Dizziness Flashcards
(13 cards)
What are the three main types of dizziness to differentiate?
Vertigo (spinning sensation), presyncope (light-headedness), and disequilibrium (imbalance while walking).
What is the classic presentation of benign paroxysmal positional vertigo (BPPV)?
Sudden episodes of vertigo triggered by head movement, lasting seconds, no hearing loss; positive Dix-Hallpike test.
What distinguishes vestibular neuritis from labyrinthitis?
Vestibular neuritis presents with vertigo without hearing loss; labyrinthitis includes hearing loss and tinnitus.
How is Ménière’s disease typically described by patients?
Recurrent episodes of vertigo lasting minutes to hours, fluctuating hearing loss, tinnitus, and aural fullness.
What are central causes of vertigo that should not be missed?
Cerebellar stroke, brainstem stroke, multiple sclerosis, and posterior fossa tumors.
How do you clinically differentiate central from peripheral vertigo?
Central: persistent nystagmus, no fatigue, poor gait, other neurological signs; Peripheral: positional, fatigable nystagmus, no CNS signs.
What is the Hallpike (Dix-Hallpike) test used for?
To diagnose BPPV by triggering vertigo and nystagmus on positional change.
What are red flag features in a patient with dizziness?
Sudden onset, inability to walk unaided, neurological deficits, headache, vertical or direction-changing nystagmus.
What non-neurological conditions can mimic dizziness?
Anemia, hypoglycemia, arrhythmias, orthostatic hypotension, anxiety.
What is the role of the Head Impulse–Nystagmus–Test of Skew (HINTS) exam?
To differentiate peripheral from central vertigo in acute vestibular syndrome; central causes have normal head impulse test, direction-changing nystagmus, and skew deviation.
What are key investigations in a patient with persistent or unclear dizziness?
Audiometry, vestibular function tests, MRI brain (if central cause suspected), ECG/BP lying and standing (for presyncope), and glucose levels.
What is the main treatment for BPPV?
Epley’s manoeuvre to reposition otoliths; reassurance and vestibular exercises.
How is Ménière’s disease managed?
Low-salt diet, betahistine, diuretics, and in severe cases, intratympanic steroids or surgery.
