18 - Dizzy Older Ps Flashcards
What is dizziness?
What is vertigo?
False sensation of movement - esp spinning
What is pre-syncope?
Prodrome of syncope - nausea, sweating, pallor
What are the three inputs into balance?
Vestibular (from inner ear) - fast
Proprioceptive (peripheral nerves) - fast
Visual - slow
Which parts of the brain are involved in balance?
Brain-stem vestibular nuclei
Cerebellum
+ Cerebrum can override
What does the utricular macula do?
Allows a person to perceive changes in longitudinal acceleration (in horizontal directions only). The macula of the utricle is in a horizontal position and detects horizontal acceleration.
What happens to our balance pathways as we age?
What defects of age can affect sight?
Presbyopia (long-sightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age).
Cataracts
What happens to our vestibular system as we age?
Hair cell loss
Neuronal loss
What happens to the somatosensory system as we age?
Neuropathy
What Qs can you ask a dizzy P in a Hx?
What examinations should you do on a dizzy P?
Neurological exam
Neuro-ontological exam (hearing, Dix-Hallpick, HINTS)
CVS exam
What is the most common cause of dizziness?
Peripheral vestibular dysfunction (Menier’s, benign paroxysmal positional vertigo, neuritis/labyrinthitis
Then - migraine or CVD
What can cause pre-syncope?
Heart - stenosis, HCM, dysrhythmia
Autonomic - VV
Volume depletion (dehydration)
Vasodilation (Sepsis)
Drugs
Situational
Steal syndrome - blood diverted from where it should be
What exam should you always do for pre syncope?
SLBP
Also - can do ECG, Echo, Ambulatory monitoring and Tilt test
What can cause acute vertigo?
Stroke
Labyrinthitis
Vestibular neuritis
Migraine
What can cause chronic vertigo?
BPPV
Meniere’s
Migraine
Stroke
Small vessel CVD
Cerebellar Sx
What causes benign paroxysmal positional vertigo?
Thought to be small particles of otoconia trapped in the semi-circular canals
What are the Sx of BPPV?
Paroxysms of vertigo and N&V - induced by head movements.
Vertigo settles with complete stillness
Nystagmus often seen
Which test is diagnostic for BPPV?
Dix-Hallpike manoeuvre
Which manoeuvre is usually effective in Rx BPPV?
Epley manoeuvre
head movements to get crystals out of the canal
What are the Sx of Menier’s disease?
Triad
Vertigo + Tinnitus + Sensorineural hearing loss
Vertigo lasts between 20mins - 12 hours, worsened but not brought on by head movements.
Feeling of fullness in the ear.
What is thought to cause Menier’s disease?
Increased volume and pressure of endolymph
What is the cause of labyrinthitis and vestibular neuritis?
Often associated with viral infection - e.g. URTI
What are the Sx of labyrinthitis and vestibular neuritis?
Vertigo
+/- Tinnitus
Worsened but not precipitated by head movement
Sx generally subside spontaneously after a few weeks
What is the management for labyrinthitis and vestibular neuritis?
Symptomatic Rx only
What is a vestibular migraine?
One that presents with vertigo & often marked sensitivity to movement
What causes peripheral vertigo?
Vestibular dysfunction
What causes central vertigo?
CNS pathology
Which syndrome with vertigo only presents in the elderly?
Multisensory dysequilibrium
What are the Sx of multisensory dysequilibrium?
Multiple defects - visual, proprioception, motor
Loss of balance without consistent vertigo
Gait usually abnormal
Falls common
Thought to be associated with DM and small vessel cerebrovascular disease
What exercise based Rx can be used to improve vertigo?
Vestibular rehabilitation
Which drugs are given for acute vertigo?
Anti-histamines (cyclizine)
Neuroepileptics (prochlorperazine)
Anti-emetics (metoclopramide, ondansetron)
Anti-migraine drugs
