Is dizziness the same as vertigo?
Dizziness is the patient's word for how they feel
Vertigo is the sensation of spinning
When a patient says they're dizzy, what might they mean?
What is vertigo?
Sensation of spinning
Vertigo has a good chance of being related to which organ?
Which structures do the vestibular nerves supply?
Which vestibular structures detect
a) head movements
b) horizontal motion
c) vertical motion?
a) Semicircular canals
What systems control balance?
What eye conditions upset balance?
Anything causing vision loss (cataracts, diabetic retinopathy, glaucoma, macular degeneration...)
What diseases can affect joint sensation, which itself affects balance?
Which cardio conditions affect balance?
What brain disorders can cause balance problems?
What is the vestibulocular reflex?
Ability to keep focused on an object when your head is moving
What are the sensory organs of rotation found in the semicircular canals?
What eye sign is caused by an impaired vestibulo-ocular reflex?
Which eye sign indicates a vestibular problem?
What is the most common GP presenting complaint in people over 75?
What questions should you ask when taking a history from someone with dizziness?
Associated symptoms? pain, hearing loss, vision, cardio
What should be examined in someone who is dizzy?
Blood pressure (lying/standing)
What is the most common ENT cause of dizziness?
Benign positional paroxysmal vertigo (BPPV)
What is the symptom of BPPV?
Veritgo on changing position, looking up
What is the most common cause of BPPV?
What is the pathophysiology of BPPV?
Movement of otolith (calcium carbonate crystals) from urticle into semicircular canals, causing sensation of motion
How long do episodes of BPPV last?
Never more than 30s
Does BPPV have any associated symptoms?
What test is used to detect BPPV?
What is the Hallpike test used to detect?
How do you do it?
What are you looking for?
Lie head over end of couch, turn head 45 to one side then return as quickly as possible, EYES OPEN
What do you need to see on performing a Hallpike test to diagnose BPPV?
patient saying they're dizzy isn't enough
Why must you wait 30s before finishing a Hallpike test?
Nystagmus can be delayed by up to 30s
Which manoeuvre can be used to alleviate BPPV?
How are patients with BPPV advised to sleep?
Sitting up slightly