Dizziness Flashcards
is menieres common
no
what are the different causes of dizziness
cardio problems haematological and metabolic anxiety neurological conditions drugs side effects/ interactions migraine otological trauma
what is dizziness
non-specific term, covers vertigo, pre-syncope (state before fainting), disequilibrium
what is vertigo
sensation of movement, usually spinning
what conditions that causes dizziness affect the vestibular contribution to the central pathway
BPPV
menieres
venstibular neuronitis
what conditions that causes dizziness affect the cardiovascular contribution to the central pathway
arrhythmias
postural hypotension
what conditions that causes dizziness affect the visual contribution to the central pathway
cataracts
DM
what conditions that causes dizziness affect the proprioceptive contribution to the central pathway
DM, arthritis, neurology
what conditions that causes dizziness affect the central pathways
stress
migraine
space occupying lesion
MS
what are the signs of a cardiac dizziness
lightheadedness, syncope, palpitation
what are the features of a neuro dizziness
blackouts, visual disturbance, paraesthesia, weakness, speech and swallow problems
what are the vestibular causes of dizziness
vertigo; feeling of spinning, falling or being pushed
what dizziness lasts seconds
BPPV
what dizziness lasts hours
menieres
what dizziness lasts days
vestibular neuritis/ labyrinthitis
what causes of dizziness are variable in length
migraine associated vertigo
what are the symptoms of a vestibular migraine
dizziness, variable duration, mostly occur without headaches, nausea, vomiting, sweating, flushing, diarrhoea, visual changes (blurring), flashing lights, difficulty focusing
bright light and loud sounds are uncomfortable, most feel need to sleep
what does dizziness with hearing loss, tinnitus and aural pressure suggest
inner ear problems- meineres
quick diagnosis:
gets dizzy rolling over in bed
BPPV
quick diagnosis:
first attack was severe, lasting hours with nausea and vomiting
vestibular neuritis
quick diagnosis:
get light sensitive during the dizzy spells
vestibular migraines
quick diagnosis:
one ear feels full/ get hearing loss before/ during the dizzy spell
menieres
what should you include in an exam of a dizzy patient
otoscopy neurological BP when lying and standing balance system audiometry dix hallpike test
what causes of dizziness need an urgent referral
AOM or cholesteatoma
what are the vestibular end organs
ampullae of lateral, posterior and superior canals (swelling containing cupulas)
maculae of the urticle and saccule (respond to changes in the head position with respect to gravity)
when turning right the cupula on which side will be most excited
the right side
in a nystagmus caused by a dead ear is the fast phase away from or towards the affected side
away from- slow to affected side, fast away from
where is the lesion in a bi directional nystagmus
central
where is the lesion in a vertical nystagmus
central, can be stroke
what investigations into someone with postural dizziness
Hb, Na, BP lying + standing
is BPPV common
yes very
what is BPPV
benign positional paroxysmal vertigo
the commonest cause of vertigo when looking up
what causes BPPV
head trauma, ear surgery, idiopathic
happens with otolith material (crystals) from urticle are displaced into semicircular canals (most commonly posterior SCC) causing perceived movement
what can BPPV be confused with
vertebrobasilar insufficiency (when bending head back blocks off the arteries)
what are the features of vertebrobasilar isufficiency
visual disturbance
weakness
numbess
vertigo
when do you get vertigo in BPPV
looking up turning in bed laying down at night first getting up in morning bending forward rising from bending moving head quickly
what is the dix hallpike test
sit up, eyes open
turn head 45 degrees to the right
lay down, doesnt have to be fast
short delay (wait up to ten seconds) and looking for symptoms and nsytagmus
eyes tell you which canal the crystals are in
in BPPV eye will bounce up and down and there will be twisting
patient will feel dizzy and might be sick
in BPPV how can you tell what canal the crystal is in
eye twisting towards the ground (geotrophic)
9/10 times BPPV will be in the posterior canal
how do you treat BPPV
epley manoeurve
or semont manoeuvre if the patient cant tolerate epley
brandt-daroff exercises
what do the posterior and superior semicircular canals join to form
crus commune
where do you want to get the crystals to end up after the epley manoeuvre
out of the semicircular canals
what is vestibular neuronitis
prolonged vertigo (days) with no associated tinnitus or hearing loss caused by an infection of the vestibular nerve within the inner ear (probably viral)
what is labryinthitis
another name for vestibular neuronitis
what is the treatment for vestibular neuronitis
supportive management with vestibular sedatives
generally self limiting
if prolonged may need exercises(looking at thumb and moving head will improve VOR)/ further investigation
what is menieres disease
endo lymphatic hydrops = high pressure within the endolymph system
what are the symptoms of menieres
episodic sudden onset of vertigo, sensorineural hearing loss (low frequency), tinnitus, and sensation of fullness in the affected ear, at least two episodes >20 mins (often lasting hours)
what is the management of menieres
supportive treatment during episodes (intratympanic steroids or gentamicin)
tinnitus therapy
hearing aids
prevention (salt restriction, betahistine, caffeine, acohol, stress)
grommet insertion
surgery
what is the most common auditory symptom of migraine
phonophobia
what is a migraine
abnormal electrical activity
what causes of dizzyness have associated hearing loss or tinnitus
menieres disease, labyrinthitis
what causes of dizzyness has aural fullness
menieres
what tumour can cause dizzyness
vestibular schwannoma
describe the nystagmus in BPPV
rotary nystagmus in posterior canal BPPV.
Purely horizontal nystagmus suggests horizontal canal BPPV.
A short latency period of a few seconds should be expected.
Nystagmus (fast component) will be upbeat and in the direction of the affected ear.
This has a limited duration, lasting <30 seconds (adaption).
On sitting, there is more vertigo, experienced as the room spinning in the opposite direction (with reversal of the nystagmus).
is BPPV is nystagmus towards or away from the affected ear
the fast phase is towards the affected ear
