DIFFERENTIAL DIAGNOSIS OF PERIPHERAL VESTIBULAR DISORDERS

Differential Diagnosis of Peripheral Vestibular Disorders

PART 14: Psychogenic Dizziness

Psychogenic dizziness includes dizzy complaints that represent severe exaggeration of symptoms or are completely non-organic in origin. Psychogenic dizziness probably represents 5% of all patients presenting to a vestibular center. This includes malingerers, patients with anxiety driven symptoms and Munchhausen’s syndrome. It is listed under fixed unilateral deficits because the complaints of these patients often sound similar to the symptoms of a fixed unilateral deficit. Many of these patients will complain of chronic disequilibrium, tinnitus and hearing loss and most will have an obvious reason to exaggerate their symptoms. Often the motive behind their secondary gain is monetary – pending lawsuit, workman’s compensation or disability claim – but other motives may be present such as drugs and attention.

Examination will show normal findings except for Romberg and Fukuda testing. Invariably, these patients will show wavering or falling on their Romberg and will stumble all about the room during the Fukuda stepping test. Their history and physical exam will usually defy diagnosis. ENG and Audiometry will show normal or symmetric findings. Computerized dynamic platform posturography (CDPP) is most helpful in evaluating these patients and will demonstrate aphysiologic sway patterns in the majority of these patients. Care must be taken in labeling someone as psychogenic before an exhaustive search is made for physiologic abnormalities.

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