Dizzy Patient Flashcards
____ is very common and __________ disease is very uncommon
BPPV is very common and MÉNIÈRE’S disease is very uncommon
non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc. defines what?
dizziness
define vertigo
a sensation of movement, usually spinning
visual cardiovascular proprioceptive vestibular vestibulospinal tract vestibule-ocular reflex
all contribute to what?
balance
the following conditions are under what umbrella contributing to balance:
BPPV
Ménière’s
vestibular neuronitis
vestibular
the following conditions are under what umbrella contributing to balance:
cataracts
DM
visual
the following conditions are under what umbrella contributing to balance:
DM
arthritis
neurology
proprioceptive
the following conditions are under what umbrella contributing to balance:
arrhythmias
postural hypertension
cardiovascular
the following conditions are under what 2 umbrellas contributing to balance:
stress
migrane
SOL
MS
vestibulospinal tract
vestibule-ocular reflex
a duration of vertigo lasting seconds
diagnosis?
BPPV
a duration of vertigo lasting hours
diagnosis?
Ménière’s
a duration of vertigo lasting days
diagnosis?
vestibular neuritis or labyrinthitis
a duration of vertigo lasting variable duration
diagnosis?
migrane associated vertigo
Do you get dizzy rolling over in bed?
if the answer was yes…
diagnosis?
BPPV
Was your first attack severe, lasting hours with nausea & vomiting?
if the answer was yes…
diagnosis?
vestibular neuritis
Do you get light-sensitive during the dizzy spells?
if the answer was yes…
diagnosis?
vestibular migraine
Does one ear feel full or do you get hearing loss before or during the dizzy spell?
the answer was yes…
diagnosis?
Ménière’s
name the 2 unusual but urgent referals of dizziness when you look in the ear
AOM
cholesteatoma
BPPV is the commonest cause of vertigo when looking in what direction?
up
what are the 3 causes of BPPV?
head trauma
ear surgery
idiopathic
BPPV pathophysiology?
otolith material from utricle displaced into semicircular canals
most commonly in posterior SCC
BPPV can be confused with vertebrobasilar insufficiency. for a diagnosis of VBI, what other symptom is needed?
visual disturbance
weakness
numbness
vertigo on:
looking up
turning in bed - often worse to one side
first lying down in bed at night
on first getting out of bed in the morning
bending forward
rising from bending
moving head quickly – often only in one direction
diagnosis?
BPPV
name the test and manœuvre performed in BPPV
dix hallpike test and epley manœuvre
is there associated tinnitus or hearing loss in vestibular neuronitis?
no
is there associated tinnitus or hearing loss in labyrinthitis?
yes
vestibular neuronitis/labyrinthitis treatment?
self limiting
supportive with vestibular sedatives
what rule is associated with vestibular neuronitis/labyrinthitis?
rule of 3:
3 days in bed
3 weeks of work
3 months off balance
history of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
occurrence of or worsening of tinnitus on the affected side
ocurrence of aural fullness on the affected side
documented SNHL on at least one occasion
diagnosis?
Ménière’s disease
is high or low frequencies that is lost in Ménière’s disease?
low frequencies
Ménière’s disease management?
supportive
tinnitus therapy
hearing aids
salt restriction
ITS - injected steroid to middle ear
ITG - injected gentamicin
grommet
surgery
is there a clear positional trigger in BPPV?
yes
in what condition is there aural fullness?
Ménière’s disease
in what 2 conditions is there associated hearing loss or tinnitus?
Ménière’s disease and labyrinthitis
rare, benign tumour of VIII nerve sheath
causes progressive imbalance and HL with tinnitus
diagnosis?
vestibular schwannoma
what is the gold standard to investigate the dizzy patient?
MRI
BPPV duration?
minutes
Ménière’s disease duration?
hours
labyrinthitis and vestibular neuronitis duration?
days-weeks
vestibular schwannoma presses against what nerve?
CN VIII
