Dizzy Patient Flashcards
Define dizziness?
Non-specific term that covers vertigo, pre-syncope, disequilibrium, etc
Define vertigo?
Sensation of movement, usually SPINNING; this can be a feeling of the room spinning or of themselves spinning
Structure of the inner ear?
Labyrinth is a complex structure with bony and membranous structures; membrane separates perilymph from endolymph
What are the 5 vestibular end-organs?
- Ampullae of superior, posterior and lateral semi-circular canals
- Maculae of the utricle and saccule
Central pathways of hearing and balance?
Vestibulospinal tract
Medial longitudinal fasciculus and ocular muscles (vestibulo-ocular reflex)
Medial lemniscus, thalamus and cerebellum
Cerebellum (via inferior cerebellar peduncle)
Systems involved with the balance systems?
Vestibular, ocular and joints - influence the brain and heart
3 diseases that influence the vestibular system and cause dizziness?
- BPPV
- Ménière’s disease
- Vestibular neuronitis
2 examples of diseases that influence the eyes and can cause dizziness?
- Cataracts
* Diabetes Mellitus
3 examples of diseases that influence the joints and can cause loss of proprioception (potential dizziness)?
- Diabetes mellitus
- Arthritis
- Neurology
2 examples of diseases/processes that arise from the CV system to cause dizziness?
- Arrhythmias
* Postural hypotension
4 examples of diseases that affect the brain and can cause dizziness?
- Stress
- Migraine
- SOL (space-occupying lesion)
- MS (multiple sclerosis)
Describe how the vestibulo-ocular reflex occurs
Eyes should be able to fix on an object (due to a compensatory eye movement) when turning one’s head
Due to excitation of extra-ocular muscles on 1 side and inhibition on the other side
Effect of vestibular pathologies on the vestibulo-ocular reflex?
Can cause NYSTAGMUS, the direction of which depends on the inv. structures
How can nystagmus be used to narrow the DD?
Most non-vestibular pathologies do not cause nystagmus, e.g: hyperventilation or anaemia
If nystagmus if accompanied by some of the 7 Ds, it is more likely to have an otological cause
Potential causal areas in dizziness?
CV, haematological and metabolic issues
Neurological conditions
Otological conditions
Anxiety
Drug (anti-hypertensives) side effects/interactions
Migraine
Trauma
Hx questions to consider with dizziness?
Triggers, e.g: certain movements
Time course
Assoc. symptoms, e.g: 7 Ds
Precipitating and alleviating factors
DH
Examination of the dizzy patient should include?
Otoscopy and audiometry
Neurological system
BP (on lying and standing)
Balance system
How to perform Hallpike’s test for BPPV?
Sit on couch so that head is off the end when they lie back; turn the head 45 degrees to the right
WARN PATIENT NOT TO CLOSE EYES IF THEY ARE DIZZY (test often does not work well when being repeated)
Lie back as quickly as possible and hold in position and observe
Cautions with Hallpike’s test?
Usually, there is a delay of ~30 seconds before the nystagmus is seen
Condition MAY be bilateral
How to confirm BPPV with Hallpike’s test?
If the test is done for a 2nd time/with repetition, response should be reduced/absent
How to perform the Epley Manoeuvre?
……….
How to perform Brandt-Daroff exercise?
……….
Why is intratympanic gentamicin/steroids given for Ménière’s disease?
For severe attacks; by this point, it is likely the patient has severe hearing impairment
Toxic to middle ear and so they deaden the vestibular apparatus
Examples of surgeries used in Ménière’s disease?
Rare as they have a high rate of complications, esp. when compared to intratympanic gentamicin injection
E.g: labyrinthectomy or vestibular nerve section
Differences between: • BPPV • Ménière's • Labyrinthitis • Vestibular neuronitis
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