Dizziness Flashcards
Define dizziness
Non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc.
Define vertigo
A sensation of room spinning around you, implies vestibular pathology
Reminder
What are the 4 main systems which are involved in balance or have an effect on it ?
- Ears
- Eyes
- MSK
- Cardiac
What are the 3 main causes of dizziness which affect the ear ?
- BPPV
- Vestibular neuronitis / labyrinthitis
- Ménière’s Disease
Describe what the vestibulo-ocular reflex is
- A rotation of the head is detected, which triggers an inhibitory signal to the extraocular muscles on one side and an excitatory signal to the muscles on the other side.
- The result is a compensatory movement of the eyes in relation to the movement of the head
What is nystagmus ?
Rapid involuntary movements of the eyes.
What does the presence of nystagmus indicate ?
Indicates a vestibular or cerebellar pathology
What is the vestibular system ?
- The vestibular system, is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance.
- It consists of two structures; the bony labyrinth of the inner eae & the structures of the membranous labyrinth contained within them.
Describe what benign positional paroxysmal vertigo is
Attacks of sudden rotational vertigo provoked by head turning
What is the pathogenesis of BPPV?
Otolith material (calcium carbonate crystals from cells within the endolymph) from utricle displaced into semicircular canals
What are some of the causes of BPPV?
Head trauma, ear surgery, idiopathic
On what movements is BPPV often experienced ?
- Looking up
- Turning in bed - often worse to one side
- On 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
What are the important symptoms which are all negative in BPPV?
No associated tinnitus, hearing loss or aural fullness
How long does BPPV last?
Minutes
What test is done to diagnose BPPV?
Halipike test
What in general is used to commonly treat nausea, vomiting & vertigo?
Prochlorperazine or anti-histamine e.g. cyclizine, cinnarizine or promethazine
What is the treatment of BPPV?
- Usually self-limiting
- But Epley manoeuvres can be done to try and treat it
What is vestibular neuronitis and what does it often develop after ?
- Infection of the vestibular nerve, which causes it to be inflamed and disturbed balance
- It is a cause of vertigo that often develops following a viral infection.
What are the main symptoms of vestibualr neuronitis ?
- Recurrent vertigo attacks lasting hours or days-weeks
- +/- N&V, horizontal nystagmus
- No tinnitus
- No hearing loss
- No aural fullness
- No positional trigger
What is the treatment of vestibular neuronitis?
- Mild cases tx = PO prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
- Severe cases tx = buccal or IM prochlorperazine
What is labyrinthitis ?
- An inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs.
- Usually caused by viral infection
What are the key symptoms of labyrinthitis ?
Patients typically present with an acute onset of:
- Vertigo: not triggered by movement but exacerbated by movement
- N&V, horizontal nystagmus
- Hearing loss (sensorineural): may be unilateral or bilateral
- Tinnitus
- Preceding or concurrent symptoms of URTI
- No aural fullness
Both labyrinthitis and vestibular neuronitis can present very similar what is the key difference between the two ?
Labyrinthitis is associated with hearing loss and tinnitus, vestibular neuronitis is not (because it only involves the vestibular nerve)
How long does the symptoms of vestibular neuronitis and labyrinthitis last ?
Days- weeks
What is menieres disease?
It is dilatation of the endolymphatic spaces of the membranous labyrinith
What are the symptoms of menieres disease ?
- Vertigo
- Tinnitus
- Sensorineural hearing loss
- Aural fullness
- Occurs for hours
What is the treatment of menieres disease ?
- Mild attacks tx = PO prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
- Severe attacks tx = buccal or IM prochlorperazine
- Prevention tx = betahistine and vestibular rehabilitation exercises may be of benefit
Note that patients with migraines can often develop symptoms of vertigo secondary to the migraine
