Ears - Dizziness Flashcards
What does ‘dizziness’ encompass (5)
Vertigo Disequilibrium Light-headedness Ataxia Diplopia
3 types of dizziness
Central
CV
Peripheral
What is central dizziness caused by
Vestibular nuclei/BS upwards
Typical PS central dizziness
Pt >60
Moment of disequilibrium + veering to one side
Ataxia
Gradual loss of balance
Causes of central dizziness (4)
SOL
Post trauma
Degenerative - MS
Intoxication
PS of CV dizziness (5)
Feeling faint/weak at the knees <60 y/o Syncope Light headed Fainting
Causes of CV dizziness (6)
HTN Postural HoTN arrhythmias Vasovagal Hyperventilation Dx
Peripheral dizziness is caused by
Labrythine or vestibular nn
PS peripheral dizziness
Sudden eps of vertigo
N+V
HL
Tinnitus
causes of peripheral dizziness (4)
BPPV (s)
Menieres (min/hr)
Vestibular migraine - min/hrs
Vestibular neuronitis - days
Vertigo
Hallucination of movement, world spinning on your movement
BPPV
Episodic vertigo when head is moved in certain directions (e.g. moving head in bed)
BPPV timescale
s-mins
Cause of BPPV
Otoliths getting caught in ant SC canals
Diagnosis BPPV
Dix-Hallpike manouvre
Outcome Dix-hallpike manouvre BPPV
Nystagmus observed, rotating towards affected ear
Mx BPPV (3)
Epley maneuver (may req several goes) Avoid sedatives rarely --> surgery
When can a vestibular migraine occur?
Before, during or after a migraine
How long does vestibular migraines typically last
15-20mins
PS basilar migraines
HL + Tinnitus
Menieres and driving
Can’t drive once diagnosed
Triad of Sx Menieres disease
Vertigo attacks (10min-24h)
Tinnitus
Fluctuating SNHL
Other Sx Meniere’s disease
Aural fullness
Are Meniere’s attacks mainly unilateral or bilateral
Unilateral
Tx Menier’es (4)
Vestibular sedative
L term - B histamine
Avoid caffiene/salt
reassure + psycho support
Last resort Tx Meniere’s
gentamicin (ototoxicity)
What is vestibular neuronitis
Inflammation of the vestibular part of CN8
Sx vestibular neuronitis
Vertigo lasting several days
NO hearing loss
Mx vestibular neuronitis
Prochlorperazine (acute)
Vestibular rehab + sedatives
Sx vestibular labyrinthitis
Vertigo
HL/Tinnitus
Do you describe nystagmus in the direction of the slow or fast phase>
fast phase
PS of nystagmus - peripheral issues
Horizontal/rotation nystagmus
PS of nystagmus - central issues
Vertical nystagmus
PS of nystagmus - destruction of labyrinthe
Nystagmus away from damaged ear
PS of nystagmus - irritative lesion
Towards affected ear
PS of nystagmus - cerebellar lesion
Ipsilateral side
