Dizziness Flashcards
Presyncope
Feeling faint or almost fainting
Dysequilibrium
Unsteadiness or feeling off-balance when walking
Vague Lightheadedness/Other
Ill defined, lacks specific characteristics of the other 3
What will help reveal the cause of dizziness?
A detailed history!
What questions will you ask to get a detailed history?
- Complete description of what the patient means by dizziness (room spins? Fainting? Unsteadiness?)
- Timing - Setting & Circumstances?
- Duration
- Aggravating/alleviating factors
- Medication History
- Past Medical Hx
Peripheral Vertigo
Most common recurrent vertigo from otoconia in canals (posterior canal)
What causes Benign Positional Vertigo (BPV)?
Sudden onset of vertigo provoked by quick head movement
How long does BPV last?
Seconds to a minute (BRIEF!)
Symptoms of BPV?
Nausea/vomiting
NO tinnitus or hearing loss
BPV Physical Exam tests?
Dix-Hallpike is positive
Delayed unidirectional nystagmus is positive
How can you treat BPV?
Epley’s Maneuver when Dix-Hallpike is positive.. Just continue on!
What are you trying to move w/Epley’s Manuever and to where?
Otoconia will hopefully move into the utricle from the posterior canal
What are symptoms of Meniere’s Disease?
Recurrent attacks of severe vertigo WITH HEARING LOSS
Onset of vertigo lasts hours (long time)
Nausea, vomiting, fullness/pressure/pain in the ear, tinnitus
What is Meniere’s disease?
Sensorineural hearing loss possibly from excess endolymph (fluid) in the inner ear
Do we treat Meniere’s Disease?
Nope, refer out to ENT
Which type of vertigo is associated with one-sided hearing loss?
Acoustic Neuroma (CN VIII tumour)
Which of the causes of vertigo occur after a viral illness?
Acute labyrinthitis/vestibular neuronitis
Which type of vertigo is due to medications?
Ototoxicity due to medications
How frequent is dizziness in cases of whiplash?
41%-48%
What will come up during the exam to suggest cervicogenic vertigo?
Positive swivel chair test
Sore neck
What would an abnormal neuro finding tell you about the patient’s dizziness?
It is a form of central vertigo
Patient walks in with a staggering gait, motor weakness and difficulty articulating what they are experiencing but they can let you know they are dizzy. What do they have?
Central Vertigo
What is nystagmus?
The eyes involuntarily look away from the point of gaze
What is the main difference between central and peripheral vertigo?
Peripheral has a normal neuro exam except hearing loss and unidirectional nystagmus
Central has neuro exam abnormalities and nystagmus changes direct w/gaze (gaze fixation may make it worse!)
What may cause central vertigo?
Transient Ischemic Attack (TIA)
Posterior Fossa Tumour
MS (autoimmune demyelination)
Dysarthria
Speech difficulties
Dysmetria
Past-pointing
Gaze evoked nystagmus
Asking patient to focus their gaze evokes oscillations of their eyes or asking the patient to following your finger and their eyes move in different directions
Presyncope
Feeling faint or almost fainting
Syncope
Fainting/loss of consciousness
Causes of Presyncope dizziness
- Vasovagal reaction (most common) dizziness often for minutes before fainting
- Orthostatic hypotension
- Cardiogenic - dizziness prodrome is very brief (
Vasovagal reaction
Vagal “over-reaction”
Recover within a few seconds
Orthostasis
Brief dizziness from sitting to standing - or from dehydration, eating, medications, autonomic dysfunction
Cardiogenic Presyncope
Prodrome
Cardiogenic syncope from exertion because?
Aortic stenosis
Heart failure
Pulmonary emboli
Anemia
Causes of dysequilibrium
Medications
Sensory deficits
Motor abnormalities
Orthopedic disorders
Vertigo
False sense of spinning or motion
T/F There is no need to instruct the patient on where to look during Dix-Hallpike
False - if they look at one point, their nystagmus may go away
What are 3 signs of Meniere’s disease?
Sensorineural hearing loss
Lasts a long time
Ringing in the ears (tinnitus)
Patient had presyncope for under 5 seconds and then they passed out. They have also been having heart palpitations. Should you be worried?
Yes - could be arrhythmia and you want to send them to their PCP
Pt had presyncope for a couple of minutes and then passed out when their blood was being drawn. Should you be worried?
No, this is probably a vasovagal reaction?
