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ENT COPY > the dizzy patient > Flashcards

the dizzy patient Flashcards

1
Q

sdizziness is

A

extremely common but is an entirely non-specific term which includes vertigo, pre-syncope and disequilibrium

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2
Q

vertigo

A

is a sensation of movement where either the person is spinning or the environment around them is spinning

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3
Q

if a patient presents with true vertigo

A

then the cause is likely to be orogenic

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4
Q

if a patient does not have true vertigo

A

then the causes is unlikely to be orogenic

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5
Q

causes of dizziness

A
  • occular= diabetic retinopathy
  • cardiac= postural hypotension, vaso-vagal syncope, cardiac arrhythmias
  • joints= diabetes mellitus, osteoarthritis
  • cerebral= anxiety, migraines, space occupying lesions, multiple sclerosis
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6
Q

vestibular causes of true vertigo

A
  1. Benign Position Paroxysmal Vertigo (BPPV)
  2. Vestibular Neuritis and Labyrinthitis
  3. Menieres disease
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7
Q

clinical relevance of the vestibulo-occuarl reflex

A
  • vestibular pathologies cause nystagmus because if the vestibulo-occualr reflex is not functioning properly then changes in head movement cannot be fully compensated by an equal magnitude but opposite direction eye movement therefore, another eye movement has to occur to re-fixate the image on the macula called NYSTAGMUS
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8
Q

most non-vestibular pathologies

A

will not cause nystagmus

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9
Q

differential diagnosis of someone presenting with dizziness

A
  • postural hypotension, vasovagal syncope, cardiac arrhythmias, aortic stenosis
  • anaemia, hypoglycaemia, adrenal insufficiency
  • hyperventilations
  • head injury, epilepsy, MS, brain tumours
  • migraine
  • true vertigo caused by vestibular causes
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10
Q

history taking in a dizzy patient

A
  • what do they actually mean by dizziness
  • what triggered the dizziness
  • how long does it last
  • any associated tinnitus or hearing loss
  • does anything precipitate the dizziness
  • are they on any medication
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11
Q

examination of a dizzy patient

A
  • otoscope
  • neurological examination
  • blood pressure when lying down and then again standing up
  • balance system
  • audiometry
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12
Q

benign positional paroxysmal vertigo (BPPV) is

A

very common and is the most common cause of vertigo upon looking upgrades

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13
Q

cause of BPPV

A

otocania from the utricle displaces into the semicircular canals (most commonly the posterior semicircular canal), when the head is still the otocania is sitting in the bottom of the posterior semicircular canal but when the head moves the otocania gets carried with the endolymph movement and stimulates the hair cells which bombards the vestibular nerve, the extra nerve messages from the affected ear conflicts with the normal messages from the unaffected ear causing vertigo

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14
Q

causes of BPPV

A

most commonly is idiopathic but can occur post head trauma and after ear surgery

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15
Q

what can BPPV be confused with

A

vertebro-basial insufficiency however, vertebra-basial insufficiency would cause vertigo as well, as visual disturbances, weakness and numbness

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16
Q

symptoms of BPPV

A
  • vertigo which usually only lasts 20-30s and nerve over a minute
  • vertigo can occur when looking up, turning over in bed, lying down in bed, standing up from lying down , rising form bending, moving head forward
  • nausea
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17
Q

what never occurs in BPPV

A

tinnitus or hearing loss

18
Q

diagnosis of BPPV

A

DIX- HALLPIKE TEST; IF THEY HAVE BPPV THIS TEST WILL INDUCE VERTIGO AND NYSTAGMUS WILL BE SEEN (patient head is turned 45 degrees and they are rapidly lowered back until there head hangs of the end of the bed)

19
Q

treatment of BPPV

A

EPLEY MANOEUVRE which causes the otocania to fall back into the utricle

20
Q

after the employ manoeuvre patients should be advised

A

to not lie in completely fast

21
Q

if patient gets symptomatic again after the employe manoeuvre what can they carry out

