Last week we discussed what has gone wrong in assessing sudden onset dizziness that leads to missing cerebellar strokes. This week we’ll delve into what should be going on in these assessments. To see this, we’ll look at 2 research articles:
Today we have the history portion of the assessment.
The history is very important when assessing someone with dizziness. It is nearly impossible to come to a full, accurate diagnosis with a person who, for one reason or another, cannot give the assessor an accurate verbal description of what’s going on. There are too many variables and tests in this realm to just do a blood test or a scan of some sort and get an answer, so history taking skills are crucial.
In the history you’re looking for several things; the first is a description of the quality of the dizziness. I find (and the authors in the articles agreed) that most patients can’t really give a good description beyond, “I’m dizzy,” so they typically require prompting. Do they feel like they are spinning or like the room is spinning around them? Do they feel like they’re on a merry-go-round or like they’re literally turning head over heels? Maybe they feel a rocking sensation, like they’re on a boat. Perhaps they feel like they’re continually falling forward or backward. How about a general “unsteady”, “imbalance” or “clumsy” feeling? Or a sensation of “giddiness”? “Lightheadedness” more describe what’s going on?
But that’s just the beginning.
Timing is also important. Does it come and go or is it there all the time? If it’s there all the time does it remain at the same intensity level all the time or does it wax and wan? If it comes and goes, how long do the episodes last? Just a few seconds? A few days? If they describe it on the lower end of the time spectrum, count out loud slowly for them, “1… 2… 3…, etc.” and have them say, “Stop,” to indicate about how long it lasts. Lots of people that say it lasts several minutes, really mean a few seconds. It’s hard to tell as when you’re dizzy like that, it feels way longer than it really is, because it’s so scary. (I have experienced an acute peripheral unilateral hypofunction myself.) Again, if it comes and goes, when it comes on what happens? Do they fall down? Do they fall toward one side or the other in particular?
Then you also want to ask about things that make it better or worse. Do head movements make it worse? How about watching other objects or people move? Does the environmental light make a difference? For example, maybe it’s worse when they get up in the middle of the night. Does focusing the eyes on a stationary object reduce the intensity any? What about fatigue, lack of sleep, or other stressors like a test at school or relationship problems? Does it change some when they eat certain foods?
As you can see, a good history involves many more questions beyond just the quality of the dizziness.
I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.