Dizziness Flashcards
What is vertigo?
sensation of movement, usually spinning
What symptoms would indicate a cardio cause of dizziness?
Lightheadedness, syncope, palpitations
What symptoms indicate a neural cause of dizziness?
Blackouts visual disturbance paraesthesia weakness speech and swallow problems
Duration of episodes can differentiate between what 4 conditions?
Seconds – BPPV
Hours – Meniere’s
Days – Vestibular neuritis
Variable – migraine associated vertigo
What questions should you ask to diagnose BPPV vertigo?
Do you get dizzy rolling over in bed?
What questions should you ask to diagnose Vestibular neuritis?
Was your first attack severe, lasting hours with nausea and vomiting?
What questions should you ask to diagnose vestibular migraine?
Light sensitivity during dizzy spells
What questions should you ask to diagnose menieres in a patient with vertigo?
one ear feel full or do you get hearing loss before or during the dizzy spell
When does vertical nystagmus occur?
When there is a central problem e.g. stroke/ brain protruding through foramen magnum
What is benign positional paroxysmal vertigo
- vertigo on looking up
- due to head trauma/ ear surgery
Describe the pathophysiology of BPPV?
Otolith material (crystals) from utricle displaced into semicircular canals Most commonly in posterior semi circ. canal
What is often confused with BPPV?
Vertebrobasilar insufficiency
cut off basilar artery supply on looking up
What test is used to diagnose BPPV and what is important to remember when carrying out the test?
Dix Hallpike Test
Remember patients eyes must be open to visualise any nystagmus or other symptoms
What other manoeuvres can be used to diagnose BPPV?
Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercises
(bottom two are for older patients who may struggle completing the manoeuvre)
Most people are symptom free after an epley manoeuvre. TRUE/FALSE?
TRUE
70-75% on 1st manoeuvre, 90% after 2nd manoeuvre
Vestibular neuronitis is usually from a viral aetiology. TRUE/FALSE?
TRUE
What is the rule of 3s with regards to vestibular neuronitis?
In bed 3 days
Off work 3 weeks
Off balance 3 months
What is thought to be the pathophysiology of menieres disease?
- Endolymphatic Hydrops
- High endolymph pressure causes membranous swelling and rupture
- endo and perilymph mix (different ion concentrations)
- hearing drops and tinnitus develops
What part of an audiogram indicates sensorineural hearing loss?
Bone conduction
How is Menieres treated?
- Supportive tx during episodes
- Tinnitus therapy
- Hearing Aids
- Grommet insertion
- Intratympanic Steroids / Gentamicin
- Surgery
How are menieres attacks thought to be prevented?
Prevention:
=> Salt restriction / caffeine / alcohol / stress
What is the most common auditory symptom in migraine and vertigo?
Phonophobia
