Dizziness Flashcards
Types of dizziness
Vertigo - circular motion of body or surrounding
Or Pseudovertigo including;
1 Giddiness or lightheadedness (uncertainty) = typical psychoneurotic
2 Fainting or syncopal episodes
(Cariogenic cause, Postural hypotension, Drug induced)
3 Disequilibrium which is Loss of balance, equilibrium or instability while walking. NO spinning, “standing on a rocking boat”.
Causes of Vertigo
1 Labyrinth and 8th CN Meniere’s disease - Over diagnosis Vestibular neuronitis eg acute labyrinthitis - COMMON Benign positional vertigo - COMMON Motion sickness trauma - COMMON Ototoxic drugs Zoster 2 Brainstem, cerebellum, cerebello-pontine angle (+nystagmus and +CN lesions) MS - don’t miss Stroke/TIA Haemorrhage Migraine Acoustic neuroma - Don’t miss 3 Cerebral cortex - Vertiginous epilepsy 4 Alcohol intoxication 5 Cervical dysfunction/spondylosis - COMMON 6 Ear wax - common
Symptoms and sign of Meniere’s disease
Triad - Episodic vertigo, tinnitus, progressive deafness.
N&V, Sweating and pallor. rapid onset episodes 30min to several hours. Nystagmus in attack
>50yrs
O/E - Sensorineural deafness, caloric reflex test, audiometry.
Tx of Meziere’s disease
- Refer to ENT or neurology to confirm DX
- Med cyclixine or prochlorperazine in short term
- encourage pt to mobilise after an acute attack
- Betahistine taken regularly may help some pt as would a thiazide diuretics, a low salt diet, vestibular rehabilitation, tinnitus maskers and or hearing aid
- reduce stress (trigger)
- look for and tx concurrent anxiety and depression
Cause of episodic vertigo lasting a few seconds or minutes
Commonly due to benign positional vertigo
Causes of episodic vertigo lasting minute to hours
Consider meniere’s disease
Causes of Prolonged vertigo >24hr
Peripheral lesion eg viral labyrinthitis or trauma or a central lesion eg MS stroke or rumour
What to look for on examination for PC vertigo
Neuro signs - esp cerebellar signs, CN lesion and Romberg’s sign
Assess BP, nystagmus, eardrums and hearing
Hall pike manoeuvre - pt moves from sitting to laying quickly with head to one side. look for nystagmus and ask about vertigo. repeat in the other direction.
What advise for pt with sudden attacks of vertigo
Consider risk of swimming, dangerous machinery and ladders.
Advise to stop driving until symptom resolve
Signs and symptoms of Benign positional vertigo
Recurrent attack of sudden onset vertigo
Last only a few seconds or minutes
Occurs with sudden changes in posture
Common after head injury or viral injury.
(cause is thought to be otoliths in labyrinth)
Diagnosed - history and +ve hall pike test and normal tympanic membrane.
Tx of benign positional vertigo
Self limiting - few weeks (may be intermittently for yr)
Reassure
Minimize symptoms by sitting and lying in stages
If not settling refer to ENT for Employ’s manoeuvre
Or refer to physiotherapy for exercise and vestibular rehabilitation.
Labyrinthine sedatives not helpful
Symptoms and signs of viral labyrinthitis
Usually follow a viral URTI
Sudden onset of vertigo, prostration, nausea and vomiting no associated loss of hearing,
Normal tympanic membrane
Tx of viral labyrnthitis
Labyrinthine sedative e.g. cyclizine or prochlorperazine
Usually resolves in 2-3 weeks
If persist for >6 wk refer
Symptoms and signs of vertebra-basilar insufficiency
Common in older patients
Hx of dizziness on extension and rotation of the neck
Normal tympanic membranes
May be associated cervical spondylosis and neck pain
Tx of vertebra-basilar insufficiency
Provide lifestyle advice
Some advocate use of a cervical collar.