A

bradt- darrof exercises

22
Q

vestibular neuronitis is

A

inflammation of the vestibular nerve

23
Q

labyrinthitis is

A

inflammation of the labyrinth of the inner ear

24
Q

vestibular neuritis and labyrinthitis are caused by

A

viral infections of the inner ear so there may be a prodromal viral illness

25
Q

vestibular neuronitis symptoms

A

prolonged vertigo which lasts for a few days but does NOT cause tinnitus or loss of hearing

26
Q

labyrinthitis symptoms

A

prolonged vertigo for a few days but can cause tinnitus and hearing loss

27
Q

management of vestibular neuritis and labyrinthitis

A

they are generally self-limiting but can causes severe nausea and vomiting so are managed symptomatically

  • buccal prochlorperazine is used to rapidly relive severe nausea or vomiting associated with vertigo
  • for less severe nausea/ vomiting and vertigo oral prochlorperazine or cinnarizine/ cyclizine
28
Q

advise the person to return if

A

symptoms do not resolve within a week

29
Q

if symptoms of vestibular neuritis/ labyrinthitis are persistent

A

refer patient for vestibular rehabilitation therapy

30
Q

menieres disease cause

A

is unknown and it is a diagnosis of exclusion

31
Q

diagnosis of menieress disease is based on the following occurring during the same episode

A
  • history of recurrent, spontaneous rotational vertigo with a least 2 episodes lasting longer than 20 minutes (in reality usually lasts a few hours)
  • tinnitus in the affected ear
  • aural fullness on the affected side
  • documented sensinoneural hearing loss on at least one occasion
  • all other causes excluded
32
Q

management of menieres disease

A
  • supportive treatment during episodes= buccal prochloperzine
  • tinnitus retraining therapy or hearing aids
  • salt restriction, beta histene, caffeine and alcohol and stress restriction to try prevent recurrence
  • grommet insertion
  • intra- tympanic gentamicin
  • surgery
33
Q

everyone with menieres disease must

A

inform the DVLA if they drive they might be able to be allowed to drive provided the condition does not cause severe and disabling vertigo

34
Q

intra-tympanic gentamicin work by

A

destroying the nerve ending that send signals of balance to the vestibular nerve (i.e. if you destroy vestibular nerve then its impossible to get the vertigo of menieres disease) however, only used if there is not a lot of hearing in the affected ear as it can cause permanent deafness

35
Q

surgery is considered last line for menieres disease

A
  • vestibular nerve section

- labyrinthectomy but completely destroys the inner ear so used as a very last resort

36
Q

what can mimic menieres disease

A

vestibular shwannoma

37
Q

vertigo cause by a migraine

A

around 35% of migraine sufferers have spontaneous attacks of vertigo and ataxia

38
Q

what is the main auditory symptom of migraines

A

photophobia

39
Q

motion sensitivity

A

with bouts of motion sickness occurs in about 2/3rds of patients with migraine

40
Q

diagnosing migrainous vertigo

A
  • episodic vestibular symptoms of at least moderate sensitivity (i.e. they impact every day activities but don’t impede them)
  • Migraine diagnosed according to the international headache society criteria
  • at least of of the following during at least 2 attacks migraine symptoms during vertigo, migraine specific precipitates of vertigo, response to anti-migraine drugs
  • other causes ruled out
41
Q

summary of the 4 vestibular causes

A
  • BPPV causes vertigo which lasts a few seconds does not cause aural fullness and does not cause tinnitus or hearing loss
  • Vestibular neuronitis cuases vertigo which lasts a few days, it does not cause aural fullness and does not cause tinnitus or hearing loss
  • labyrinthitis causes vertigo which lasts a few days, does not cause aural fullness and can cause hearing loss and tinnitus
  • menieres disease causes vertigo which lasts a few hours, it does cause aural fullness and does causing tinnitus and hearing loss

ENT COPY (12 decks)

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