Funny turn - dizziness

Question 1

Differentials

Answer 1

BPPV
Stroke/TIA
Meniere’s disease

Vestibular neuritis
Labrynthitis
Vestibular migraine

Question 2

Causes of vertigo

Answer 2

Central:

• Stroke/TIA
• Migraine
• Acoustic neuroma

Peripheral:

• BPPV
• Vestibular neuritis
• Meniere’s disease
• Ototoxicity e.g. gentamicin
• Infections e.g. viral labyrinthitis

Question 3

Symptoms to ask in HPC

Answer 3

Explore the vertigo, when, how often, how quickly did it come on? etc…

Any weakness of the limbs or face or difficulty speaking?

Any hearing loss?
Any tinnitus? (Ringing in ears?)

Any headache?

Otherwise well? Any recent illnesses? (Vestibular neuritis and labyrinthitis - Usually follows a viral URTI.)

Question 4

Examinations

Answer 4

Cranial nerve examination
Hearing assessment (Rinne’s and Weber’s)
Otoscopy

Question 5

Investigations for BPPV

Answer 5

Dix-Hallpike manoeuvre for BPPV

Positive if see nystagmus (within 20-30s usually)

Explain it is important to keep eyes open

Do twice with head to both sides

Question 6

Treatment for BPPV

Answer 6

Epley manoeuvre

Rotate the head 90 degrees and hold head while patient sits up and then they keep chin to chest for a bit