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What Causes Dizziness While Sitting Or Standing?
Question: An 18y/o Female presents with complaints of ‘dizziness” episodes occur 1-3x a week for the last 3 weeks. She reports that she feels like the room is spinning around her, this occurs when sitting and standing, however symptoms worsen when she gets up too quickly. She reports feeling nausea after episodes and has had one episode of vomiting. During exam, she loses balance when she is asked to stand up with her eyes close. Additionally, when she is asked to lay down and turn her head to the left, she experiences dizziness and nausea. You note nystagmus in both eyes.
Student Question: just interested in what potential causes there may be for these symptoms? I am assuming the vestibule is affected due to the lost of balance and tinnitus, there is nystagmus so could be a nerve problem CN III, IV, or IV or an oculomotor muscle problem, or patient is drunk (unlikely). Thank you for your assistance. This will be my last case study question for a while.
Student Question: just interested in what potential causes there may be for these symptoms? I am assuming the vestibule is affected due to the lost of balance and tinnitus, there is nystagmus so could be a nerve problem CN III, IV, or IV or an oculomotor muscle problem, or patient is drunk (unlikely). Thank you for your assistance. This will be my last case study question for a while.
Brief Answer:
Read below
Detailed Answer:
Hello! Thank you for coming to HCM for your questions.
Now the first thing is to look for signs of central vertigo, meaning a careful exam of especially cranial nerves, gait and coordination. A better description of nystagmus is necessary, when looking to one side or every direction, vertical, horizontal beating, rotating component etc.
Now judging from only what you say I would say this is most peripheral vertigo, perhaps a case of benign positional paroxysmal vertigo.
Nystagmus is present in vestibular disease as well, as well as veering on the side of the affected ear, so not necessarily central. If no ocular movement limitation no need to suspect oculomotor nuclei involvement, nystagmus on both eyes if central would indicate cerebellar or vestibular nuclei involvement (from MS, cerebellopontine angle tumor, stroke).
I remain at your disposal for further questions.
Read below
Detailed Answer:
Hello! Thank you for coming to HCM for your questions.
Now the first thing is to look for signs of central vertigo, meaning a careful exam of especially cranial nerves, gait and coordination. A better description of nystagmus is necessary, when looking to one side or every direction, vertical, horizontal beating, rotating component etc.
Now judging from only what you say I would say this is most peripheral vertigo, perhaps a case of benign positional paroxysmal vertigo.
Nystagmus is present in vestibular disease as well, as well as veering on the side of the affected ear, so not necessarily central. If no ocular movement limitation no need to suspect oculomotor nuclei involvement, nystagmus on both eyes if central would indicate cerebellar or vestibular nuclei involvement (from MS, cerebellopontine angle tumor, stroke).
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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