Balance disturbances Flashcards
What is required for good balance?
input from the vestibular system to be integrated centrally with proprioceptive and visual inputs
can be caused by disorders at the level of the vestibular apparatus, cerebellum or brainstem, extrapyramidal, spinal cord, or neuromuscular system.
What is vertigo?
the hallucination of movement
Pass med: false sensation that the body or environment is moving
What are central and peripheral causes of vertigo?
Central:
stroke
Migraine
neoplasms
demyelination e..g MS
Drugs
peripheral:
BPPV
Meniere’s disease
Vestibular Neuronitis
What are central and peripheral causes of vertigo?
Central:
stroke
Migraine
neoplasms
demyelination e..g MS
Drugs
peripheral:
BPPV
Meniere’s disease
Vestibular Neuronitis
What is the pathophysiology behind BPPV?
Peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements.
otoliths (crystals) in the semicircular canals (often posterior) cause abnormal stimulation of the hair cells giving the hallucination of movement - vertigo
What are som RF for BPPV?
increasing age, female sex, head trauma, vestibular neuronitis, labyrinthitis, migraines, inner ear surgery, Meniere’s disease
How does BPPV present?
specific provoking positions
brief / episodic vertigo
severe and sudden onset vertigo
nausea / lightheaded
Relevant negatives:
absence of other otological symptoms e.g. hearing loss / tinnitis/ aural fullness
How do you diagnose and treat BPPV?
Diagnosis: Dix-Hallpike- Rotatory nystagmus
Treatment: Epley manoeuvre
What is Meniere’s disease?
disorder of the inner ear of unknown cause.
Characterised by excessive pressure and progressive dilation due to increased fluid in the endolymphatic system
What are the clincial features of Meniere’s disease?
Recurrent episodic vertigo (+ nausea & vomiting) lasting mins to hours
tinnitus in affected
Fluctuating sensorineural hearing loss
Aural fullness
nystagmus and a positive Romberg test
bilateral symptoms may develop after a number of years
How does Mernieres disease progress over years?
initially - pt well between attacks
then: reduced vestibular function/ sensorineural hearing loss means feel unsteady between attacks
then: disease burns itself, no more acute vertigo but reduced hearing and generally unbalanced
if they have a good ear pt can compensate
Management of Menieres? (workbook)
Diet :
reduce salt / choc / alcohol / caffeine
Medical :
Thiazide diuretic e.g. bendrofluaxide
Betahistine
Vestibular sedatives e.g. prochlorperazine for ACUTE ATTACKS
Surgical:
Grommets
Dexamethasone middle ear injection
Endolymph§atic sac decompression
What must pts with Menieres be advised to do that might affect day to day life ?
Inform the DVLA- cant drive until control symptoms
What are some complications of Menieres?
Falls
Profound hearing loss
What is vestibular neuronitis?
inflammation of the vestibular nerve often due to viral infection. Can cause severe incapacitating vertigo
