2- dizziness Flashcards
what does vestibulospinal tract do? what does vestibulo-ocular reflex?
vestibulospinal tract = keeps upright
vestibulo-ocular reflex = keeps eyes focus
if dizzy for these durations - what is most likely cause?
a) seconds
b) hours
c) days
d) variable
a) BPPV (benign paroxysmal positional vertigo)
b) meniere’s
c) vestibular neuritis/labyrinthitis
d) migraine associated vertigo
what is dizzy when rolling over in bed buzzword of?
benign paroxysmal positional vertigo
what is buzzwordy if first attack super severe with lasting hours of nausea & vomiting?
vestibular neuritis/labrythitis
when do you get light sensitivity in dizzy spells? (which condition)
vestibular migraine
what is 1 ear fulling full or change in hearing or tinnitus during dizzy spell buzz wordy for?
menieres
what is spontaneous nystagmus?
when eye flicking fast 1 direction then moving slowly back another way
= suggests unilateral ear problem, eye flicks away from affected ear
what is bi-directional nystagmus?
fast flicking in both ways - brain stem problem
what is vertical nystagmus?
flicking downwards of eye (suggests problem with both ears)
what is benign positional paroxysmal vertigo?
= very common (triggered by head movement)
typical presentation is momentary spinning when looking up, turning in bed, 1st getting up or lying down in bed, bending forwards
what is cause of BPPV?
= crystals of calcium carbonate displaced in semicircular canals (disrupting flow of endolymph)
urticle is for feeling of gravity
- if urticle crystals displaced then sensation of spinning
= the crystals are displaced in BPPV
(commonly the posterior semicircular canals)
what is vertebrobasilar insufficiency? why confused with BPPV?
- don’t need to know much about it, just that it’s rare and presents similar to BPPV but also with visual issues, weakness & numbness
what is management of BPPV?
manoeuvres that put crystals back in place
e.g. epley, semont, brandt-daroff exercises
*epley is when like lie over couch & twist head around - can solve symptoms after 1 or 2 times
what is vestibular neuronitis?
= inflammation of vestibular nerve - usually due to viral infection
what is management of vestibular neuronitis?
it’s usually self limiting & treated supportively (prochlorperazine or antihistamines)
rule of 3:
3 or 4 days in bed, 3 or 4 weeks off work, 3 or 4 months before back to normal
what is menieres?
= excessive build up of endolymph in labyrinth of inner ear making high pressure disrupting sensory signals (high pressure in ear = called endolymphatic hydrops)
- unknown cause
what is management of meniere’s?
- prevention of things that increase pressure - salt, caffeine, alcohol, stress
- acute attack drugs like prochlorperazine or antihistamines
- prophylaxis drugs like betahistine
what is management of migraines?
lifestyle modification like caffeine & alcohol
medications for during attack - abortive agents like triptans
medications for prophylaxis like propranolol, amitriptyline
what are causes of
a) peripheral vertigo
b) central vertigo
a) affecting vestibular system - BPPV, menieres, vestibular neuronitis, labyrinthitis
b) affecting brainstem/cerebellum - posterior circulation stroke, tumour, MS, vestibular migraine
what is dix hallpike test?
= diagnostic manoeuvre for BPPv
- positive finding is patient experiencing rotational nystagmus & symptoms of vertigo
what is epley manoeuvre?
= treatment of BPPV
- idea is to move crystals into areas of semicircular canals that don’t disrupt endolymph flow
what is presentation of meniere’s?
TRIAD of recurrent vertigo, tinnitus & hearing loss (usually low frequency, sensorineural)
*also get feeling of fullness on affected side - think about feeling the high pressure
what is presentation of vestibular neuronitis?
acute onset vertigo - preceded by viral URTI
- usually more severe symptoms 1st few days w maybe constant vertigo then gets better
(no tinnitus or hearing loss since cochlea & cochlear nerve not affected)
what is labrythitis?
inflammation of bony labyrinth of inner ear (semicircular canals, vestibule, cochlea)
= usually after viral URTI (occasionally bacetrial)
