The Dizzy Patient Flashcards
What is dizziness?
a non-specific term which may cover vertigo, pre-syncope,
What is vertigo?
a sensation of movement, usually spinning, usually in the horizontal plane
What semicircular canal is invovled in dizziness on a roundabout?
lateral (horizontal) canal
What are the organs involved in balance?
ear; eye; joints; heart; brain
Why would RA or OA affect balance?
joint receptors give information about where those joints are- proprioception- if RA or OA, these receptors could be affected
How could stress lead to vertigo?
if stressed and hperventilate
When does nystagmus occur?
when the semicircular canals are being stimulated while the head is not in motion- VOR is initiated
What does the direction of nystagmus depend on?
the canal being stimulated
What does nystagmus differentiate between in the causes of dizziness?
nystagmus will be observed in vestibular pathologies but not in non-vestibular
What are hte most common causes of diziness?
postural hypotension; side effect of medication and psychogenic
What are some associated symptoms of dizziness?
tinnitus; LOC; palpitations; incontinence
What is the commonest cause of vertigo on looking up?
benign positional paroxysmal vertigo
What are the causes of BPPV?
head trauma; ear surgery; idiopathic
What is the pathophysiology of BPPV?
otolith materal from utricle displaced into semicircular canals
What SCC is commonly affected in BPPV?
posterior
What may BPPV be confusedwith?
vertebrobasilar insufficienc
How can you differentiate between BPPV and vertebrobasilar insufficienct?
for VBI need other symptoms of impaired circulation in posterior brain eg visual disturbance; weakness; numbenss
When do patients wtih BPPV get vertigo?
always on movement- looking up; turning in bed; moving head quiccklly; bending forward etc
How long do BPPV episodes last?
seconds- minutes
What are the associated symptoms of BPPV?
none- no tinnitus; hearing loss or aural fullness
What is the diagnostic test for BPPV?
Hallpike’s test
How is Hallpike’s test carried out?
sit on couch so that head will be off one end when pt lies back, turn head 45 to one side- to the side you want to test; warn pt NOT to close eyes if dizzy; lie back as quickly as possible ; hold in position and observe
What is the limitation of Hallpike’s test?
only tests posterior and superior SCC- not the anterior
How long must you wait for Hallpike’s test?
at least 30 seconds
What does Hallpike’s test show?
Nystagmus
What is the limitation of the test?
test fatigues- much reduced or absent response on repition- so if fails first time cannot do for a while
What type of nystagmus does posterior SCC give?
torsional
What is the purpose of the Epley manoeuvre?
move patient into different positions, wait 30s in each to move the crystals out of the SCC
What is the Brandt-Daroff exercise?
similar idea to Epley manouevre but easier for patients who are very dizzy
How long does vestibular neuronitis last?
days- throwing up continously
What are the associated symptoms of vestibular neuronitis?
no associated tinnitus or hearing loss but may have other viral infection smptoms
What causes vestibular neuronitis?
virus
What is the difference between vestibular neuronitis and labyrinthitis?
labyrinthitis involves the whole labyrinth, not just the vestibular nerve so may have associated tinnitus or hearing loss
What is the treatment for vestibular neuronitis/ labyrinthitis?
supportive with vestibular sedatives- self-limitin
What is the pathophysiology of Menieres?
pressure of endolymph is greater than perilymph so perilymph is smaller- ?salt balance
What is seen on history of Menieres?
hx of recurrent, spontaneous, rotational vertigo with at least 2 eps >20 mins (often lasting hours0
worsening tinnitus on affected side
aural fullness on affected side
SNHL
What is the managemnt of menieres?
supportive; tinnitus therpay; hearing aids-pts will eventuall get HL; prevention- salt restriction (diuretics?); bethistine; caffeine; alcohol; stress; frommet insertion; intratympanic gent/steroids
What is important to do in the diagnosis of Menieres?
exclude other causes eg vestibular schwannoma- do MRI”
How does intratympanic gentamicin work in menieres?
poisons vestibular apparatus so dont get vertigo- will also destroy hearing
What is ataxia?
loss of control over body movements
What is the most common auditory symptom with migraine?
phonophobia
what other symptoms do pts with migraines get?
vertigo and ataxia and motion sickness
