Diagnostic Tests for Dizziness - Diabetic Balance, Dizziness Diagnosis and Tests

Diagnostic Tests for Dizziness
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Diagnostic Test list for Dizziness:
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The list of diagnostic tests mentioned in various sources as used in the diagnosis of Dizziness includes:

Physical examination
Observe for pallor of skin or conjunctiva. Moderate or severe anemia will cause lightheadedness and dizziness, but usually not true vertigo
Blood pressure taken when lying down and again after rapidly arising to standing position. High blood pressure may cause true vertigo or lightheadedness. Low blood pressure or postural drop in blood pressure is more likely to cause lightheadedness not true vertigo
Examine the ear for abnormalities. Abnormalities on ear examination with nil other abnormalities found on nervous system examination may suggest ear wax, otitis media (middle ear infection), cholesteatoma or petrositis
Complete nervous system examination should be performed including visual acuity, inspecting for nystagmus, cranial nerve and cerebellar examination. If abnormalities are found may suggest multiple sclerosis, advanced brain stem tumor, acoustic neuroma or basilar artery insufficiency
Hallpike maneuver (i.e. head positional testing to induce vertigo and nystagmus) should be done. If the test causes vertigo and nystagmus for several seconds after a short latent period and then abates and is not reproducible for 10-15 minutes than it would suggest benign positional vertigo. If there is no latent period, no fatigability or the nystagmus persists this would suggest a lesion of the brain stem e.g. multiple sclerosis or of the cerebellum e.g. metastatic cancer
Complete cardiovascular examination. If irregularities of heart beat, heart murmurs or heart enlargement is found may suggest cardiac arrhythmia, aortic stenosis and insufficiency, mitral stenosis, prolapse of the mitral valve or congestive cardiac failure as a cause of the dizziness

Blood tests
Full blood count and electrolytes - if dizziness is not true vertigo.
Blood glucose (hypoglycemia may cause dizziness)
24 hour Blood pressure monitoring - may be considered if dizziness is not true vertigo.
Holter monitoring - for detection of cardiac arrhythmias may be considered if dizziness is not true vertigo.
Audiogram (hearing test)
Caloric stimulation test - used to confirm vestibular dysfunction e.g. vestibular neuronitis, Meniere's syndrome.
Radiological investigations
X-Ray of the mastoid bones, petrous bones and internal auditory canals (if audiogram and caloric tests are abnormal)
MRI brain if suspect acoustic neuroma or multiple sclerosis
MRI angiography of vertebral basilar artery if suspect arterial insufficiency
Echocardiogram may be considered if dizziness is not true vertigo
Spinal fluid tap - if MRI brain is negative for acoustic neuroma. Spinal tap fluid analysis can exclude neurosyphilis and multiple sclerosis.
Electrophysiological tests such as visual-evoked response (VER) and Somatosensory evoked potentials (SSEPs) - may be required to diagnose Multiple sclerosis.
EEG (awake and sleep) - needs to be done to exclude temporal lobe epilepsy.

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