Dizzy Patient Flashcards
Define vertigo
Sensation of movement usually spinning
What symptoms would indicate a cardiac cause of dizziness?
Lightheadedness, syncope, palpitations
What symptoms would indicate a neurological cause of dizziness?
Blackouts, visual disturbance, tingling, weakness
If the dizziness lasts seconds what is the likely cause?
Benign positional paroxysmal vertigo
If the dizziness lasts hours what is the likely cause?
Menieres
If the dizziness lasts days what are two possible causes?
Vestibular Neuritits
Labyrinthitis
Describe the symptoms of menieres
hearing loss, tinnitus, aural pressure
What symptoms can be associated with vestibular neuritis?
Nausea and vomitting
What is the commonest cause of vertigo?
BPPV
What causes BPPV?
Head trauma, ear surgery, idiopathic
Describe the pathology of BPPV
Otoconia from the utricle becomes displaced into the semicircular ducts - most commonly the posterior semicircular canal
When does vertigo in BPPV often occur?
Looking up Turning in bed Lying down at night Getting up in the morning Bending/rising Moving head quickly
What is the test used to diagnose BPPV?
Dix Hallpike test
Sit up on couch with eyes open, turn head 45 degrees and slowly lower down
What characteristics of BPPV will be seen in the dix hall pike test?
Symptomatic, nystagmus, vertical/torsional geotropic
Name three methods of treatment for BPPV
- Epley manoeuvre
- Semout manoeuvre
- Brandt-Daroff
Describe the epley manoeuvre
- Patient lies on couch with affected ear towards floor
- Head is rotated 90 degrees to the other side
- Then a further 90 degrees by getting the patient to run onto their side with head facing the floor
- With their chin to their chest the patient is brought back to sitting position
What is the cause of menieres?
Unknown
Describe the pathology of menieres
Endolymphatic hydrops - endolymph tube swells and increased pressure leads to rupture
How will a patient with menieres present?
History of recurrent, spontaneous rotational vertigo with at least two episodes of >20 mins (usually hours).
Tinnitus, aural fullness and hearing loss
How is menieres managed?
Supportive, tinnitus therapy, hearing aids and prevention of aggravating factors
What medication can help menieres disease?
Gentamicin and steroids
Describe the presentation of vertigo associated with migraines
Phonophobia, fluctuating/acute hearing loss (small percentage)
How are vertigo related migraines treated?
Avoid triggers - caffeine, chocolate, citrus fruit
Pharmacological management - abortive (triptans) or prophylactic (propranolol, amitriptyline)
What might a vertical nystagmus indicate?
A problem in the brain stem
