"The Dizzy Patient" Flashcards
Is meniere’s disease common?
No
Is benign positional paroxysmal vertigo common?
Yes (v common)
easily treated
What is “dizziness”?
non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc.
What is “vertigo”?
a sensation of movement, usually spinning
What is the name of the complex structure in the inner ear?
Labyrinth
Is all dizziness “vertigo”?
no
Is all dizziness otogenic?
no
What does BPPV stand for?
Benign Positional Paroxysmal Vertigo
BPPV, Meniere’s and Vestibular Neuronitis are issues due to what component of the balance system?
The inner ear
Diabetes Mellitus affects what components of the balance system?
The eye, the joints
Arrhythmias and postural hypotension affect what component of the balance system?
The heart
Stress, migraine, SOL and MS affect what components of the balance system?
The brain
What is the christa ampullaris?
The sensory organ of rotation
What is the name of the sensory organ of rotation?
The christa ampullaris
What is nystagmus?
rapid involuntary movements of the eyes
What is the word for rapid involuntary movements of the eyes?
Nystagmus
Is nystagmus observed in vestibular pathologies?
Yes
What is the commonest cause of vertigo on looking up?
Benign Positional Paroxysmal Vertigo
Name (3) causes of bening positional paroxysmal vertigo:
Head trauma
Ear surgery
Idiopathic
Pathophysiology of BPPV:
Otolith material from utricle displaced into semicircular canals. Most commonly in posterior SCC.
What insufficiency may BPPV be confused with?
May be confused with Vertebrobasilar insufficiency.
For a diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo:
e.g. visual disturbance
weakness
numbness
Benign Positional Paroxysmal Vertigo is vertigo on:
looking up
turning in bed - often worse to one side
first lying down in bed at night
on first getting out of bed in the morning
bending forward
rising from bending
moving head quickly – often only in one direction
Does BPPV have associated tinnitus or hearing loss?
No
What exercises are used for treatment of BPPV?
Brandt-Daroff Exercises
Which (2) manouvre’s are used to manage BPPV?
Epley Manoeuvre and Semont Manoeuvre
What does the Dix–Hallpike test/manoeuvre test for?
BPPV
What manouvevre is a diagnostic test for BPPV?
Hallpike’s Test
What hapens in the Dix-hallpike test?
Sit on couch so that head will be off end when lies back Turn head 45º to one side Warn patient not to close eyes if dizzy Lie back as quickly as comfortable Hold in position and observe Usually delay of approx. 30 seconds Classical nystagmus Test fatigues - much reduced or absent response on repetition Condition may be bilateral
What is the name of this test:
Sit on couch so that head will be off end when lies back Turn head 45º to one side Warn patient not to close eyes if dizzy Lie back as quickly as comfortable Hold in position and observe Usually delay of approx. 30 seconds Classical nystagmus Test fatigues - much reduced or absent response on repetition Condition may be bilateral
The Dix-hallpike test
What is the Brandt-daroff exercise?
Start in an upright, seated position.
Move into the lying position on one side with your nose pointed up at about a 45-degree angle.
Remain in this position for about 30 seconds (or until the vertigo subsides, whichever is longer). …
Repeat on the other side.
How do you do the Eppley Manoeuvre?
start sitting on a bed and turn your head 45° to the right.
Place a pillow behind you so that on lying back it will be under your shoulders. Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds. Turn your head 90° to the left (without raising it) and wait again for 30 seconds. Turn your body and head another 90° to the left and wait for another 30 seconds. Sit up on the left side.
Vestibular neuronitis:
4
Prolonged vertigo (days)
No associated tinnitus or hearing loss
Probable viral aetiology
May be viral prodromal symptoms
What is Labyrinthitis?
inflammation of the labyrinth or inner ear.
Management of labyrinthitis:
Supportive management with vestibular sedatives
Generally self-limiting
(if prolonged or atypical may require further investigation)
May be helped by rehabilitation exercises if prolonged
What is the cause of Meniere’s Disease?
Unknown
lol, trick question
Is meniere’s disease common?
No
50-200/100,000
History of Meniere’s Disease:
Recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
Occurrence of or worsening of tinnitus on the affected side
Occurrence of aural fullness on the affected side
Documented sensorineural hearing loss on at least one occasion
Other causes excluded
Management of Meniere’s disease:
Supportive treatment during episodes
Tinnitus therapy
Hearing Aids
Prevention
Grommet insertion/Meniette
Intratympanic Gentamicin/ Steroids
Surgery
What are the preventative measures agaisnt menieres disease?
Salt restriction Betahistine (used to ease symptoms) Caffeine Alcohol Stress
What does betahistine ease symptoms of?
Meniere’s disease
Does meniere’s disease cause hearing loss?
Yes
Migranous vertigo =
Episodic vestibular symptoms of at least moderate severity (interfere but not impede daily activities)
Migraine according to International Headache Society criteria
At least 1 of the following during at least 2 attacks:
Migrainous symptoms during vertigo, migraine-specific precipitants of vertigo, response to anti-migrainous drugs
Other causes ruled out
PROBABLE migrainous vertigo:
Episodic vestibular symptoms of at least moderate severity (interfere but not impede daily activities)
At least 1 of:
Migrainous headache, photophobia, phonophobia, visual or other aura
Other causes ruled out
BPPV lasts for:
minutes/hours/days-weeks
Minutes
Meniere’s disease lasts for:
minutes/hours/days-weeks
Hours
Labrinthitis lasts for:
minutes/hours/days-weeks
Days-Weeks
Vestibular Neuronitis lasts for:
minutes/hours/days-weeks
Days-weeks
Is there an associated hearing loss or tinnitus with BPPV?
No
Is there an associated hearing loss or tinnitus with Meniere’s Disease?
Yes
Is there an associated hearing loss or tinnitus with Labyrinthitis?
Yes
Is there an associated hearing loss or tinnitus with Vestibular Neuronitis?
No
Do patients get “aural fullness” with BPPV?
No
Do patients get “aural fullness” with Meniiere’s Disease?
Yes
Do patients get “aural fullness” with Labyrinthitis?
No
Do patients get “aural fullness” with vestibular neuronitis?
No
Does BPPV have a clear positional trigger?
Yes
Does Meniere’s have a clear positional trigger?
No
Does Labrynthitis have a clear positional trigger?
No
Does Vestibular neuronitis have a clear positional trigger?
No
