Dizziness and Vertigo Flashcards
What is vertigo?
Sensation of motion.
e.g. falling spinning being pushed
What should be asked about in a history taking of someone complaining of vertigo?
Tiggers Duration Associated symptoms Precipitating facers Alleviating factors Medication
If someones vertigo lasts seconds it is usually ?
BPPV
Benign Positional Paroxysmal Vertigo
If someones vertigo lasts hours it is usually?
Menieres
If someones vertigo lasts days it is usually?
Vestibular neuritis
If someones vertigo duration is variable it is likely to be?
Vestibular migraines
If someones ear feels full and has vertigo it is likely to be?
Menieres
If someone has light sensitivity and vertigo it is likely to be?
Vestibular migraines
If someone says they experience vertigo when rolling over in bed what is the likely diagnosis?
BPPV
Benign Positional Paroxysmal Vertigo
If someone has severe nausea and vomiting for days alongside vertigo what is the likely diagnosis?
Vestibular neuritis
If a patient presents in clinic with vertical nystagmus what is the risk?
RED FLAG
Indicates brain stem involvement
What is the cause of BPPV?
Otoconia have broken off the sensory hair cells and are loose within the semi circular canals.
In a clinical investigations what will someone with BPPV show?
Vertical and torsional nystagmus
+ve dix hallpike test - nausea and vomiting
What is the treatment for someone with BPPV
Repositioning manoeuvres
Epley - moves the otoconia out of the semicircular canals
Brandt Darrof - Acclimatises the patient
What is the rule of three associated to vestibular neuritis?
In bed 3 days
Off work 3 weeks
Off balance 3 months
What is the disease history of someone with vestibular neuritis?
Flu like illness prior
Generally self limiting
Is there hearing loss associated with vestibular neuritis?
No, if there is hearing loss it indicates labryinthitis, which means the virus has also infected the cochlear region.
What is the cause of menieres?
Unknown cause, but a rupture causes mixing of the endolymph and perilymph.
What is the disease profile of menieres?
Recurrent spontaneous rotational vertigo
New tinnitus
Hearing loss
Aural fullness and pressure on affected side.
What hearing loss is associated with menieres?
Low frequency
What is the supportive management for menieres?
Tinnitus therapy
Hearing aids
What is the best treatment for menieres?
ITS Intra tympanic steriod injections
ITG Intra tympanic gentamicin injections
What is the idea behind ITG?
Gentamicin damages the ear, aim is to ablate the semicircular canals to stop vertigo.
What is the risk associated with ITG?
Gentamicin also causes deafness so could result in total healing loss.
What is the abortive treatment for migraines?
Triptans
What treatment is used prophylactically in migraines?
Propanolol
Amitriptyline
What is the most common auditory symptom linked to vestibular migraines?
Phenophobia- dislike of loud noises
