Diagnostic position for dizziness
The vertigo diagnosis is based on a detailed medical history and a thorough physical examination. Most vertigo syndromes can be diagnosed and differentiated in this way.
Diagnosis from your family doctor
What examinations are performed by the family doctor? The standard examination includes checking the so-called vital parameters (blood pressure, pulse, respiration). With this the doctor wants to check whether the cause of the dizziness is due to a disturbance of the cardiovascular system.
This includes the measurement of blood pressure, pulse and respiratory rate. In order to exclude a cardiac arrhythmia, heart valve defects or outflow disturbance of the heart, the heart is listened to (auscultation) and an electrocardiogram (ECG) is taken. The cervical arteries (Aa.
carotides) are listened for flow sounds. If such flow noises are detected, this indicates a narrowing of the arteries (stenosis). The lungs are tapped (percussion) and listened to (auscultation) to rule out pneumonia, which could lead to an oxygen deficiency in the entire circulation.
The doctor will shine a small lamp into the eyes to test the pupil reaction. He will also test the jerky adjustment movements of the eyes when looking to the right and left (nystagmus). Unequal adjustment movements would indicate central (brain) or systemic dizziness originating from the organ of balance. By means of a short neurological examination, the physician checks reflexes with the reflex hammer, sensitivity of the skin, feeling of pressure and joint perception with closed eyes to obtain an indication of the patient’s surface and depth perception. A disturbance of these perceptions could promote a disturbance of balance or dizziness.
Diagnosis from a specialist
What is examined when the family doctor refers me to a specialist? Since dizziness can have its cause in many different specialties, many different specialty disciplines can perform examinations. In vertigo outpatient clinics, which some practices and clinics offer, comprehensive diagnostics are offered in cooperation with all specialties.
Examinations are performed in the following specialties:
- ENT examination (ear, nose and throat medicine)
- Ophthalmologic examination (ophthalmology)
- Orthopedic examination (orthopedics)
- Neurological examination (Neurology)
An ENT (ear, nose and throat) doctor will flush the auditory canals with cold and warm water if a disturbance in the area of the balance organ is suspected (caloric test). This will provoke neurological reactions, such as a nystagmus, which may indicate a cause of the dizziness. A storage test can provide information about freely moving particles in the archwire system of the vestibular organ (canalolithiasis).
The ophthalmologist examines the general vision, a restriction of the visual field and measures the intraocular pressure. Limitations of these qualities provoke an uncertain feeling when walking with dizziness, especially in older people. The orthopedist (specialist in orthopedics) will take a closer look at the spine, especially the cervical spine, and examine it for postural defects, muscle profile, blockages and tension.
A neurologist will pay particular attention to symptoms that are signs of brainstem or cerebellar injury. Sensitivity disorders of the oral mucosa, paralysis of the soft palate, swallowing disorders, eye movement disorders or hemiplegia provide indications of a central cause of dizziness. If an injury, bleeding, skull base fracture or a tumor is suspected, the neurologist will request a computed tomography (CT) or magnetic resonance imaging (MRI) of the skull in order to obtain a precise overview of the inside of the skull.
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