Balance/Vertigo Problems Flashcards
presentation of cardiac dizziness/ fainting
light-headed
syncope
palpitations
presentation of neurological dizziness
blackouts visual disturbance paraesthesia weakness speech swallow
presentation of vestibular dizziness
vertigo
sense of motion e.g. spinning, falling, being pushed
what three systems must you distinguish between to find the cause of dizziness?
cardiac
neurological
vestibular
diagnosis of dizziness
otoscopy neurological BP lying/standing balance system audiometry
common causes of dizziness
postural dizziness
side effects of medication
what does a vertical nystagmus/ nystagmus that changes direction indicate?
central lesion on the brain rather than a problem with this reflex (cirae malformation)
four conditions that present with vertigo
- BPPV
- Meniere’s disease
- Labyrinthitis/ vestibular neuritis
- Migraine associated vertigo
what is benign paroxysmal positional vertigo?
otoconia from the utricle displaces into the SCC (usually posterior)
causes of BPPV
trauma
ear surgery
idiopathic
presentation of BPPV
vertigo on rotation movement of head
vertigo that lasts seconds/minutes
vertigo when rolling over in bed, bending, moving head quickly
what must BPPV be differentiated from?
vertebrobasilar insufficiency
what is vertebrobasilar insufficiency?
impaired circulation of posterior brain
presentation of vertebrobasilar insufficiency
vertigo
visual disturbance
weakness
numbness
diagnosis of BPPV
Dix-Hallpike test
management of BPPV
repositioning manoeuvres:
- Epley manoeuvre
- semont manoeuvre
- Brandt-Daroff exercises (10 reps a day)
what is Meniere’s disease?
Endolymphatic hydrops
excessive, high pressure endolymph
swelling and risk of rupture
presentation of Meniere’s
recurrent, rotational vertigo with at least 2 episodes lasting longer than 20 minutes (hours)
one ear feels full/ change to hearing (low frequency SNHL)
tinnitus around dizzy spell
spontaneous nystagmus
supportive management of Meniere’s during episodes
vestibular sedatives
hearing aids
prevention methods of Meniere’s
salt restriction caffeine alcohol stress ITS (steroid injections) or ITG (gentamicin- vestibular toxic)
problem of cutting vestibular nerve in Meniere’s
stops dizziness but leads to loss of balance
what is vestibular neuritis?
inflammation of the vestibular nerve
what is labyrinthitis?
inflammation of vestibular and cochlear nerve
potential cause of vestibular neuritis/labyrinthitis?
viral cause
presentation of vestibular neuritis/labyrinthitis?
dizziness lasting days occurring with N&V
viral prodromal symptoms
rule of 3’s= 3 days in bed, 3 weeks off work and 3 months off balance
difference between vestibular neuritis and labyrinthitis in terms of presentation
labyrinthitis has associated hearing loss or tinnitus
management of vestibular neuritis/labyrinthitis
self-limiting so supportive with vestibular sedatives e.g. lorazepam
rehabilitation exercises if prolonged as may aid faster recovery
presentation of migraine associated vertigo
variable duration of dizziness
motion sickness
episodes of vertigo on movement with photophobia
fluctuating/permanent hearing loss
management of migraine associated vertigo
lifestyle and avoid triggers
abortive agents e.g. triptans
prophylaxis e.g. propranolol and amitriptyline
what are triptans?
dopamine agonists
what are triggers for migraine associated vertigo?
alcohol caffeine chocolates citrus fruit lack of sleep
