Dizzy Patient

Question 1

Define vertigo

Answer 1

Sensation of movement usually spinning

Question 2

What symptoms would indicate a cardiac cause of dizziness?

Answer 2

Lightheadedness, syncope, palpitations

Question 3

What symptoms would indicate a neurological cause of dizziness?

Answer 3

Blackouts, visual disturbance, tingling, weakness

Question 4

If the dizziness lasts seconds what is the likely cause?

Answer 4

Benign positional paroxysmal vertigo

Question 5

If the dizziness lasts hours what is the likely cause?

Answer 5

Menieres

Question 6

If the dizziness lasts days what are two possible causes?

Answer 6

Vestibular Neuritits

Labyrinthitis

Question 7

Describe the symptoms of menieres

Answer 7

hearing loss, tinnitus, aural pressure

Question 8

What symptoms can be associated with vestibular neuritis?

Answer 8

Nausea and vomitting

Question 9

What is the commonest cause of vertigo?

Answer 9

BPPV

Question 10

What causes BPPV?

Answer 10

Head trauma, ear surgery, idiopathic

Question 11

Describe the pathology of BPPV

Answer 11

Otoconia from the utricle becomes displaced into the semicircular ducts - most commonly the posterior semicircular canal

Question 12

When does vertigo in BPPV often occur?

Answer 12

Looking up 
Turning in bed
Lying down at night 
Getting up in the morning 
Bending/rising 
Moving head quickly

Question 13

What is the test used to diagnose BPPV?

Answer 13

Dix Hallpike test

Sit up on couch with eyes open, turn head 45 degrees and slowly lower down

Question 14

What characteristics of BPPV will be seen in the dix hall pike test?

Answer 14

Symptomatic, nystagmus, vertical/torsional geotropic

Question 15

Name three methods of treatment for BPPV

Answer 15

• Epley manoeuvre
• Semout manoeuvre
• Brandt-Daroff

Question 16

Describe the epley manoeuvre

Answer 16

1. Patient lies on couch with affected ear towards floor
2. Head is rotated 90 degrees to the other side
3. Then a further 90 degrees by getting the patient to run onto their side with head facing the floor
4. With their chin to their chest the patient is brought back to sitting position

Question 17

What is the cause of menieres?

Answer 17

Unknown

Question 18

Describe the pathology of menieres

Answer 18

Endolymphatic hydrops - endolymph tube swells and increased pressure leads to rupture

Question 19

How will a patient with menieres present?

Answer 19

History of recurrent, spontaneous rotational vertigo with at least two episodes of >20 mins (usually hours).
Tinnitus, aural fullness and hearing loss

Question 20

How is menieres managed?

Answer 20

Supportive, tinnitus therapy, hearing aids and prevention of aggravating factors

Question 21

What medication can help menieres disease?

Answer 21

Gentamicin and steroids

Question 22

Describe the presentation of vertigo associated with migraines

Answer 22

Phonophobia, fluctuating/acute hearing loss (small percentage)

Question 23

How are vertigo related migraines treated?

Answer 23

Avoid triggers - caffeine, chocolate, citrus fruit

Pharmacological management - abortive (triptans) or prophylactic (propranolol, amitriptyline)

Question 24

What might a vertical nystagmus indicate?

Answer 24

A problem in the brain stem

Question 25

What is vestibular neuritis and labyrinthitis associated with?

Answer 25

Upper respiratory infections

Question 26

What is the difference between vestibular neuronitis and labyrinthitis?

Answer 26

Labyrinthitis is associated with tinnitus/hearing loss

Question 27

What is the management of labyrinthitis/vestibular neuronitis?

Answer 27

Vestibular sedatives (anti-histamine, anti-emetic)
Fluids
Rehab exercises