Dizziness & Vertigo (Vestibular disease)

Question 1

Background

Answer 1

Vertigo is a type of dizziness.
They are symptoms not disease.
Vertigo - false sensation of movement (spinning/rotation) of the person or their surroundings without physical movement.

If Dizziness is ear related it will happen when patient is lying down and not upright.

Vertigo types;
Peripheral Vertigo- caused by ear issues
Central Vertigo- issue with brainstem and cerebellum.

Question 2

Causes

Answer 2

Dizziness
Labyrinthitis, migraine, stress/ anxiety, Hypoglycaemia, postural hypotension, Dehydration/ exhaustion, Vertebrobasilar insufficiency (decreased blood flow to back of brain)

Vertigo
benign paroxysmal positional vertigo (BPPV), migraines, labyrinthitis, vestibular neuronitis – inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help to control balance.

Question 3

Signs and Symptoms/ Assessments

Answer 3

Dizziness - spinning sensation, losing balance

Vertigo - Movement sensation without physical activity.
VERTIGO ASSESSMENTs:
History taking (SOCRATES, Medical)
Ear exam, Neurological exam (look at nerves), Examine eyes - nystagmus (uncontrollable movement = vertigo), CV exam, Other tests (in cks- relevance not sure)

Question 4

Treatment

Answer 4

Procholperazine/ANTIHISTAMINES - Severe use IV/IM
Central Vertigo (brain related)
Requires referral - can be stroke linked.
Short term symptomatic treatment
- Rapid relief of severe N, V, Vertigo - Consider - Buccal prochlorperazine or Deep IM prochlorperazine or cyclizine injection
- Less severe N, V, Vertigo - Consider - short oral course of prochlorperazine or cinnarizine, cyclizine, or promethazine (antihistamines)

Peripheral Vertigo (ear related)
Admit/Urgent refer if Severe N or V, sudden onset, central neurological symptom or acute deafness.
Others refer to balance specialist.
Consider SYMPTOMATIC drugs:
Antihistamines MAX 1 week.
Same as Central vertigo (rapid/ less severe dependant)

Doses - (extra info)
Oral cinnarizine - 30mg TDS
Oral cyclizine 50mg up to TDS
IM Cyclizine 50mg up to TDS
Oral Prochlorperazine 5mg TDS
Buccal Prochlorperazine 3-6mg BD
IM Prochlorperazine 12.5mg then oral after 6 hours
Oral Promethazine 25mg ON MAX 100mg

Question 5

Treatment Non Pharmacological

Answer 5

• Vestibular rehabilitation training (VRT), -Exercises for dizziness and balance problems
• Series of simple head movements is used to treat BPPV.
• Simple exercises = correct symptoms
• Sleep with the head slightly raised on two or more pillows.
• Getting up slowly when getting out of bed and sit on the edge of the bed for 1min or + before standing.
• Avoiding bending down
• Avoid extending the neck
• Moving the head carefully and slowly during daily activities.
• Doing exercises triggering vertigo, = brain gets used to it and reduces symptoms