Drugs don't work in patients who don't take them.

DOT treatment of TB

What to do when a patient complains of dizziness?

most patients who complain of dizziness are actually complaining of 1 of 3 distinct symptoms:
• vertigo
• near syncope
• dysequilibrium.
(Patients who are unable to clearly describe their dizziness, are referred to as having ill-defined light-headedness.)

Therefore, the first step asks the patient “What does it feel like when you are dizzy?” Patients must then be given enough time, without interruptions or suggestions, to describe their dizziness as clearly as possible.

The transient loss of vision in one eye.
It's a harbinger of imminent stroke and should be taken seriously.

إذا ورة ما تسأل المريض يوصفلك الدوخة مالته، يجاوبك بـ :
• كأنما كلشي حوله ديفتر وعنده إحساس بالحركة حتى وهو ثابت، فهذا دوار Vertigo.
• أما إذا المريض يحس أنّه رح يتخربط، كأنما نظره ديغوش أو يصير أسود (tunnel vision)، وعادةً لما يوكف (orthostatic hypotension) فهالشي بالعادة pre-syncope.
• أما إذا المريض ما عنده شعور بالدوار أو أنّه رح يتخربط، بس لما يمشي يحس رح يوكع وتوازنه يختل (رجليه ما يحملنّه) فهذا ببساطة خلل بالتوازن Dysequilibrium.

Vertigo is a sense of spinning or motion and is the most common type of dizziness. The differential diagnosis of vertigo is extensive and includes diseases of the peripheral nervous system (inner ear) and CNS (brainstem). The most important task in the evaluation of patients with vertigo is to identify patients with “must not miss” life-threatening central causes, including stroke, hemorrhage, tumors, and multiple sclerosis (MS).

1- Check for focal neurological symptoms like ataxia, dysarthria, loss of proprioception, diplopia, and other symptoms that can indicate stroke, or other CNS urgent problems like cerebellar degeneration.

2- Ask about the duration of each episode and the triggers. This can narrow down your ddx significantly:

  • episodes < 1min and triggered by head motions (like rolling over in the bed) are almost always caused by BPPV¹
  • episodes last from minutes to hours (rarely days) and not triggered by head motion can be due to Meniere's disease, TIA², or vestibular migraine.
  • episodes last for days and not triggered by head motions are called acute vestibular syndrome. It's usually caused by either vestibular neuritis, or stroke.


¹Benign Paroxysmal Positional Vertigo
²Transient Ischemic Attack

Peripheral vs central vertigo

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