Week 9- Dizziness and Vertigo

Question 1

What are the main categories of Dizziness?

Answer 1

1. vertigo0 false sense of motion, possibly spinning sensation
2. Disequilibrium- Off-balance or wobbly
3. Presyncope- Feeling of losing consciousness or blacking out
4. Lightheadedness- vague symptoms, possible feeling disconnected with the environment

Question 2

What are some vestibular causes of dizziness>
Other causes?
When assessing a patient with dizziness you should con side?

Answer 2

Dizziness
Vestibular causes of dizziness can be;
1. Peripheral – lesions that affect the labyrinths or vestibular nerves 2. Central – central vestibular pathways
Other causes of dizziness o Non-vestibular imbalance -
o Gait disorders o Anxiety
When assessing a patient with dizziness you should consider;
1. Is it dangerous? – arrhythmia, TIA, or stroke 2. Is it vestibular?
3. If it is vestibular, is it peripheral or central?
The history and examination should answer these questions.

Question 3

Taking a history for Dizziness
The history should focus on?
8 n9

Answer 3

Physical symptoms depends on: if -lesion is unilateral or bilateral

• acute/ chronic
• whether it is progressive

Vertigo- Indicates an asymmetrical vestibular input from the two labyrinths or in
their central pathways. It is usually acute

History should focus on?

• whether the dizziness is paroxysmal (a sudden attack that occurs repetitively)
• the duration of each episode
• any provoking factors
• any accompanying symptoms

Question 4

History
Common causes of intermediate (minutes) dizziness are?
Common causes of long (hours) dizziness are

How can symptoms that accompany vertigo help to distinguish peripheral from central lesions?
10

Look at symptoms of central and peripheral vertigo pg 11

Answer 4

o Common causes of intermediate (minutes) dizziness are;
• TIA
• Migraines
• Cervicogenic aetiology
o Common causes of long (hours) dizziness are; • Migraines
• Meniere’s disease
o Symptoms that accompany vertigo can help to distinguish peripheral from
central lesions
• Unilateral hearing loss and other aural symptoms (ear pain, pressure, fullness) usually indicate a peripheral cause
• The auditory pathways become bilateral upon entering the brainstem so central lesions are unlikely to cause unilateral hearing loss
• Double vision, numbness and limb ataxia suggest a brainstem or cerebellar lesion

Question 5

Dizziness Examination

Answer 5

o Particular focus should be given to;
• Vestibular function
o Dynamic visual acuity – a drop in visual acuity during head motion of more than one line is abnormal on the Snellen Chart. Measure with head still then again as examiner rotates head back and forth (1-2Hz). 120 degrees per second, 20 seconds.
o Also computer version. • Hearing
o When a vestibular cause is suspected audiometry should be done
o Unilateral sensorineural hearing loss supports a peripheral disorder
o All patients with episodic dizziness should be tested with the Dix-hallpike maneuver.

Question 6

Tell me about acute prolonged vertigo

Answer 6

o An acute unilateral vestibular lesion causes constant vertigo, nausea,
vomiting oscillopsia (motion of the visual scene) and imbalance.
o These are due to a sudden asymmetry of inputs from the two labyrinths or in the their central connections. It simulates a continuous rotation of the head. The vertigo continues even after the head is not moving. In BPPV the vertigo stops once the head stops moving.
o When a patient presents with an acute vestibular syndrome, the most important question is;
• Is the lesion central?
o It may be life-threatening
o Dyplopia
o Weakness
o Numbness
o Dysarthria
• Is the lesion peripheral?
o Affecting the vestibular nerve or labyrinth.

-if head impulse test is normal- acute vetib lesion unlikely,

Question 7

Tell me about Bening paroxysmal positional vertigo

Answer 7

o BPPV is a common cause or recurrent vertigo
o Episodes are;
• Brief lasting from <1 min to 15-20 min
• Always provoked by changes in head position relative to gravity
o The attacks are cause by free-floating otoconia (calcium carbonate crystals) that have been dislodged and moved into the semi circular canals. (usually the posterior canal)
o When the head moves, gravity causes the otoconia to move and this causes vertigo and nystagmus.
o Otoconia in the posterior canal results in the nystagmus beating upwards and torsionally (the upper poles of the eyes beat toward the affected ear)
o Otoconia in the horizontal canal results in horizontal nystagmus when the patient is lying with either eye down. (this not as common as the posterior canal)
o BPPV is treated using maneuvers that use gravity to remove the otoconia from the semi circular canals. Epley maneuver is the most common (this is very similar to the Dix Hallpike test.

Question 8

Look at table on slide 19 to differentiate what kind of dizziness.
And treatment for cervicogenic dizziness slide 20

Answer 8

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