Dizziness Flashcards
A patient complains of short episodes of dizziness, usually when turing in bed.
BPPV
How do you relieve BPPV?
Epley manoevre
How does the epley manoevre relieve BPPV?
By dislodging calcified particles within the inner ear particles which are causing the dizziness
What causes BPPV?
Loose otoliths in the semicircular canals
What semi circular canal is most commonly affected in BPPV?
Posterior
How do you make a diagnosis of BPPV? What do you look for in this test
Hallpike manoevre should bring on symptoms and also nystagmus.
If the patient has dizziness with nystagmus then what system is the problem most likely to be in?
Vestibular
Describe the vestibulo - ocular reflex
Head rotation causes a compensatory movement of both eyes in the opposite direction.
A patient comes in with recurrent episodes of disabling dizziness. During attacks she also gets hearing loss and a sense of fullness within the ear.
Menierre’s disease
What treatments are recommended in patients with menierre’s disease?
Supportive treatment during episodes (anti emetics, vestibular sedatives such as cinnarzine)
Salt restricted diets, caffeine restriction, alcohol restriction
Betahistine dichloride
Gentamicin to destroy the vestibular epithelium
What happens when you treat a patient with menierre’s disease with gentamicin?
Destroys vestibular epithelium which causes severe vertigo for two weeks until the body compensates for a lack of the vestibular system on that side. After that the patient may get occasional mild vertigo but will not get the disabling attacks as seen in menierre’s.
What is vertebrobasilar insufficiency?
Ischaemia to the parts of the brain supplies by the vertebrobasilar parts of the brain. This presents as vertigo, visual disturbance, weakness and numbness.
A 56 year old man was hanging washing on the line when he suddenly felt very dizzy and felt his legs go very weak.
Vertebrobasilar insufficiency.
What is supplied by the posterior circulation of the brain?
medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex
A patient presents as they have been feeling very dizzy for the last few days and have also felt very nauseus. They do not have any tinntus or hearing loss.
Vestibular neuronitis
