The dizzy patient Flashcards
What can cause dizziness?
CV system Haematological and metabolic Anxiety Neurological conditions Drug side-effects/ interactions Migraine Otological Trauma
What is dizziness?
A non-specific term which covers vertigo, presyncope, disequilibrium etc
What is vertigo?
A sensation of movement, usually spinning or falling
What vestibular problems can cause dizziness?
BPPV
Meniere’s
Vestibular neuronitis
What visual problems can cause dizziness?
Cataracts
DM
What proprioceptive problems can cause dizziness?
DM
Arthritis
Neurology
What cardiovascular problems can cause dizziness?
Arrhythmias
Postural hypotension
What central pathways can cause dizziness?
Stress
Migraine
SOL - space occupying lesion
MS
What would point to a cardiac cause of dizziness in the history?
Lightheadedness
Syncope
Palpitations
What would point to a neurological cause of dizziness in the history?
Blackouts Visual disturbance Paraesthesia Weakness Speech and swallow problems
Why is the duration of vertigo cruital in history taking for a diagnosis?
Seconds - benign positional paroxysmal vertigo
Minutes/hours - meniere’s
Days - vestibular neuritis
Variable - migraine associated vertigo
What are common signs of meniere’s disease?
Vertigo for mins/hours
Hearing loss
Tinnitus
Aural pressure - inner ear problem causing SNHL
What would point to a migraine cause of vertigo?
Smell or vision triggers
Closing eyes makes it better
Photophobia
What are good questions to ask in a dizzy history?
Do you get dizzy rolling over in bed? BPPV
Was your first attack severe, lasting hours with assoc N+V? Vestibular neuritis
Are you light-sensitive during the spells? Vestibular migraine
Do you feel one ear full or do you get hearing loss before or during the spell? Meniere’s
What should be included in an examination of a dizzy patient?
Otoscopy Neurological BP lying and standing Balance system Audiometry
What would stem an urgent referral to an ENT surgeon upon examination of the ears of a dizzy patient?
Acute otitis media
Cholesteatoma
What does the fast phase of a nystagmus tell you?
The affected ear - the fast phase is away from the affected ear
What is bi-directional nystagmus pathognomonic of?
Central MS plaque
What does a vertical nystagmus tell you?
Central lesion - commonly a stroke
What can cause BPPV and what is the pathophysiology of it?
Causes: head trauma, ear surgery, idiopathic
Pathophysiology: otolith material from utricle displaced into the posterior semicircular canal
What other condition can benign positional paroxysmal vertigo be confused with?
Vertebrobasilar insufficiency
For a diagnosis of VBI, need other symptoms of impaired circulation in the posterior brain such as visual disturbance, weakness and numbness
What commonly triggers vertigo in BPPV?
Looking up
Turning in bed
Upon first lying down at night and on first getting out of bed in the morning
Bending forwards
Rising from bending
Moving head quickly - often only in one direction
How can BPPV be diagnosed?
Sit up with eyes open
Lie down rather quickly
Look for a short delay and then symptoms of vertigo and vertical nystagmus with twisting
Feel dizzy and sick
How can BPPV be treated?
Epley manoeuvre
Semont manoeuvre
Brandt-daroff exercises
