Dizziness and Vertigo

Question 1

What is vertigo?

Answer 1

Sensation of motion.

e.g. falling spinning being pushed

Question 2

What should be asked about in a history taking of someone complaining of vertigo?

Answer 2

Tiggers
Duration
Associated symptoms
Precipitating facers
Alleviating factors
Medication

Question 3

If someones vertigo lasts seconds it is usually ?

Answer 3

BPPV

Benign Positional Paroxysmal Vertigo

Question 4

If someones vertigo lasts hours it is usually?

Answer 4

Menieres

Question 5

If someones vertigo lasts days it is usually?

Answer 5

Vestibular neuritis

Question 6

If someones vertigo duration is variable it is likely to be?

Answer 6

Vestibular migraines

Question 7

If someones ear feels full and has vertigo it is likely to be?

Answer 7

Menieres

Question 8

If someone has light sensitivity and vertigo it is likely to be?

Answer 8

Vestibular migraines

Question 9

If someone says they experience vertigo when rolling over in bed what is the likely diagnosis?

Answer 9

BPPV

Benign Positional Paroxysmal Vertigo

Question 10

If someone has severe nausea and vomiting for days alongside vertigo what is the likely diagnosis?

Answer 10

Vestibular neuritis

Question 11

If a patient presents in clinic with vertical nystagmus what is the risk?

Answer 11

RED FLAG

Indicates brain stem involvement

Question 12

What is the cause of BPPV?

Answer 12

Otoconia have broken off the sensory hair cells and are loose within the semi circular canals.

Question 13

In a clinical investigations what will someone with BPPV show?

Answer 13

Vertical and torsional nystagmus

+ve dix hallpike test - nausea and vomiting

Question 14

What is the treatment for someone with BPPV

Answer 14

Repositioning manoeuvres
Epley - moves the otoconia out of the semicircular canals
Brandt Darrof - Acclimatises the patient

Question 15

What is the rule of three associated to vestibular neuritis?

Answer 15

In bed 3 days
Off work 3 weeks
Off balance 3 months

Question 16

What is the disease history of someone with vestibular neuritis?

Answer 16

Flu like illness prior

Generally self limiting

Question 17

Is there hearing loss associated with vestibular neuritis?

Answer 17

No, if there is hearing loss it indicates labryinthitis, which means the virus has also infected the cochlear region.

Question 18

What is the cause of menieres?

Answer 18

Unknown cause, but a rupture causes mixing of the endolymph and perilymph.

Question 19

What is the disease profile of menieres?

Answer 19

Recurrent spontaneous rotational vertigo
New tinnitus
Hearing loss
Aural fullness and pressure on affected side.

Question 20

What hearing loss is associated with menieres?

Answer 20

Low frequency

Question 21

What is the supportive management for menieres?

Answer 21

Tinnitus therapy

Hearing aids

Question 22

What is the best treatment for menieres?

Answer 22

ITS Intra tympanic steriod injections

ITG Intra tympanic gentamicin injections

Question 23

What is the idea behind ITG?

Answer 23

Gentamicin damages the ear, aim is to ablate the semicircular canals to stop vertigo.

Question 24

What is the risk associated with ITG?

Answer 24

Gentamicin also causes deafness so could result in total healing loss.

Question 25

What is the abortive treatment for migraines?

Answer 25

Triptans

Question 26

What treatment is used prophylactically in migraines?

Answer 26

Propanolol

Amitriptyline

Question 27

What is the most common auditory symptom linked to vestibular migraines?

Answer 27

Phenophobia- dislike of loud noises