The Dizzy Patient Flashcards
Define Vertigo
A sensation of movement, usually spinning
What are the 5 vestibular end organs
3 semi-circular canals:
Lateral, posterior and superior
2 otolith organs: utricle and saccule
What is the function of the utricle
It senses motion in the horizontal plane
What is the function of the saccule
It senses motion in the sagittal plane
What is the function of the semi-circular canals
They sense motion in an angular plane (head rotations)
What cochlear problems can result in an upset in the balance system
BPPV
Meniere’s
Vestibular neuronitis
What optic problems can result in an upset in the balance system
Cataracts
Diabetes Mellitus
What MSK problems can result in an upset in the balance system
Diabetes mellitus
Arthritis
Neurology
What cardiac problems can result in an upset in the balance system
Arrhythmias
postural hypotension
What neurological problems can result in an upset in the balance system
Stress
Migraine
SOL
MS
How can SCC be tested
Caloric tests
What is the supposed diagnosis if the vestibulo-ocular reflex is not working
Nystagmus
Where is the problem if the eye is pointing towards the left side of the nose nose
Right ear
What are some of the causes of Dizziness
Cardiovascular Haematogological and metabolic Drug side - effects / interactions Migraines otological trauma
What are some triggers of dizziness
Head movement
Sitting down or standing up
What are some possible associated symptoms with dizziness
Palpitations
fits
incontinence
What are some common alleviating factors
Eyes open or closed
What are some medications that can cause dizziness
Alcohol
Benzodiazipines
What examination should be carried out for dizziness
Otoscopy - usually normal and regular Neurological - nystagmus at rest --> SOL BP - lying and standing Balance system - stand up and close eyes and be prepared for falling Audiometry
What are the 3 common causes of dizziness
Postural dizziness
Side effect of medication
Psychogenic and interaction with imbalance
What are some underlying causes of postural dizziness
Hb, Na or BP lying and standing
What medication can cause dizziness
Medication for anxiety or depression
What are specific causes of dizziness
Miner's disease BPPV Vestibular neuronitis Labyrinthitis Migrainous vertigo
What is Meniere’s Disease
a disease of unknown cause affecting the membranous labyrinth of the ear, causing progressive deafness and attacks of tinnitus and vertigo
Benign paroxysmal positional vertigo (BPPV)
is a disorder arising in the inner ear.
What is the most common cause of vertigo
BPPV
What are some causes of BPPV
Head trauma, ear surgery, idiopathic
What is the pathophysiology of BPPV
Otolith material from utricle displaced into semicircular canals
What is BPPV sometimes confused for
Vertebrobasilar insufficiency (VBI)
How can we make a diagnosis of VBI
Other symptoms of impaired circulation in posterior brain associated with the vertigo
e.g. visual disturbance
Weakness
Numbness
What are some of the common phrases a patient with BPPV would come out with
Dizziness on: looking up turning in bed first lying down in bed at night first getting out of bed in the morning bending forward rising from bending moving head quickly
Is BPPV long lasting or brief episodes
Brief episodes
What can be done to help BPPV
Hallpike’s test
Epley Manoeuvre
Semont Manoeuvre
Brandt- Daroff Exercises
What is the purpose of the Epley Manoeuvre
To physically change the position of the calcium carbonate crystals within the SCC
What is Vestibular neuronitis
Prolonged vertigo (days) with no associated tinnitus or hearing loss
What is the underlying cause of vestibular neuritis
Inflammation of the vestibular nerve
What is Labyrinthitis
Prolonged vertigo (days) that may be associated with tinnitus or hearing loss
What is the main cause of labyrinths
Viral
What is the treatment for both vestibular neuronitis / labyrinthitis
Supportive management with vestibular sedatives
What are the main symptoms of Meniere’s disease
History of recurrent, spontaneous, rotational vertigo with t least 2 episodes >20 mins often lasting hours
Occurrence of or worsening of tinnitus on the affected side
occurrence of aural fulness on the affected side
What is the treatment for Meniere’s disease
supportive treatment during episodes tinnitus therapy hearing aids prevention: salt restriction, Betahistine, caffeine, alcohol, stress
What is the management for Meniere’s disease
Grommet insertion
Intratympanic Gentamicin / steroids
Surgery
What is the issue with using gentamicin
It can destroy the hair cells and result in hearing loss
What is the most common symptom of migraine
phonophobia (fear of loud sounds)
What condition causes Aural Fullness
Meniere’s disease
What condition causes a clear positional trigger
BPPV
What conditions cause associtted HL or tinnitus
Meniere’s disease and labyrinthitis