Causes of syncope = HEAD, HEART, VESSELS
H = Hypoglycemia / Hyperglycemia (DKA) / Hypoxia
E = Epilepsy
A = Anxiety
D = Dysfunction of the brain stem
H = Heart attack / Right Heart failure
E = Embolism of pulmonary artery
A = Aortic obstruction
R = Rhythm disturbance (arrhythmia)
T = Tachycardia (especially ventricular tachycardia)
V = Vasovagal attack (i.e.: due to intense pain)
E = Ectopic heart beat (e.g.: complex ventricular ectopic activity)
S = Situational (micturition, defaecation)
S = Subclavian steal syndrome (proximal stenosis of subclavian artery)
E = Ectopic pregnancy (due to hemorrhagic shock)
L = Low vascular resistance
S = Sensitive carotid sinus / carotid sinus syncope (loss of consciousness can be rapid)
Vertigo is a condition when someone experiences an illusion that the surroundings are spinning. There are various causes of vertigo. Most of the time the cause is benign and nothing to be worried about. Benign positional vertigo manifests as an episodic vertigo which is lasting for a short period either a few seconds or minutes. Meniere’s disease should be considered if the episodic vertigo lasting between minutes to hours. Prolonged vertigo (more than 24 hours) indicate peripheral or central lesion. Peripheral lesion may be due to viral labyrinthitis, otitis media, vestibular neuronitis, mastoiditis, lesions to 8th cranial nerve or trauma to structures of the ear. It can also be due to some ototoxic drugs like streptomycin and gentamicin. Central lesion might be due to multiple sclerosis, stroke (infarction or haemorrhage of cerebral cortex, cerebellum or brainstem) or tumor (posterior fossa tumor or other type of brain tumour) however in these cases there is also presentation of other neurological signs. Basilar migraine, hypotension, severe hypertension, vertebrobasilar artery insufficiency, Arold-Chiari malformation or temporal lobe palsy may also contribute to vertigo. Psychogenic causes like hyperventilation and hysteria may also lead to vertigo. Anemia and fever will also lead to vertigo.
If you go to your doctor due to vertigo, he or she will ask the duration and frequency of the symptom, mainly to reach for the diagnosis. He/she will ask you if there is any other associated symptom like nausea, deafness and tinnitus. Recent viral infections might be important.
Upon examination, your doctor will look for neurological signs especially cerebellar signs and Romberg’s sign. He/she will do cranial examination to rule out central lesion. After that he/she will look for nystagmus (movement of the eye), hearing and look at your ear drum using otoscope. He/she will do the Hallpike manouvre to look for your vertigo. In this manouvre, you will be asked to move quickly from sitting to lying with your head turn to one side and extended over one side of the bed. At the same your doctor will look for nystagmus and ask you if you experience and vertigo. The test will be repeated with you head turn to the other side. If this test positive it is likely for you to have benign positional vetigo.
The treatment is base on the underlying cause. If you have this kind of problem, not to worry so much, most of the time there is nothing serious about it. Seek your doctor for proper examination and treatment.
Reference:
1. Oxford Handbook of General Practice. Oxford University Press. 2005.
2. Ferri’s cliical advisor instant diagnosis ad treatment. Mosby. 2008.
