18 - Dizzy Older Ps

Question 1

What is dizziness?

Answer 1

Question 2

What is vertigo?

Answer 2

False sensation of movement - esp spinning

Question 3

What is pre-syncope?

Answer 3

Prodrome of syncope - nausea, sweating, pallor

Question 4

What are the three inputs into balance?

Answer 4

Vestibular (from inner ear) - fast
Proprioceptive (peripheral nerves) - fast
Visual - slow

Question 5

Which parts of the brain are involved in balance?

Answer 5

Brain-stem vestibular nuclei
Cerebellum

+ Cerebrum can override

Question 6

Answer 6

Question 7

What does the utricular macula do?

Answer 7

Allows a person to perceive changes in longitudinal acceleration (in horizontal directions only). The macula of the utricle is in a horizontal position and detects horizontal acceleration.

Question 8

Answer 8

Question 9

What happens to our balance pathways as we age?

Answer 9

Question 10

What defects of age can affect sight?

Answer 10

Presbyopia (long-sightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age).

Cataracts

Question 11

What happens to our vestibular system as we age?

Answer 11

Hair cell loss
Neuronal loss

Question 12

What happens to the somatosensory system as we age?

Answer 12

Neuropathy

Question 13

What Qs can you ask a dizzy P in a Hx?

Answer 13

Question 14

What examinations should you do on a dizzy P?

Answer 14

Neurological exam
Neuro-ontological exam (hearing, Dix-Hallpick, HINTS)
CVS exam

Question 15

What is the most common cause of dizziness?

Answer 15

Peripheral vestibular dysfunction (Menier’s, benign paroxysmal positional vertigo, neuritis/labyrinthitis

Then - migraine or CVD

Question 16

What can cause pre-syncope?

Answer 16

Heart - stenosis, HCM, dysrhythmia

Autonomic - VV

Volume depletion (dehydration)

Vasodilation (Sepsis)

Drugs

Situational

Steal syndrome - blood diverted from where it should be

Question 17

What exam should you always do for pre syncope?

Answer 17

SLBP

Also - can do ECG, Echo, Ambulatory monitoring and Tilt test

Question 18

What can cause acute vertigo?

Answer 18

Stroke
Labyrinthitis
Vestibular neuritis
Migraine

Question 19

What can cause chronic vertigo?

Answer 19

BPPV
Meniere’s
Migraine
Stroke
Small vessel CVD
Cerebellar Sx

Question 20

What causes benign paroxysmal positional vertigo?

Answer 20

Thought to be small particles of otoconia trapped in the semi-circular canals

Question 21

What are the Sx of BPPV?

Answer 21

Paroxysms of vertigo and N&V - induced by head movements.

Vertigo settles with complete stillness

Nystagmus often seen

Question 22

Which test is diagnostic for BPPV?

Answer 22

Dix-Hallpike manoeuvre

Question 23

Which manoeuvre is usually effective in Rx BPPV?

Answer 23

Epley manoeuvre
head movements to get crystals out of the canal

Question 24

What are the Sx of Menier’s disease?

Answer 24

Triad
Vertigo + Tinnitus + Sensorineural hearing loss

Vertigo lasts between 20mins - 12 hours, worsened but not brought on by head movements.

Feeling of fullness in the ear.

Question 25

What is thought to cause Menier's disease?

Answer 25

Increased volume and pressure of endolymph

Question 26

What is the cause of labyrinthitis and vestibular neuritis?

Answer 26

Often associated with viral infection - e.g. URTI

Question 27

What are the Sx of labyrinthitis and vestibular neuritis?

Answer 27

Vertigo +/- Tinnitus Worsened but not precipitated by head movement Sx generally subside spontaneously after a few weeks

Question 28

What is the management for labyrinthitis and vestibular neuritis?

Answer 28

Symptomatic Rx only

Question 29

What is a vestibular migraine?

Answer 29

One that presents with vertigo & often marked sensitivity to movement

Question 30

What causes peripheral vertigo?

Answer 30

Vestibular dysfunction

Question 31

What causes central vertigo?

Answer 31

CNS pathology

Question 32

Which syndrome with vertigo only presents in the elderly?

Answer 32

Multisensory dysequilibrium

Question 33

What are the Sx of multisensory dysequilibrium?

Answer 33

Multiple defects - visual, proprioception, motor Loss of balance without consistent vertigo Gait usually abnormal Falls common Thought to be associated with DM and small vessel cerebrovascular disease

Question 34

What exercise based Rx can be used to improve vertigo?

Answer 34

Vestibular rehabilitation

Question 35

Which drugs are given for acute vertigo?

Answer 35

Anti-histamines (cyclizine) Neuroepileptics (prochlorperazine) Anti-emetics (metoclopramide, ondansetron) Anti-migraine drugs