Dizziness

Impairment in spatial perception and stability.

Because the term dizziness is imprecise, it can refer to vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness.

One can induce dizziness by engaging in disorientating activities such as spinning.

Dizziness and vertigo are symptoms that commonly lead patients to seek neurologically or emergency care. Because symptoms are often vague and imprecise, a systematic approach is essential. By categorizing vestibular disorders based on the timing, triggers, and duration of symptoms, as well as emphasizing focused ocular motor and vestibular examinations, the majority of vestibular diagnoses can be made at the bedside ¹⁾.

Disequilibrium is the sensation of being off balance, and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting.

Presyncope is lightheadedness, muscular weakness and feeling faint as opposed to a syncope, which is actually fainting.

Non-specific dizziness is often psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation.

Dizziness etiology.

Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Bulbous corpuscles into diseased cervical discs may be related to cervicogenic dizziness.

Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain.

There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group.

This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis ²⁾.

Dizziness, whether vague or specifically rotational, is a common sequel to head injury, and is often postural. One hundred and sixty-five patients with this symptom were examined. The simple posture tests employed to detect positional nystagmus are described. This physical finding was present in one-quarter of the entire group, and in nearly one-half of cases of longitudinal fracture of temporal bone. In such cases, it is an objective finding that corresponds precisely to the patient's complaint of vertigo.Transverse fracture of temporal bone destroys the inner ear in both cochlear and vestibular parts. Longitudinal fracture is commoner and causes bleeding from the ear; inner-ear damage is usually minor.In the rare cases where persisting postural vertigo and positional nystagmus are disabling, relief of the symptom may be achieved by vestibular denervation of the affected side ³⁾.

Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness ⁴⁾.

A 51-year-old woman experiencing dizziness, left-sided predominant gait instability, and dropping objects from her hands, primarily on the left side.

Lesions in the right thalamus and temporal lobe, show a clear progression of suggestive neoplastic lesions. A brain MRI confirmed the progression of the two previous cerebral lesions (right thalamus and temporal lobe) with the appearance of a new 5mm focus in the temporal region.

Given the suspicion of metastases, an exhaustive extension study was conducted with contrast-enhanced CT scans of the chest, abdomen, and pelvis, tumor markers, mammography, dermatology examination, and finally, a total body PET-CT, which did not reveal evidence of high-grade macroscopic tumoral disease. The patient also presents a depressive reaction to the current situation, which has been assessed by psychology.

Infectious disease consultation noted the risk of complications from Clostridium in the future and was advised to report any new symptoms.

Due to the suspicion of primary CNS neoplasia, the case was discussed with neurosurgery to consider performing a biopsy. The hypometabolic activity in the PET-CT, not entirely consistent with neoplasia, caught attention. Nevertheless, the case was accepted for further evaluation and consideration of a cerebral biopsy.

Chest X-ray: Normal radiological characteristics of lung parenchyma without infiltrates or parenchymal consolidations. Normal costophrenic sinuses. Normal limits for the intracranial tension (ICT), cardiac mediastinal silhouette, lung hilum, and main airway. No thoracic bone lesions.

CT Head without/with contrast Signs suggesting metastatic disease in the right basal ganglia and temporal lobe, causing subfalcine herniation and tentorial herniation.

Contrast-enhanced thoracoabdominopelvic CT

Mild diffuse hepatic steatosis without focal lesions.

Conclusion: Mild diffuse hepatic steatosis, without other notable findings.

PET-CT study without evidence of high-grade macroscopic tumoral disease. Right thalamic-putaminal hypometabolism and focal hypometabolism in the right anterior temporal region, are to be correlated with brain MRI.

A T1 3D neuro-navigator sequence with contrast is performed for the biopsy of brain lesions located in the right temporal lobe and left basal-thalamic ganglia. These lesions show a similar uptake as in the previous study but with a decrease in surrounding edema. A small satellite lesion posterior to the temporal lesion is noted, which was also identified in the previous study.There appears to be less mass effect with reduced subfalcine herniation and decreased collapse of the right lateral ventricle.