The Dizzy Patient Flashcards
What is the most common reason for presenting to the GP in patients over 74?
Dizziness
What are some underlying aetiologies that cause dizziness?
CV system, haematological and metabolic, drug side effect, neurological conditions, migraine, otological, trauma
What does dizziness describe?
Non-specific term which may cover a number of conditions
What is vertigo?
Sensation of movement, usually spinning
What are some pathologies affecting the vestibular and cardiovascular systems that may cause dizziness?
Vestibular = BPPV, Meniere's, vestibular neuritis CV = arrhythmias, postural hypotension
What are some conditions that affect the proprioceptive and visual pathways to cause dizziness?
Visual = diabetes, cataracts Proprioceptive = diabetes, arthritis, neurology
What conditions may cause dizziness by affecting the vestibulospinal tract and vestibulo-ocular reflex?
Stress, migraine, SOL, MS
What must you differentiate between in the history?
Whether the underlying pathology is cardiovascular, neurological or vestibular
What associated symptoms would indicate that dizziness is being cause be a cardiovascular problem?
Lightheadedness, syncope, palpitations
What associated symptoms would suggest that a neurological problem is causing dizziness?
Blackouts, visual disturbances, paraesthesia, weakness, speech and swallow problem
What symptom occurring alongside dizziness would suggest that the underlying cause is a vestibular issue?
Vertigo = sensation of motion (falling, spinning, being pushed)
What are some important things to ascertain in the history of a patient with dizziness?
Triggers, time course, associated symptoms, precipitators, alleviating factors, medication
What is the key to diagnosing vertigo?
Duration of attacks = seconds is BPPV, hours is Meniere’s, days is vestibular neuritis variable would be migraine-associated vertigo
What are some common associated symptoms of dizziness?
Hearing loss, tinnitus, pressure, migraines or sensory sensitivity, sound/pressure induced symptoms
What are some top questions that narrow down the list of differentials?
Do you get dizzy rolling over in bed? = BPPV
Was your first attack severe, lasting hours with nausea and vomiting? = vestibular neuritis
Do you get light sensitive during episodes? = vestibular neuritis
Does one ear feel full, or do you get hearing loss before/during the dizzy spell? = Meniere’s
What would be examined in a dizzy patient?
Otoscopy, neurological exam, blood pressure (including lying/standing), balance system, audiometry
What are the vestibular end organs?
Ampullae of lateral/posterior/superior semi-circular canals, maculae of utricle and saccule
What are common causes of nystagmus?
Postural dizziness, side effect of medication, psychogenic and interaction with imbalance
What is the most common cause of vertigo when looking up?
Benign positional paroxysmal vertigo (BPPV)
What are some causes of BPPV?
Idiopathic, head trauma, ear surgery
What is the underlying pathology of BPPV?
Otolith material from utricle is displaced into semi-circular canals (most commonly posterior canal)
What is BPPV often confused with?
Vertebrobasilar insufficiency
What is needed to diagnose vertebrobasilar insufficiency?
Other symptoms of impaired circulation in posterior brain associated with the vertigo = weakness, visual disturbances, numbness
What movements trigger vertigo in a patient with BPPV?
Looking up , turning in bed (worse on one side), when first lying down/getting out of bed, bending forward, rising from bending, moving head quickly (often in one direction)
