Objective
• Identify and define
symptoms of dizziness
• Differential diagnosis
of pediatric dizziness
• Assessment of dizziness
in children
• Treatment
1
5/14/16
Input Output
Visual Ocular
reflex
Rotation
Gravity Postural
control
Pressure
Nausea
2
5/14/16
History
• Prenatal or perinatal infection
• Ototoxic medications
• Syndromes
• Craniofacial anomalies
• Family hx of hearing loss, vertigo, migraine, seizure
disorders or demyelinating disease
3
5/14/16
History
• Episodic vs. continuous
• Acute vs. slow onset
• Provoked by changes
of head position
• Paroxysmal vertigo
with or without HL
• Loss of postural control
• Unremitting, neurological signs
Physical Exam
• Otologic exam
• Neurological exam
4
5/14/16
• Vestibulospinal testing
– Fukuda
– Romberg test
– Tandem gait
Nature of Symptom
Acute/Vertigo Chronic/Dizziness
Labyrinthitis Head Trauma? Benign Headache? Cerebellopontine Cholesteatima Post Fossa Tu Headache
Paroxysmal Angle Tumor Autoimmune Degenerative Stress?
Yes No Vertigo Yes No Disease
Yes No
Concussion Ototoxic Anxiety? Positional?
or Fistula Drugs? Chronic Systemic
Yes No Yes No
Yes No Headache, Disease
Rule Out (Endocrine,
Psychogenic Migraine Vomiting? Loss of Consciousness? Depression Metabolic)
Ototoxicity Vomiting?
Yes No Yes No
Yes No
A simplified diagnostic approach to dizziness in children. Ravid S - Pediatr Neurol - 01-OCT-2003; 29(4): 317-20.
5
5/14/16
Workup
• Audiology evaluation • Imaging indication
• Eye examination – Focal neurological symptoms
or findings
• Vestibular function test
– Worsening symptoms – Prolonged
• EEG LOC (> 1 min)
• Hematological workup – Failure of symptoms to improve
(CBC, electrolytes,
glucose, thyroid tests)
6
5/14/16
Imaging
• CT of Temporal Bone
– Further evaluate craniofacial syndromes & PLF
– Defects in bony labyrinth, cholesteatoma
– Suspect tumor or previous trauma
7