dizziness

Question 1

first line investigation when patient presents with dizziness

Answer 1

check bp

Question 2

vertigo lasting days

Answer 2

vestibular neuritis

labyrinthitis

Question 3

vertigo lasting hours

Answer 3

menieres

Question 4

hearing loss, tinnitus, aural pressure, episodes

Answer 4

menieres

Question 5

first attack severe, lasting hours with nausea + vomiting

Answer 5

vestibular neuritis

Question 6

one ear feels full or notice change to hearing (or tinnitus) around time of dizzy spell

Answer 6

menieres disease

Question 7

physiology of vestibular system

Answer 7

semicircular canal filled with endolymph - orientated different ways to detect different movement
fluid shift is detected by hairs in the ampulla = stereocilia

vestibular nerve takes info from vestibular apparatus to vestibular nucleus in brainstem + cerebellum

Question 8

what is fluid shift of endolmph detected by?

Answer 8

stereocilia

Question 9

pathophysio of BPPV

Answer 9

otoconia (crystals of calcium carbonate) that become displaced into the semicircular canals
–> crystals disrupts normal flow through canals

Question 10

presentation of BPPV

Answer 10

vertigo on movement
last around a minute before symptoms settle
vertigo on: looking up, turning in bed, rising from bending etc

Question 11

diagnosis of BPPV

Answer 11

Dix-hallpike manoeuvre

Question 12

management of BPPV

Answer 12

sometimes symptoms occur over several weeks then resolve

treatment = epley manoeuvre (only needs to be done once or twice)

Question 13

vestibular neuronitis

Answer 13

acute onset vertigo - prolonged (days)

inflammation of vestibular nerve - distorts signals
caused by viral infection

management = supportive (may develop BPPV after)

Question 14

labyrinthitis

Answer 14

acute onset vertigo with hearing loss - prolonged (days)

inflammation of structures of inner ear
caused by viral infection

management = supportive

Question 15

difference between vestibular neuronitis + labyrinthitis

Answer 15

Labyrinthitis = L = hearing Loss

vestibular Neuronitis = N = NO hearing loss

Question 16

menieres disease

Answer 16

long term inner ear disorder with recurrent attacks of vertigo
triad = hearing loss, vertigo, tinnitus

middle aged, NOT asociated with movement or position, unilateral episodes

Question 17

pathophysio of menieres disease

Answer 17

excessive buildup of endolymph in semicircular canals causing higher pressure than normal = endolymphatic hydrops

disrupts sensory signals

Question 18

presentation of menieres

Answer 18

recurrent, spontaneou, rotational vertigo with at least 2 episodes >20mins (often lasts hrs)
hearing loss - low frequency most
tinnitus
aural fullness

Question 19

management of menieres disease

Answer 19

supportive treatment during episodes, tinnitus therapy, hearing aids

prevention - salt restriction, caffiene, alcohol, stress

short term managment of symptoms in acute attacks - prochlorperazine, antihistamines

prophylaxis = betahistine

Question 20

management of migraine vertigo

Answer 20

lifestyle modifications, search for triggers

pharmacological

• abortive agents - triptans
• prophylaxis - propranolol, amitriptyline