Dizziness and vertigo

Question 1

How is balance maintained within the ear?

Answer 1

There are sacculi with fluid that tells you about tilting

And there are Semi-circular ducts that tell you about left/right movement

Question 2

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Answer 2

It’s short-lived vertigo on turning the head Eg, laying down
- Caused by displaced cells into the wrong places

Treated with Epley manoeuvere (Sequence of movements to remove the cells from the wrong places)

Diagnosed with Dix-Hallpike test

Question 3

What is Vestibular neuritis / labyrinthitis?

Answer 3

An inflammation of the vestibular portion on 8th cranial nerve

Acute severe vertigo lasting a few hours
= Vestibular neuritis
+ hearing loss
= Labyrinthitis
+ neurological signs? – consider posterior circulation stroke

Treat acutely with vestibular sedatives (prochlorperazine)
Or Vestibular rehab (recovery worse in elderly)

Question 4

What is a vestibular migraine?

Answer 4

Sudden attacks of dizziness that lasts minutes-hours
Associated with headaches, sensitivity to light/sounds, sensitivity to movement

Treated with Triptans and b-blockers or Ca2+ channel blockers for prevention

Question 5

What conditions can mimic dizziness?

Answer 5

Heart issues: drop in BP, palpitations

CNS: constant unsteadiness and neuro symptoms

Psychological: doesn’t fit diagnosis and there may be history of anxiety