Dizziness Flashcards
1
Q
Case history:
- lady mid-30s
- intermittent episodes of dizziness
- last 1 day at a time
- had it for past 6 months
- recently started experiencing ringing and increased pressure in ears
- presented with husband, he’s not sure if it’s relevant that she has turned up the sound on the TV => experiencing hearing loss
- went to GP
- did MRI for head and turned out normal
- the worst symptom is the dizziness
What is her complaint?
A
- Ménière’s disease
2
Q
Case history:
- a lady in mid-40s (or man)
- dizziness + nausea for past 3 weeks
- everything is spinning
- lasts a few seconds, occurs several times a day
- worse when moves head and bends forwards
- occasionally dizziness so severe she can vomit, but not all the time
- does not have tinitus, pain in ears, hearing loss or high blood pressure
A
- benign paroxysmal postitional vertigo (BPPV)
3
Q
Case history:
- tennis player (athlete)
- once had a viral infection, runny nose, high temperature and sneezing lasting for 2 weeks
- recovered
- a copule of weeks later she developed vertigo
- induced every time she goes on the court to play tennis
- when she plays tennis she feels dizzy
- sometimes vomits, sometimes doesn’t
- feels comfortable hugging a bucket to throw up
- no tinitus, high blood pressure or ear pain, no hearing loss, is cognitive (talking well)
- sometimes has HAs
A
- vestibular neuronitis
4
Q
What is the definition of vertigo?
A
- illusion of movement of subject or surroundings, typically rotatory
- can be accompanied by vomiting
- feel of getting off a roundabout
- made worse by head movements
- patients prefer to stay still
- nystagmus (flickering eyes) principal sign
5
Q
What will happen during neurological testing of vertigo patients?
A
- testing will be normal
6
Q
When will nystagmus occur?
A
- only during an incident of vertigo
7
Q
If vertigo is seconds - minutes, which diagnosis is most likely?
A
- benign paroxysmal position vertigo
8
Q
If vertigo lasts minutes to hours, which diagnosis is most likely?
A
- Meniere’s disease
9
Q
If vertigo lasts hours to days, which diagnosis is most likely?
A
- labyrinthine or central pathology (something with brain)
10
Q
What are the causes of dizziness in patients?
A
- vertigo
- presyncopal (fainting) sensations due to transient cerebral hypo perfusion
- unsteadiness (cerebellum or postural stability disorders)
- nonspecific dizziness (anxiety, medication or hyperventilation => breathing shallowly for too long)
- peripheral (vestibular system) => deafness, otalgia (ear pain) + tinnitus
- central (brain stem + connections => accompanying symptoms => diplopia (double vision), weakness, cerebellum signs or cranial nerve palsy. Continuous true vertigo with nystagmus
11
Q
What questions should you ask patients with dizziness? What should you observe?
A
- attack duration => intermittent or sustained
- frequency
- trigger factors (head positions)
- problem with hearing
- medication (anticonvulsants, aminoglycosides cause irreversible vestibular damage)
- nystagmus without vertigo => CNS
- signs of CNS involvement e.g. ataxia (lack of coordination), dysarthria (speech disorder), sensory + motor signs in limbs => intracranial problem
12
Q
Name vestibular disorder with vertigo
A
- benign paroxysmal positional vertigo
- vestibular neuronitis
- Ménière’s disease
- migrainous vertigo (when they have a migraine)
- trauma (head trauma)
13
Q
What are the central causes of vertigo?
A
- can be brain stem pathology => more typically one comptent of a complex pathology with other symptoms + examination findings
- infarcts involving vestibular nuclei in medulla e.g. stroke
- demyelination involving brain stem e.g. MS, b12, vitamin D, encephalitis
- posterior fossa mass lesions (tumour, haemorrhage, vascular malformation)
- migraine
- tumours compressing vestibular nerve
- drugs (anticonvulsants, alcohol => fluidity of Aquarius humour in cochlear affected)
14
Q
What are the signs and symptoms of vestibular neuronitis?
A
- acute attack of isolated vertigo
- with nystagmus + often vomiting
- can follow viral infections e.g. labrynthitis
- lasts days/weeks
- sometimes followed by BPV
- self limiting and rarely recurs
15
Q
What differential diagnosis are there for vestibular neuronitis?
A
- MS
- brain stem vascular lesions
16
Q
What are the signs and symptoms of benign paroxysmal positional vertigo?
A
- rotatory vertigo (sign it’s coming form the ear)
- cause => loose otoliths in posterior semi-circular canal
- precipitated by head movements to particular position => when turning in bed or sitting up
- sudden and distressing onset
- last seconds or minutes
- becomes less severe when repeated (fatigue phenomenon)
- can follow vestibular neuronitis, head injury or ear infection
17
Q
What are the signs and symptoms of Ménière’s disease?
A
- recurring episodic rotatory vertigo
- unpredicatable, sever and disabling attacks
- lasts 30 minutes => a few hours
- attacks recurr over months/years
- comes with low frequency hearing loss, feeling of fullness in ear, loss of balance, tinnitus, vomiting
18
Q
What are the signs and symptoms of tinnitus?
A
- sensation of sound when theres no auditory stimulus
- due to heightened awareness of neural activity in auditory pathways
- hissing/ringing in ears, causing distress
- causes: vascular malformation, aneurysms, vascular tumours
19
Q
What a patient says ‘dizzy’, what might this mean?
A
- feeling of spinning of self or environment (vertigo/peripheral or central vestibular disorder)
- feeling of lightheaded News and impending fainting (Pre syncope)
- feeling of altered awareness and impaired consciousness (altered consciousness/complex partial seizures, a sense of attacks)
- unsteadiness with a clear head (ataxia/cerebellum or proprioception)
