Dizziness

Question 1

What is the most common cause of presentation to the primary care physician in people over 74?

Answer 1

Dizziness

Question 2

Define vertigo

Answer 2

a sensation of movement, usually spinning

Question 3

What are some important questions to ask according to dizziness?

Answer 3

triggers, time course(most important) , associated symptoms, precipitators, alleviating factors, medication

Question 4

Why is time course the most important question to ask in a history of dizziness?

Answer 4

Duration of episodes is the key:
Seconds – BPPV
Hours – Meniere’s
Days – Vestibular neuritis
Variable – migraine associated vertigo

Question 5

In dizziness what are the 4 quick questions that can be asked to make a quick diagnosis

Answer 5

dizzy rolling over in bed - BPPV
was your first attack severe, lasting hours with vomiting +nausea?- vestibular neuritis
light sensitive during dizzy spells - vestibular migraine

Does one ear feel full or do you notice a change in hearing; around the time of the dizzy spell - Menieres

Question 6

what are the utricle and saccule used for?

Answer 6

Sense horizontal and vertical motion

Question 7

Is an acoustic neuroma likely to cause vertigo?

Answer 7

No very unlikely as it is slow growing and usually is diagnosed in unilateral hearing loss from an MRI

Question 8

Spontaneous nystagmus =

Bi-directional nystagmus -

Nystagmus (vertical) -

Answer 8

the eye moves from left to right a little bit when you look straight

when moves eye from left to right there is a little bit a lag behind

This is another central sign – a purely vertical nystagmus cannot be produced by a peripheral problem. Basically only lags behind when look up and down