness: approach to evaluation and management. American Family Physician, 95(3): 154-162. Retrieved from https://www.aafp.org/afp/2017/0201/p154.html.

Jason’s Response:

Lightheadedness and vertigo are both symptoms that patients present with typically stating they are “dizzy”. However,

there is a difference and a very broad range of possible degrees of severity. Dains, Baumann, & Scheibel (2016) define

lightheadedness as a “feeling that one is about to faint (near syncope)” (p. 148). Possible causes of lightheadedness include

anemia, hypoglycemia, or hyperventilation syndrome (Dains, Baumann, & Scheibel, 2016). Orthostatic hypotension is the

most common cause of lightheadedness with position changes (Branch & Barton, 2014). Typically, these symptoms only last

seconds to minutes and resolve spontaneously, but persistent lightheadedness should be evaluated for arrhythmias and

vasovagal etiologies.

According to McCance, Huether, Brashers, & Rote (2014), the definition of vertigo is “the sensation of spinning that

occurs with inflammation of the semicircular canals in the ear. The individual may feel either that he or she is moving in space

or that the world is revolving. Vertigo often causes loss of balance” (p. 506). Vertigo is either categorized as peripheral or

central. Common causes of peripheral vertigo include benign paroxysmal positional vertigo, vestibular neuritis, and Meniere

disease (Furman, 2017). Central vertigo should always be referred to a specialist. Common causes of central vertigo include

vestibular migraine, brainstem ischemia, rotational vertebral artery syndrome, cerebellar infarct or hemorrhage, Chiari

malformation, and multiple sclerosis (Furman, 2017). According to Labuguen (2006), patients should certainly be referred to a

specialist when there are other “associated neurologic signs and symptoms, such as nystagmus that does not lessen when the

patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected

laboratory and radiologic studies such as magnetic resonance imaging” (p. 244).

References

Branch, W. T., & Barton, J. J. (2014). Dizziness. In M. J. Aminoff & D. G. Deschler (Eds.), Approach to the patient with dizziness.

Retrieved from https://www.uptodate.com

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St.

Louis, MO: Elsevier.

Furman, J. M. (2017). Vertigo. In M. J. Aminoff, D. G. Deschler, & J. L. Wilterdink (Eds.), Pathophysiology, etiology, and differential

diagnosis of vertigo. Retrieved from https://www.uptodate.com

Labuguen, R. H. (2006, Janurary 15). Initial evaluation of vertigo. American Family Physician, 73(2), 244-251. Retrieved from

https://www.aafp.org/journals/afp.html

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and

children (7th ed.). Retrieved from www.elsevier.com/