Harrison's Internal Medicine Chapter 22. Dizziness and Vertigo Dizziness and Vertigo: Introduction Dizziness is a common and often vexing symptom. Patients use the term to encompass a variety of sensations, including those that seem semantically appropriate (., lightheadedness, faintness, spinning, giddiness) and those that are misleadingly inappropriate, such as mental confusion, blurred vision, headache, or tingling. Moreover, some individuals with gait disorders caused by peripheral neuropathy, myelopathy, spasticity, parkinsonism, or cerebellar ataxia complain of "dizziness" despite the absence of vertigo or other abnormal cephalic sensations. In this context, the term dizziness is being used to describe disturbed ambulation. . | Chapter 022. Dizziness and Vertigo Part 1 Harrison s Internal Medicine Chapter 22. Dizziness and Vertigo Dizziness and Vertigo Introduction Dizziness is a common and often vexing symptom. Patients use the term to encompass a variety of sensations including those that seem semantically appropriate . lightheadedness faintness spinning giddiness and those that are misleadingly inappropriate such as mental confusion blurred vision headache or tingling. Moreover some individuals with gait disorders caused by peripheral neuropathy myelopathy spasticity parkinsonism or cerebellar ataxia complain of dizziness despite the absence of vertigo or other abnormal cephalic sensations. In this context the term dizziness is being used to describe disturbed ambulation. There may be mild associated lightheadedness particularly with impaired sensation from the feet or poor vision this is known as multiple-sensory-defect dizziness and occurs in elderly individuals who complain of dizziness only when walking. Decreased position sense secondary to neuropathy or myelopathy and poor vision from cataracts or retinal degeneration create an overreliance on the aging vestibular apparatus. A less precise but sometimes comforting designation to patients is benign dysequilibrium of aging. Thus a careful history is necessary to determine exactly what a patient who states Doctor I m dizzy is experiencing. After eliminating the misleading symptoms or gait disturbance dizziness usually means either faintness presyncope or vertigo an illusory or hallucinatory sense of movement of the body or environment most often a feeling of spinning . Operationally after obtaining the history dizziness may be classified into three categories 1 faintness 2 vertigo and 3 miscellaneous head sensations. Faintness Prior to an actual faint syncope there are often prodromal presyncopal symptoms faintness reflecting ischemia to a degree insufficient to impair consciousness. These include lightheadedness dizziness .
