4: Dizzy patient Flashcards
Is dizziness the same as vertigo?
Dizziness is the patient’s word for how they feel
Vertigo is the sensation of spinning
When a patient says they’re dizzy, what might they mean?
Vertigo
Pre-syncope
Seizures
What is vertigo?
Sensation of spinning
Vertigo has a good chance of being related to which organ?
Ear
Which structures do the vestibular nerves supply?
Semicircular canals
Urticle
Saccule
Which vestibular structures detect
a) head movements
b) horizontal motion
c) vertical motion?
a) Semicircular canals
b) Urticle
c) Saccule
What systems control balance?
Ear
Eyes
Joints (proprioception)
Heart
What eye conditions upset balance?
Anything causing vision loss (cataracts, diabetic retinopathy, glaucoma, macular degeneration…)
What diseases can affect joint sensation, which itself affects balance?
Arthritis
Neurological disorders
Which cardio conditions affect balance?
Arrythmias
Postural hypotension
What brain disorders can cause balance problems?
Migraine
Space-occupying lesions
Multiple sclerosis
What is the vestibulocular reflex?
Ability to keep focused on an object when your head is moving
What are the sensory organs of rotation found in the semicircular canals?
Crista ampullaris
What eye sign is caused by an impaired vestibulo-ocular reflex?
Nystagmus
Which eye sign indicates a vestibular problem?
Nystagmus
What is the most common GP presenting complaint in people over 75?
Dizziness
What questions should you ask when taking a history from someone with dizziness?
Triggers?
Duration?
Associated symptoms? pain, hearing loss, vision, cardio
Alleviating factors?
Medication?
What should be examined in someone who is dizzy?
Ear exam
Neuro exam
Blood pressure (lying/standing)
What is the most common ENT cause of dizziness?
Benign positional paroxysmal vertigo (BPPV)
What is the symptom of BPPV?
Veritgo on changing position, looking up
What is the most common cause of BPPV?
Idiopathic
What is the pathophysiology of BPPV?
Movement of otolith (calcium carbonate crystals) from urticle into semicircular canals, causing sensation of motion
How long do episodes of BPPV last?
Never more than 30s
Does BPPV have any associated symptoms?
No
What test is used to detect BPPV?
Hallpike test
What is the Hallpike test used to detect?
How do you do it?
What are you looking for?
BPPV
Lie head over end of couch, turn head 45 to one side then return as quickly as possible, EYES OPEN
Nystagmus
What do you need to see on performing a Hallpike test to diagnose BPPV?
Nystagmus
patient saying they’re dizzy isn’t enough
Why must you wait 30s before finishing a Hallpike test?
Nystagmus can be delayed by up to 30s
Which manoeuvre can be used to alleviate BPPV?
Epley manoeuvre
How are patients with BPPV advised to sleep?
Sitting up slightly
What is vestibular neuronitis?
Prolonged vertigo associated with vomiting
No other associated symptoms
What is a condition causing prolonged vertigo AND tinnitus, hearing loss?
Labyrinthitis
How are vestibular neuronitis and labyrinthitis managed?
Supportive (sedatives, anti-emetics)
How long do vestibular neuronitis and labyrinthitis last?
Days - Weeks
What is a disease causing recurrent rotational vertigo lasting 2+ hours?
Meniere’s disease
What are the symptoms required to diagnose Meniere’s disease?
Recurrent, prolonged rotational vertigo attacks
Worsening of hearing > hearing loss
Aural fullness
all on one side
What type of hearing loss is seen in Meniere’s disease?
Sensorineural hearing loss
What type of anti-emetic is used in vertigo?
Buccastem
buccal administration
How is Meniere’s disease treated?
Supportive
Tinnitus therapy
Hearing aids
Restrict triggers
What are some possible triggers of Meniere’s disease?
Caffeine
Alcohol
Stress
Which antibiotic can be used to intentionally destroy residual balance function to stop vertigo in Meniere’s disease?
Gentamicin
Which common condition, causing headache, can also cause balance problems?
Migraine
___ and vertigo often go together.
Migraine
