Dizziness Flashcards
Dizziness aetiology
CV & Haem (arrhythmia, postural hypotension, anaemia)
Psychiatry & neurology (anxiety, MS, migraine)
Otology (vestibular problem)
Other (trauma, medications)
What systems are associated with balance
INPUT
- Visual
- Proprioceptive
- Cardiovascular
- Vestibular
OUTPUT
- Vestibulospinal tract
- Vestibuloocular reflex
What symptoms can help differentiate between dizziness caused by CV vs Neuro vs Otological problem
CV
- Lightheadedness,
- syncope,
- palpitations
Otology/ vertigo
- sensation of motion: spinning, falling, being pushed
Neuro
- Blackouts,
- visual disturbance,
- paraesthesia & weakness,
- speech & swallow problems
To identify type cause of vertigo it is helpful to ask the duration. If vertigo lasts seconds vs hours vs days vs variable, what is the likely cause?
→Seconds – BPPV
→Hours – Meniere’s
→Days – Vestibular neuritis
→Variable – migraine associated vertigo
What associated symptoms should you ask about in someone presenting with vertigo
•Hearing loss , tinnitus, aural pressure
•Migraines or sensory sensitivity
•Sound or pressure induced symptoms
Dizziness vs vertigo
If someone says they get dizzy rolling in over in bed, what is the likely diagnosis
If someone says their first attack was severe, lasted hours and was associated with N&V, what is the likely diagnosis
If someone says they are light sensitive during their dizzy spells, what is the most likely diagnosis
If someone says one ear feelss full or they notice a change in hearing (or tinnitus) aound the time of the dizzy spell, what is the most likely diagnosis
What examinations would you want to carry out to work out the diagnosis
Otoscopy
Neurological assessment
Blood pressure when standing - postural hypotension
Balance
Audiometry
What does a bi directional nystagmus indicate
Brain stem problem e.g. stroke
What does a vertical nystagmus indicate
If the eyes don’t move to stay focused on one area during the head impulse test, what type of problem does the patient have
Peripheral vestibular problem
benign positional paroxysmal vertigo pathophysiology
presence of otoliths in the semi-circular canal instead of the utricle
movement of the patient’s head will result movement of the otoliths, causing an abnormal movement of endolymph which results in vertigo
benign positional paroxysmal vertigo aetiology
- Head trauma
- Ear surgery
- Idiopathic
Geographic, torsional nystagmus indicates what condition
BPPV
What clinically features indicate BPPV
Vertigo on looking up & vertigo on turning in bed that lasts seconds
+/- vertigo on bending & standing up from bending
+/- vertigo on lying down & getting out of bed
+/- vertigo on moving head quickly in one direction
What is the diagnostic test for BPPV
Dix-Hallpike manoeuvre
Describe the Dix-Hallpike manoeuvre
BPPV treatment
Repositioning exercises!
•Epley manoeuvre
•Semont Manoeuvre
•Brandt-Daroff Exercises
