The Dizzy Patient Flashcards
What is the difference between dizziness and vertigo?
Non-specific term which may cover vertigo, pre-syncope etc but vertigo is a sensation of movement (usually spinning- either them or the room)
Is meniere’s disease common?
no
Can vertigo be vertical?
yes
What is vertigo ussually associated with?
Ear pathology
What is the function of semi-circular canal?
Sensation of rotational movements
What affects balance?
Ears (vestibulocochlear nerve, semi-circular canals etc) , eyesight, arthritis (joint sensation), heart problems (e.g. reduced perfusion of brain and low blood pressure), neurological problems (stress, hyperventilation, migraines)
Explain the vestibulo-ocular reflex
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What can go wrong with the vestibulo-ocular reflex?
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What is nystagmus?
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What is the usual pathology in nystagmus?
Left to right
When will nystagmus be observed?
Vestibular pathologies
Will non-vestibular pathologies cause nystagmus?
No
What is the most common cause of presentation to primary care in people over 74?
Dizziness
What do you want to ask about when present with dizziness?
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What examinations would you do on a dizzy patient?
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How will patients with depression present with dizziness?
non-specific
What is BPPV?
Benign positional paroxysmal vertigo -
Otolith material from the utricle (calcium carbonate crystals that attach to the hair follicles) have been displaced to the semi-circular canals (most commonly the posterior)
Is BPPV common?
Yes
What is a symptom of BPPV?
Brief vertigo on turning head in bed, leaning backwards or fowards.
What are the causes of BPPV?
head trauma, ear surgery or idiopathic
What can BPPV be confused with?
vertebrobasilar insufficiency
What is the difference between BPPV and vertebrobasilar insufficiency?
VBI will have other symptoms of impaired circulation in the posterior brain ass with the vertigo such as visual disturbance, weakness and numbness (as is a neurological problem)
Is tinnitus or hearing loss associated with BPPV?
no
What test can you carry out to confirm BPPV?
Explain
Hallpike’s test - the patient is seated so their head will be off end of couch when lie back, turn head 45 degrees to one side, warn patient not to close eyes if dizzy, lie back quickly and observe for nystagmus.
Can this test be repeated?
It loses effect quickly so may not get another positive reading
If no movement seen after 30seconds of the Hallpike’s test should you move on?
No - as there is the possibility of a positive result even up to a minute after leaning back.
When would the hallpike test be less effective?
On repetition and if the crystals are in the lateral or superior SCC.
What is the Epley Manoeuvre?
this is a series of movements of the head that attempt to move the otolith crystals back to the utricle.
What is the Brandt-Daroff exercise?
This is an easy exercised for patients to do at home that is almost as effective as the epley manoeuvre.
What are the symptoms of vestibular neuronitis?
prolonged vertigo (days)
no associated tinnitus or hearing loss
May have viral symptoms
What is the most common cause of vestibular neuronitis?
Viral infection
What are the symptoms of labyrinthitis?
Prolonged vertigo (days) with associated tinnutis and/or hearing loss. May have viral symptoms too
What is the most likely cause of labyrinthitis?
Viral infection
What is the treatment for vestibular neuronitis/labyrinthitis?
Supportive management as it is usually self-limiting.
Vestibular sedatives e.g. clyclizine can reduce nausea.
If prolonged then may required further investigations and if damage is done then rehab can be considered to re-train the brain to compensate and improve balance
What is the cause of Meniere’s disease?
Unknown cause
What are the symptoms of Meniere’s disease?
Recurrent and spontaneous episodes of rotational vertigo with at least two episodes lasting longer than 20mins (often hours)
Tinnitus
Aural fullness
Sensorineural hearing loss
How is Meniere’s diagnosed?
Is usually a case of diagnosis by exclusion
What should always be excluded when considering the diagnosis of Meniere’s?
A vestibular schwannoma
How is Meniere’s treated?
Supportive treatment during episodes, tinnitus therapy, hearing aids, and prevention with salt restriction and avoidance of caffeine, alcohol and stress
What are more advanced management techniques for Meniere’s?
- Grommet insertion
- Intratympanic gentamicin
- Surgery
How does grommet insertion help Meniere’s?
acts as a form of micropressure therapy to reduce pressure within the ear.
What is a side effect of gentamicin injections intratympanically?
does not stop hearing loss
What percentage of migraine sufferers experience attacks of vertigo and ataxia?
25%
What is a common side effect of migrain?
Phonophobia - fear of loud noises
Motion sensitivity
What are the requirements for a diagnosis of definite migrainous vertigo?
Migrainous symptoms during vertigo, migrai-specific precipitant of vertigo and response to anti-migrainous drugs (1 of these on at least 2 accounts) and other causes ruled out.
What are the requirements for a diagnosis of probable migrainous vertigo?
At least one of: migrainous headache photophobia phonophobia visual or other aura disturbances And other causes ruled out
