Published 22 September 2009, doi:10.1136/bmj.b3493
Cite this as: BMJ 2009;339:b3493

Practice

Diagnosis in General Practice

Vertigo

¹ Painswick GL6 6TY, ² Neuro-otology Unit, Division of Neurosciences and Mental Health, Imperial College London

Strategies for improving the pattern recognition involved in making a correct diagnosis amount to forcing yourself to use analytic reasoning (doi:10.1136/bmj.b3490); diagnosis of vertigo is an example

The first 150 words of the full text of this article appear below.

A 58 year old woman presented to her general practitioner stating that she woke that day feeling that the room was moving. She had vomited twice. She seemed anxious, was slightly unsteady on her feet, and was hyperventilating. She did not have fever but had a sore throat, slight difficulty swallowing, slight hoarseness, and a red throat. The Hallpike test induced vertigo and nystagmus; the nystagmus was sustained. The general practitioner thought the likely diagnosis was either viral labyrinthitis with pharyngitis, or benign paroxysmal positional vertigo.

Click on image to view video Hallpike positioned manouvre: Instruct the patient to keep their eyes open and stare at the examiner's nose. In each position, observe eyes for up to 30 seconds for nystagmus. With the patient sitting upright on a couch, head turned 45 degrees to the right, lie the patient down rapidly until head is dependent. Return patient to upright position.

 
In the 1970s a classification of . . . [Full text of this article]

Eyes
Ears and face
Body and limbs

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Iterative diagnosis

Geoff Norman, Kevin Barraclough, Lisa Dolovich, and David Price
BMJ 2009 339: b3490. [Extract] [Full Text]

Fortnightly Review: Benign positional vertigo: recognition and treatment

Thomas Lempert, Michael A Gresty, and Adolfo M Bronstein
BMJ 1995 311: 489-491. [Abstract] [Full Text]

This article has been cited by other articles:

• Norman, G., Barraclough, K., Dolovich, L., Price, D. (2009). Iterative diagnosis. BMJ 339: b3490-b3490 [Full text]  

Rapid Responses:

Read all Rapid Responses

Bare below the elbows?

Richard P Smith, et al.
bmj.com, 30 Sep 2009 [Full text]

Vertigo - what about children?

Katherine Harrop-Griffiths
bmj.com, 2 Oct 2009 [Full text]

Halmagyi Head Thrust test lacks 100% sensitivity.

Desmond A Nunez
bmj.com, 4 Oct 2009 [Full text]

Has a diagnosis for vertigo got lost in dizziness?

Karena A Hanley
bmj.com, 5 Oct 2009 [Full text]

Vertigo or Dizziness

Richard Symonds
bmj.com, 9 Oct 2009 [Full text]

Authors' response

Kevin Barraclough, et al.
bmj.com, 13 Oct 2009 [Full text]

Online poll

Find out more on doc2doc >>