Dizziness
COVID-19 clinical presentation
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<p style="text-size:12px;">COVID-19 can present with a myriad of symptoms so should probably be on most differential diagnosis lists during the pandemic</p>
<li><a href="https://productivemedic.com/covid-remote-assessment/" target="_blank">COVID assessment, DDx and complications</a></li>
<li><a href="https://www.google.com/imgres?imgurl=https%3A%2F%2Ff6publishing.blob.core.windows.net%2F2ab0884c-0618-4586-aaf1-41004e6ad656%2FWJCC-8-3956-g002.png&imgrefurl=https%3A%2F%2Fwww.wjgnet.com%2F2307-8960%2Ffull%2Fv8%2Fi18%2F3956.htm&tbnid=I0G0VvXcx_akPM&vet=12ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ..i&docid=IBDQMbzRItpvKM&w=3307&h=2168&q=covid%2019%20presentation&safe=strict&ved=2ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ" target="_blank">Clinical presentation summary infographic</a></li>
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*Common causes
- Viral infection
- Vertigo
<a href="https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice/" target="_blank" rel="noopener noreferrer">An approach to vertigo in general practice - RACGP</a> <table class="table table-bordered"><caption>Most common differential diagnoses of vertigo</caption> <tbody> <tr></tr> <tr><th>Differential diagnosis</th><th>Onset and duration</th><th>Provoking factors</th><th>Special features</th><th>Physical exam findings</th></tr> <tr> <td>Labyrinthitis</td> <td>Few seconds to minutes</td> <td>Change in the head position</td> <td>Tinnitus</td> <td>Hearing loss present</td> </tr> <tr> <td>Vestibular neuronitis</td> <td>Seconds to minutes</td> <td>Recent upper respiratory tract infection</td> <td>Imbalance, while nystagmus is horizontal or rotational, the direction of the fast component is away from the side of the lesion</td> <td>Absence of hearing loss</td> </tr> <tr> <td>Benign paroxysmal positional vertigo</td> <td>Seconds</td> <td>Change in the head position</td> <td>Positional</td> <td>Positive Dix−Hallpike</td> </tr> <tr> <td>Ménière’s disease</td> <td>Hours</td> <td>Spontaneous</td> <td>Hearing loss and tinnitus</td> <td>Hearing assessment for sensorineural hearing loss</td> </tr> </tbody> </table> - Psychogenic (Anxiety
) - Vasovagal syncope
- Orthostatic hypotension
- Vestibular migraine
- Anaemia
- Hypothyroidism
*Must not miss!
*Easily missed
Red flags
- Progressive symptoms
- Confusion/behavioural changes
- Associated symptoms
- Collapse
- Chest pain
- Dyspnoea
- Headache
- Neurological symptoms
- Hearing loss
Investigations to consider
- FBC, CRP/ESR
- U+Es, LFTs, Bone profile, Serum glucose
- Urinalysis
- CXR
- CT scan/MRI
- ECG/24h ECG
- Echocardiogram
- Audiometry
- Carotid Doppler
- EEG