Dizzy patient Flashcards
What is the difference between dizziness and vertigo?
Dizziness is an umbrella term covering things like vertigo, pre syncope, disequilibrium etc. Vertigo is a specific thing
Define vertigo
Sensation of movement, usually spinning movement.
Dizziness is the most common cause of GP presentation over 74years of age - true/false
true
there are 7 possible categories of causes of dizziness - what are they?
Cardiovascular causes Haematological Causes Anxiety (hyperventilation) Neurological conditions Migraines Otological causes traumatic causes
What is labyrinth?
This is the complex structure of the inner ear
The labyrinth has a boney and membranous part with two separate fluid containing spaces - true/false
True
There are ____ vestibular end organs which are the _____
5
Ampullae of the lateral, posterior and superior semicircular canals and the maculae of the utricle and saccule
balance is about more than just the ear - explain why your eyesight impacts your balance.
The eyes and ears are telling you different things about where you are in space if your eyesight is poor; thus this throws your balance off.
How do proprioceptors play into balance?
the proprioceptors in joints tell you where you are in space. if these aren’t working then your brain gets confused as to where you are, as your eyes/ears and proprioceptors are telling you different things.
How does poor perfusion to the brain affect balance?
you will deck it if your brain has no oxygen and this is why the heart plays into balance.
Vasovagal syncope, arrhythmia and postural hypotension all cause balance issues - true/false
true
What is the vestibulo-ocular reflex?
This is when you focus your eye on one thing and turn your eye but your eyes move to remain fixed on that object.
How does the vestibule-ocular reflex work?
The lateral semi-circular canal is constantly sending impulses. when the head moves, these impulses decrease and your eyes move in order to remain fixed on your object of sight.
Why is the vestibule-ocular reflex important?
This is important for using nystagmus to distinguish between a vestibular and non-vestibular pathology
Define nystagmus?
Dancing eyes - rapid, involuntary movement of the eyes
Nystagmus will be present in non-vestibular pathology - true/false
False - it will only be present in a vestibular pathology
What questions should you ask about dizziness?
Relevant socrates questions: - triggers - better or worse - how long/when started - associated symptoms - alleviating factors medications they take
Examinations you would carry out for dizziness include: 1. 2. 3. 4. 5.
- Otoscopy
- neurological examination
- BP, lying and standing
- balance system
- Audiometry
Other Investigations for dizziness include: 1. 2. 3. Why are you doing these?
- FBC - look for anaemic
- U+Es - sodium imbalance, hypotension and postural hypotension
- lying and standing BP - postural hypotension
What is the cause and incidence of Ménière’s Disease?
Cause - unknown
Incidence 50-200/100,000
What are the symptoms of Ménière’s Disease
Recurrent, spontaneous, rotational vertigo with at least 2 episodes lasting more than 20mins (sometimes more than hours).
Tinnitus and a feeling of aural fullness on the affected side.
Documented sensorineural hearing loss on at least one occasion.
Ménière’s Disease is a disease that is diagnosed clinically from the history- true/false
true as it doesn’t have any specific testing
also false as it is a diagnosis of exclusion, it is only diagnosed by excluding all other causes.
management of Ménière’s Disease includes: 1. 2. 3. 4. 5. 6.
- supportive management and tinnitus therapy
- hearing aids
- Prevention e.g. avoiding excess salt, betahistine, caffeine, alcohol and stress
- Grommet or meniette insertion
- intratympanic gentamicin and/or steroids
- Surgical
What is the commonest cause of vertigo when you look upwards?
Benign positional paroxysmal vertigo (BPPV).
Give three potential causes of BPPV
head trauma, ear surgery, idiopathic
Describe the pathophysiology of BPPV
Otolith material of the utricle becomes displaced into semicircular canals. Most commonly seen in posterior squamous cell carcinoma.
What other disease is BPPV often confused with? What must be present in this other disease?
Vertebrobasilar insufficiency
Must have symptoms of impaired circulation in the posterior brain associated with the vertigo e.g. visual disturbance, weakness and numbness.
Symptoms of BPPV include vertigo on: 1. 2. 3. 4. 5. 6. 7.
this is usually a brief episode with no tinnitus, hearing loss or aural fullness -true/false
- Looking up
- Turning in bed - often worse turning to one side
- First lying down in bed at night
- first getting out of bed in the morning
- Bending forward
- Rising from bending
- Moving head too quickly - often in one direction
true
What is the Dix-Hallpike test and what is it used for?
It involves sitting a patient on a couch turning their head 45degrees to the affected side and putting them in a supine position as quickly as comfortable with their head hanging over the end of the couch and the neck in approximately 30degrees extension. Make sure they know they cannot close their eyes if they get dizzy Hold in position and observe. Usually delay up to 30seconds and then classical nystagmus.
Used to diagnose BPPV.
Why is the Dix-Hallpike test not able to be repeated numerous times?
The test fatigues
Treatment for BPPV involves the _____ which can be repeated up to ___ times
Epley Manoeuvre. up to 2x so total of three procedures.
Vestibular neuronitis is a prolonged vertigo lasting ____ with (no/some) associated tinnitus and hearing loss
Vestibular neuronitis is a prolonged vertigo lasting days with no associated tinnitus and hearing loss
What may be the cause of vestibular neuronitis?
Viral
Labyrinthitis is a prolonged vertigo lasting ____ with (no/some) associated tinnitus and hearing loss
Labyrinthitis is a prolonged vertigo lasting days with some associated tinnitus and hearing loss
What may be the cause of Labyrinthitis?
Viral
What is the treatment for Labyrinthitis/vestibular neuronitis?
Supportive management with the use of vestibular sedatives. Generally self-limiting
If there is prolonged or atypical infection in a labyrinthitis/vestibular neuronitis further investigation is warranted. What other treatments may be helpful?
Rehabilitation exercise
___% of the population are affected by migraine. of these ____% suffer spontaneous bouts of vertigo and ataxia.
15-20%
25%
Photophobia is the most common auditory symptoms of migraine - true or false? Define phonophobia
True
it is the fear of loud noises or sometimes the fear of voices/ones own voice.
Fluctuating Hearing loss and acute permanent loss are common/uncommon in those affected with migraine
Uncommon - occur in a small percentage of migraine sufferers.
Motion sensitivity with motion sickness occurs in ____% of migraine sufferers.
66% (2/3rds)
Episodes of vertigo occur in ___% of migraine sufferers
25%.
