dizziness Flashcards
how is dizziness differentiated?
cardiac- Lightheadedness, syncope, palpitations
neurological- Blackouts, visual disturbance,
paraesthesia, weakness, speech &
swallow problems
vesitbular- spinning, falling, being pushed
how do you narrow down causes of vertigo?
Seconds – BPPV
Hours – Meniere’s
Days – Vestibular neuritis
Variable – migraine associated vertigo
what are some good positive predictors for the different vertigo diseases?
dizzy rolling over in bed- BPPV
first attack very severe, lasting hours with nausea/vomiting- vestibular neuritis
light sensitive during dizzy spells- vestibular migraines
dizzy with hearing changes- menieres disease
what are the vestibular end organs?
Ampullae of lateral, posterior & superior semicircular canals
Maculae of the utricle & saccule
what are the features of BPPV?
IT IS VERY COMMON
It is the commonest cause of vertigo on looking up
Causes: Head trauma, ear surgery, idiopathic
Pathophysiology: Otoconia from utricle displaced into semicircular canals.
Most commonly into posterior SCC.
when do people with BPPV experience vertigo?
looking up
turning in bed - often worse to one side
first lying down in bed at night
on first getting out of bed in the morning
bending forward
rising from bending
moving head quickly – often only in one direction
how is BBPV treated?
using repositional manoeuvres
Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercises
what are the features of vesibular neuronitis?
prolonged vertico (days)
probable viral aetiology
how is vestibular neuronitis treated?
supportive management with vestibular sedatives
generally self limiting
if prolonged/atypical then investigate further
rule of 3s: 3 days in bed, 3 weeks off work, off balance 3 months
what is the pathophysiology of menieres?
endolymphatic hydrops
how is menieres diagnosed?
History of recurrent, spontaneous, rotational vertigo with at least four episodes >20mins (often lasting hours)
New tinnitus (or worsening) on the affected side
Aural fullness on the affected side
Documented SNHL on at least one occasion
Other causes excluded
what kind of hearing loss is seen in menieres?
typically low frequency sensorineural hearing loss
how is menieres treated?
supportive therapy during episodes
tinnitus therapy
hearing aids
ITS
ITG
salt restriction/caffeine/alcohol reduction
what is a vestibular schwannoma?
a rare benign tumour of the CN VIII sheath
