dizziness Flashcards
what is the difference in presentation of cardiac, neurological and vestibular dizziness?
cardiac - Lightheadedness, syncope, palpitations
neurological - Blackouts, visual disturbance, paraesthesia, weakness, speech & swallow problems
vestibular - Vertigo is a sensation of motion: spinning, falling, being pushed
what is the likely cause of short episodes (seconds) of vertigo?
BPPV (benign positional paroxysmal veritgo)
ask - do you get dizzy rolling over in bed?
what is the likely cause of hours long episodes of vertigo?
merniere’s
does one ear feel full or do you notice hearing changes or tinnitus during the dizzy spell?
what is the likely cause of days long episdoes of vertigo?
vestibular neuronitis
was your first attack severe lasting hours with nausea and vomiting?
what is the cause of variable lengths of episodes of vertigo?
migraine associated vertigo
do you get light sensitive during your dizzy spells?
what is nystagmus?
rhythmical, repetitive and involuntary movement of the eyes. can be in any direction
spontaneous (one side) is less worrying
bi directional or vertical are more worrying
what are common causes of BPPV?
Head trauma, ear surgery, idiopathic
Pathophysiology: Otoconia from utricle displaced into semicircular canals.
Most commonly into posterior SCC
what are the symptoms of BPPV?
Vertigo on:
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 do you treat BPPV?
repositioning manoeuvres:
Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercises
what are the symptoms of meniere’s disease?
History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
New tinnitus (or worsening) on the affected side
Aural fullness on the affected side
what type of hearing loss does meniere’s disease cause?
low frequency sensorineural hearing loss
what is the management of meniere’s disease?
Management:
Supportive treatment during episodes
Tinnitus therapy
Hearing Aids
Prevention
Salt restriction / caffeine / alcohol / stress
how does gentamicin work in treatment of meniere’s?
damages vestibular system to stop vertigo attacks whilst preserving cochlear system
what is the management of migraine and vertigo?
avoid alcohol, chocolate, caffeine, citrus
abortive agents e.g. triptans
prophylaxis e.g. propanolol, amtriptyline
