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ENT > 2.2: Dizziness > Flashcards

2.2: Dizziness Flashcards

1
Q

What is dizziness?

A 
Vague term:
Covers 
- Vertigo
- Pre-syncope
- Blackouts
- Lightheadedness
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2
Q

What is vertigo?

A

This is the sensation of movement - usually spinning. Feels like the person or the room is spinning

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3
Q

Describe the effect of lesions in the brain on the eyes and balance?

A

The vestibular pathways involve the eyes, the inner ear and the brain. Lesions along these pathways can affect the ear movements and balance.

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4
Q

What affects balance system:

- Semi-circular canals?

A

BPPV
Meniere’s
Vascular Neuronitis

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5
Q

What affects balance

- Eyes?

A

Diabetes

Cataracts

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6
Q

What affects balance

- Joints?

A

Arthritis
Diabetes
Neurology

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7
Q

What affects balance

- Heart?

A

Arrythmia

Postural Hypotension

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8
Q

What affects balance

- Brain?

A

Stress
Migraine
Space Occuping Lesions
MS

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9
Q

Describe the vestibule-ocular reflex?

A

This is important for keeping your eyes fixed on something

If you turn your head, a compensatory response occurs to ensure your keep focused on the object

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10
Q

Describe the rate of firing in the vestibulo-ocular reflex?

A

The side you turn away from is inhibited

The side you turn to is stimulated

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11
Q

Clinical relevance of the vestibulo-ocular reflex?

Fast and slow =?

A

If there is a vestibular pathology, you will see a NYSTAGMUS
The direction of the nystagmus depends on the involved structures
If there is a fast and slow phase it is most likely to be peripheral
If there is no fast and slow phase it is most likely to be central

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12
Q

How common is dizziness?

A

Most common presentation to GP of those over 74

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13
Q

Give some causes of dizziness?

A 
Cardiology - arrythmia
Haematological - anemia
Anxiety
Neurological conditions
Drug side effects
Migraine
Otological (Ear)
Trauma
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14
Q

What should you ask in the history?

A 
Triggers?
Time Course?
Associated symptoms?
Precipitating factors
Alleviating symptoms
Medications?
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15
Q

What does a nystagmus at rest suggest?

A

Space Occupying Lesion

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16
Q

Why is it hard to do standing/lying BP?

A

In the time taken to do a standing BP, the BP will have returned to normal even if they have postural hypotension

17
Q

Commonest causes of dizziness?

A

Postural Dizziness
Side Effect of Medication
Psychogenic and Balance Interaction

18
Q

What is BPPV?

  • What
  • Causes?
  • Associated symptoms?
A

Benign Paroxysmal Positional Vertigo
This is when certain movement causes dizziness
Causes can include trauma and head injury although majority are idiopathic
No associated symptoms

19
Q

Give a classic presentation of BPPV?

A

When someone rolls over in bed, they become very dizzy. This lasts for approx. 1 minute and resolves

20
Q

Describe the physiology/anatomy behind BPPV?

A

In the semi-circular canals there are little pieces of material called Otoliths. These become dislodged and float around the SCCs. When the head is turned, the material moves and stimulates the ampulla causing vertigo
Most common in the posterior SCC

21
Q

Describe the signs of BPPV?

A

Classic Nystagmus

22
Q

List some occasions when BPPV occurs?

A 
Rolling over in bed
Getting out of bed
Lying down in bed
Bending forward
Rising from bending
23
Q

Describe a test for BPPV?

  • Limitations?
  • What must you make sure?
A 
Hallpike's Test
Get patient to lie with their head off the couch
Turn head to side you want to test
Keep eyes open
Look for classic nystagmus

Can fatigue - doesn’t work again without a break
Must keep eyes open

This classic nystagmus is diagnostic

24
Q

Describe a treatment for BPPV done in clinic?

  • Effectiveness?
  • Follow up?
A 
Epley Manoeuvre 
- Lay patient on back
- Turn head towards affected side
- Turn head away from affected side
- Roll body towards floor
- Sit up
Hold each position for 30 seconds
Tap on mastoid

Effective in most patients
Need to sleep propped up for a few nights

25
Q

Describe a BPPV treatment done at home?

A 
Brandt-Daroff Exercise
- Sit on bed
- Fall to one side
- Fall to other side
- Sit back up
Easily done by patients
26
Q

What is vestibular neuronitis?

  • What?
  • Cause?
  • associated symptoms?

Describe the course of an attack

A

This is prolonged vertigo over a number of days
Cause is likely viral aetiology
No associated symptoms

Patient feels under the weather, flu like symptoms for days beforehand
Room begins to spin
Very intense dizziness with vomiting too
Self resolving

27
Q

What is Labyrinthitis?

  • What?
  • Cause
  • Associated Symptoms?
A

This is prolonged vertigo over a number of days
Cause is likely viral aetiology
There may be associated symptoms such a tinnitus or hearing loss

28
Q

Treatment for vestibular neuronitis or labrynthitis?

A

Both are self limiting

Give some drugs for dizziness or vomiting e.g.: Cyclizine

29
Q

What is Meniere’s Disease?

Criteria?

A

This is a rare disease of unknown cause
There is thought to be endolymphathic space enlargement

Criteria:
History of recurrent, spontaneous vertigo with at least two episodes lasting greater than 20 minutes
Occuring/worsening of tinnuitis
Aural fullness
Severe dizziness, vomiting
30
Q

Describe an attack in Meniere’s disease?

Lasting damage?

A

Patient knows its coming - increased tinnitus, pressure in the ear, decreased hearing

Causes vertigo

With each attack, hearing is decreased

31
Q

Treatment of Meniere’s?

A 
Supportive
Cyclizine to support during episodes
Beta-histine used to prevent attack
Limit intake of salt, caffeine and alcohol
Hearing aid for tinnitus

Grommet and Meniette
Intratympanic gentamycin

32
Q

Migraine and vertigo?

A

25% of migraine suffers also get vertigo

Other symptoms include photophobia and hearing loss (permanent or temporary)

ENT (17 decks)

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