Dizziness

Question 1

The Dx test for BPPV?

Answer 1

Dix-Hallpike maneuver :

1) rotate patient’s head to 45 degree to one side
2) lay patient supine with neck slightly extended.
3) positive on that side if vertigo or nystagmus initiated.

Question 2

The Tx test for BPPV?

Answer 2

Epley manœuvre , check Youtube videos

Question 3

presentation of vertigo?

Answer 3

1) feels the room or patient themselves are spinning

2) it is triggered or worsened by turning your head or rolling on the bed.

Question 4

Ddx of vertigo:

Answer 4

1) most common: Benign proxysmal positional vertigo (BPPV), migraine related vertigo
2) vestibular neuritis/labyrin’thitis (sudden onset, severe, persistent for days, N&V, imbalance)
3) Meniere’s disease: recurrent episodes of vertigo (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness.
4) vestibular toxicity (medications): ahminoglycosides (gentamicin), loop diuretics, ASA, NSAIDS, amiodarone, quinine, cisplatin (chemo drug)
5) cerebellar infarct/stroke (central cause of vertigo)

Question 5

presentation of pre-syncopal dizziness

Answer 5

feels like nearly fainting or blacking out

Question 6

Ddx of dizziness

Answer 6

vertigo, lightheadedness, imbalance, (pre-)syncope

Question 7

SSx of cerebellar stroke

Answer 7

acute, sudden vertigo with n/v, nystagmus is usually present (either vertical or bilateral), suggesting a central cause of the vertigo. patients may also have other neurological signs, e.g., ataxia and impaired gait.

distinct factor vs. vestibular neuritis, patient w/ cerebellar stroke can not stand by themselves even with eyes open, whereas pt with vestibular neuritis are usually okay to stand.

When taking histories, risk factors of having a stroke should be inquired, and level of suspicion is high, order a MRI immediately. MRI brain and internal acoustic meatus