Dizziness Flashcards
Define dizziness vs vertigo
Dizziness = non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc. Vertigo = a sensation of movement, usually spinning – either they’re spinning, or they’re standing still and the room is spinning.
What are the five systems involved in the balance system?
Inner ear Eye MSK - joint receptors tell you where your body is in relation to your head Heart Brain
What is the function of the vestibulo-ocular reflex?
Keeps your eyes fixed on something when your head moves.
Fluid turns opposite to the head movement in the lateral semi-circle.
What is the clinical relevance of nystagmus?
Nystagmus will be observed in vestibular pathologies – if patients have no nystagmus then think something outside of the middle ear e.g. hypertension.
Direction of nystagmus will depend on involved structures – which semicircular canal.
Which questions should yo ask when taking the history of a dizzy patient?
- Triggers? – if episodes e.g. standing up, turning over, moving in a certain way
- Time Course? Seconds? Days?
- Associated symptoms? – hearing loss, tinnitus beforehand or during, palpitations, loss of consciousness, incontinence
- Precipitators?
- Alleviating factors?
- Medication?
BPPV
- What does this stand for?
- Common or rare?
- Main complaint?
- Causes?
Benign positional paroxysmal vertigo
Very common
Patient says when they look up everything spins for a moment
Head trauma, ear surgery, idiopathic
Pathophysiology of BPPV?
Otoliths – tiny crystals supposed to be attached to otolithic membrane. Trauma can knock them into the endolymph – gravity tends to take them into the posterior semi-circular canal, and occasionally the superior semicircular canal. They break off and float in fluid – when patient turns their head, they move and either affect the fluid movement or touch the cupula.
What can BPPV be confused with?
What differentiates the two?
Vertebrobasilar insufficiency– also causes brief episodes of dizziness when the patient puts their head back – to do with pinching circulation in brain – usually has other neurological symptoms. For a diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo
- e.g. visual disturbance
- Weakness
- Numbness
Give some common precipitants of vertigo in BPPV
- 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
Episodes are brief and patients never get it whilst sitting still in a chair
What are some associated ENT symptoms of BPPV?
No associated tinnitus, hearing loss or aural fullness
Which test is used when examining HPPV?
Hallpike test - remember to leave it for at least 30s as there is a delay in the nystagmus starting
Nystagmus is torsional
Test fatigues - much reduced or absent response on repetition
Head tilt to right = testing right vestibular apparatus
Which two movements can a patient do to treat BPPV?
Epley manoeuvre
Brandt-Daroff exercise
Vestibular neuronitis
- Symptoms?
- Aetiology?
Prolonged vertigo (days)
No associated tinnitus or hearing loss
Presumed viral aetiology - irritates the vestibular nerve - may be viral prodromal symptoms
Causes days/weeks of persistent vertigo – wake up in morning and start throwing up. Worse if they move around.
Labyrinthitis
- Symptoms?
Prolonged vertigo (days)
May be associated tinnitus or sensorineural hearing loss
Probable viral aetiology - may have viral prodromal symptoms
How do you differentiate between vestibular neuronitis and labyrinthitis?
Labyrinthitis has other ear symptoms e.g. tinnitus, hearing loss
