Balance/Vertigo Problems

Question 1

presentation of cardiac dizziness/ fainting

Answer 1

light-headed
syncope
palpitations

Question 2

presentation of neurological dizziness

Answer 2

blackouts
visual disturbance
paraesthesia
weakness
speech
swallow

Question 3

presentation of vestibular dizziness

Answer 3

vertigo

sense of motion e.g. spinning, falling, being pushed

Question 4

what three systems must you distinguish between to find the cause of dizziness?

Answer 4

cardiac
neurological
vestibular

Question 5

diagnosis of dizziness

Answer 5

otoscopy
neurological
BP lying/standing
balance system
audiometry

Question 6

common causes of dizziness

Answer 6

postural dizziness

side effects of medication

Question 7

what does a vertical nystagmus/ nystagmus that changes direction indicate?

Answer 7

central lesion on the brain rather than a problem with this reflex (cirae malformation)

Question 8

four conditions that present with vertigo

Answer 8

1. BPPV
2. Meniere’s disease
3. Labyrinthitis/ vestibular neuritis
4. Migraine associated vertigo

Question 9

what is benign paroxysmal positional vertigo?

Answer 9

otoconia from the utricle displaces into the SCC (usually posterior)

Question 10

causes of BPPV

Answer 10

trauma
ear surgery
idiopathic

Question 11

presentation of BPPV

Answer 11

vertigo on rotation movement of head
vertigo that lasts seconds/minutes
vertigo when rolling over in bed, bending, moving head quickly

Question 12

what must BPPV be differentiated from?

Answer 12

vertebrobasilar insufficiency

Question 13

what is vertebrobasilar insufficiency?

Answer 13

impaired circulation of posterior brain

Question 14

presentation of vertebrobasilar insufficiency

Answer 14

vertigo
visual disturbance
weakness
numbness

Question 15

diagnosis of BPPV

Answer 15

Dix-Hallpike test

Question 16

management of BPPV

Answer 16

repositioning manoeuvres:

• Epley manoeuvre
• semont manoeuvre
• Brandt-Daroff exercises (10 reps a day)

Question 17

what is Meniere’s disease?

Answer 17

Endolymphatic hydrops
excessive, high pressure endolymph
swelling and risk of rupture

Question 18

presentation of Meniere’s

Answer 18

recurrent, rotational vertigo with at least 2 episodes lasting longer than 20 minutes (hours)
one ear feels full/ change to hearing (low frequency SNHL)
tinnitus around dizzy spell
spontaneous nystagmus

Question 19

supportive management of Meniere’s during episodes

Answer 19

vestibular sedatives

hearing aids

Question 20

prevention methods of Meniere’s

Answer 20

salt restriction
caffeine
alcohol
stress
ITS (steroid injections) or ITG (gentamicin- vestibular toxic)

Question 21

problem of cutting vestibular nerve in Meniere’s

Answer 21

stops dizziness but leads to loss of balance

Question 22

what is vestibular neuritis?

Answer 22

inflammation of the vestibular nerve

Question 23

what is labyrinthitis?

Answer 23

inflammation of vestibular and cochlear nerve

Question 24

potential cause of vestibular neuritis/labyrinthitis?

Answer 24

viral cause

Question 25

presentation of vestibular neuritis/labyrinthitis?

Answer 25

dizziness lasting days occurring with N&V viral prodromal symptoms rule of 3's= 3 days in bed, 3 weeks off work and 3 months off balance

Question 26

difference between vestibular neuritis and labyrinthitis in terms of presentation

Answer 26

labyrinthitis has associated hearing loss or tinnitus

Question 27

management of vestibular neuritis/labyrinthitis

Answer 27

self-limiting so supportive with vestibular sedatives e.g. lorazepam rehabilitation exercises if prolonged as may aid faster recovery

Question 28

presentation of migraine associated vertigo

Answer 28

variable duration of dizziness motion sickness episodes of vertigo on movement with photophobia fluctuating/permanent hearing loss

Question 29

management of migraine associated vertigo

Answer 29

lifestyle and avoid triggers abortive agents e.g. triptans prophylaxis e.g. propranolol and amitriptyline

Question 30

what are triptans?

Answer 30

dopamine agonists

Question 31

what are triggers for migraine associated vertigo?

Answer 31

``` alcohol caffeine chocolates citrus fruit lack of sleep ```