dizzy patient

Question 1

what is vertigo?

Answer 1

• a sensation of movement, usually spinning

- sometimes falling

Question 2

what is disequilibrium?

Answer 2

-problem with or poor balance

Question 3

what is pre-syncope?

Answer 3

light headedness before you faint

Question 4

what is important to ask if a patient presents with vertigo?

Answer 4

• Duration of episodes is key
• associated symptoms (hearing loss, tinnitus, aural pressure, migraines or sensory sensitivity, sound or pressure induced symptoms)

Question 5

what condition is associated with vertigo lasting seconds?

Answer 5

BPPV

Question 6

what condition is associated with vertigo lasting hours?

Answer 6

meniere’s

Question 7

what condition is associated with vertigo lasting days?

Answer 7

vestibular nephritis

Question 8

what is associated with variable vertigo?

Answer 8

migraines

Question 9

what are the vestibular end organs?

Answer 9

• lateral, posterior and superior semicircular canals (responsible for sensing rotation)
• maculae of utricle and saccule (horizontal and vertical motion/linear acceleration)

Question 10

what vestibular end organs are responsible for sensing rotation?

Answer 10

-superior, lateral and posterior semicircular canals

Question 11

what vestibular organs are responsible for sensing linear acceleration/ horizontal and vertical motion?

Answer 11

maculae of saccule and utricle

Question 12

explain the vetibulo-ocular reflex using the example of your head moving right and eyes moving left

Answer 12

focusing eyes on object in distance and move head to right hand side then your eyes will move to the left

because the fluid in the semicircular canals (horizontal) will deflect the capilla to the opposite direction

-excitation in the right semicircular canal and inhibition in the left semicircular canal

Question 13

what is the commonest cause of vertigo in adults?

Answer 13

BPPV

benign positional paroxysmal vertigo

Question 14

what causes BPPV (benign positional paroxysmal vertigo)?

Answer 14

• head trauma
• idiopathic
• ear surgery

-otoconia from utricle displaced into semi circular canal, most commonly in posterior semi circular canal

Question 15

what may a history of :

• dizzy rolling over in bed
• looking up
• first lay down in bed at night
• first get out of bed in morning
• rising up from gardening
• tilting head in shower
• moving head quickly

suggest?

Answer 15

BPPV (benign positional paroxysmal vertigo)

Question 16

what is the treatment for BPPV (benign positional paroxysmal vertigo)?

Answer 16

Reposition manouveres:

• Epley manœuvre
• Semont manouvere
• Brandt Daroff exercises

Question 17

what is the treatment for vestibular neuritis?

Answer 17

Supportive:
-anti nausea and vestibular sedatives (benzodiazepine)

Rule of 3s:

• in bed 3 days
• 3 weeks off work
• off balance for 3 months

May be helped by rehabilitation exercises if prolonged

Question 18

what is the diagnostic criteria for Manieres’?

Answer 18

Clinical:

• history of recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 minds (often lasting hours)
• new tinnitus (or worsening) on affected side
• aural fullness on affected side
• documented SNHL on at least one occasion

Audiogram:
-typically low frequency sensorineural hearing loss