33- dizzy Flashcards
at what age do you prescribe antibiotics to acute otitis media
below 6 mo
6 mo-2 yrs- observe, variable
Presyncope
Feeling light-headed or faint, as opposed to actually passing out. Sometimes patients with presyncope feel worse when they stand up quickly
Disequilibrium -
A feeling of being off balance.
Presyncope etiologies
inadequate cerebral perfusion:
MI afib bradyarrhythmias valvular heart disease aortic stenosis acute blood loss such as gastric ulcer bleed thyroid storm- tachycardia
Orthostatic Hypotension criteria
A drop in systolic blood pressure of ≥ 20 mmHg or
A drop in diastolic blood pressure of ≥ 10 mmHg
when changing position from supine to standing
accompanied by feelings of dizziness or light-headedness
Vestibular neuritis
Commonly associated with a recent URI.
Nystagmus caused by a peripheral lesion such as this does not change direction with gaze.
Benign paroxysmal positional vertigo (BPPV)
Causes acute onset vertigo that can be associated with nausea and vomiting and intact hearing.
caused by calcium carbonate debris in the semicircular canals.
episodic rather than constant vertigo that is triggered by positional change as calcium debris moves within the semicircular canals. Symptoms usually resolve several seconds to minutes following position change in BPPV
Vestibular migraine
a variant of migraine that can cause central vertigo.
Most patients will give a history of previous migraine headaches. However, at the time of a vestibular migraine, many patients do not have a headache.
Peripheral vs. Central Vertigo in location of problem
peripheral: problems with the inner ear or vestibular system
central: problems in CNS (more serious)
nystagmus in peripheral veritgo
unidirectional (usually horizontal and rotational) and does not change direction
inhibited by fixating on a point and intensifies when fixation is withdrawn
Frenzel glasses prevent fixation and bring out the nystagmus
nystagmus in central veritgo
purely horizontal, vertical, or rotational
does not lessen when the patient focuses gaze
persists for a longer period
classic triad of Meniere’s disease.
unilateral hearing loss, tinnitus, and vertigo
cause of vestibular neuritis
viral (or, less commonly, bacterial) infection of the inner ear causes inflammation of the vestibular branch of the eighth cranial nerve.
Acute labyrinthitis occurs when
an infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo.
Dix-Hallpike Maneuver
diagnose BPPV
Turn the patient’s head to 45 degrees and quickly lay him down supine with his head just over the end of the exam table. Then turn the head to the side which should reproduce the symptoms of dizziness and produce nystagmus. Observe for 20 to 30 seconds. If present, the nystagmus will have the fast component in the direction of the pathology. Next, sit the patient up and observe again for nystagmus.
diagnosing BPPV and vestibular neuritis
clinical (MRI to rule out scary things)
head thrust test
demonstrate a likely peripheral lesion.
Normally, when you face your patient and ask them to keep looking at your nose, his eyes will stay fixed on your nose if you move his head suddenly to the side. If there is a peripheral lesion in the vestibular system, the vestibular ocular reflex will be disrupted and his eyes will move with the head and then saccade back to center when his head is moved in the direction of the lesion. A normal head thrust test in the presence of vertigo means the peripheral vestibular system is intact and that the lesion is central.
When Neuroimaging is Indicated for Patients with Vertigo
age, HTN
nystagmus that changes direction and that does not inhibit with focus (central)
A normal head thrust test in the face of constant and new vertigo combined with a history of migraines indicates a possible central lesion.
acute vestibular neuritis management
self limiting- days - week
what can help manage menieres>
diuretics
hallmark of treatment for BPPV
Epley maneuver- relieves symptoms by returning the deposits back to the vestibule
Epley maneuver- how to do it
To perform the Epley maneuver for right-sided symptoms, the patient sits on the exam table with his head turned 45 degrees to the right. With the clinician supporting the head, the patient quickly lies back with his head hanging over the exam table supported by the clinician as in the Dix-Hallpike test. Once the nystagmus has stopped, the clinician turns the head 90 degrees to the left and the position is held for 30 seconds. Next, the patient rolls onto his left side, with his face at a 45 degree angle to the floor. This position is held for 30 more seconds. The patient returns to the sitting position now with his legs off the left edge of the table. After another 30 seconds, the patient can resume normal head position. The maneuver can also be repeated on the other side.
management for unilateral peripheral vestibular dysfunction
vestibular rehabilitation- PT
Vestibular suppressant medications
Effective short-term treatment of vertigo.
Commonly used anticholinergic vestibular suppressants such as meclizine and dimenhydrinate also have some anti-emetic effects that are useful in controlling the nausea and vomiting associated with vertigo.
Safety of Vestibular Suppresant Medications While Breastfeeding
Occasional doses of meclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply…”
“Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation.”
Safety of Vestibular Suppressant Medications While Breastfeeding
Occasional doses of meclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply…”
“Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation.”
