Dizziness

Question 1

Presyncope

Answer 1

Feeling faint or almost fainting

Question 2

Dysequilibrium

Answer 2

Unsteadiness or feeling off-balance when walking

Question 3

Vague Lightheadedness/Other

Answer 3

Ill defined, lacks specific characteristics of the other 3

Question 4

What will help reveal the cause of dizziness?

Answer 4

A detailed history!

Question 5

What questions will you ask to get a detailed history?

Answer 5

1. Complete description of what the patient means by dizziness (room spins? Fainting? Unsteadiness?)
2. Timing - Setting & Circumstances?
3. Duration
4. Aggravating/alleviating factors
5. Medication History
6. Past Medical Hx

Question 6

Peripheral Vertigo

Answer 6

Most common recurrent vertigo from otoconia in canals (posterior canal)

Question 7

What causes Benign Positional Vertigo (BPV)?

Answer 7

Sudden onset of vertigo provoked by quick head movement

Question 8

How long does BPV last?

Answer 8

Seconds to a minute (BRIEF!)

Question 9

Symptoms of BPV?

Answer 9

Nausea/vomiting

NO tinnitus or hearing loss

Question 10

BPV Physical Exam tests?

Answer 10

Dix-Hallpike is positive

Delayed unidirectional nystagmus is positive

Question 11

How can you treat BPV?

Answer 11

Epley’s Maneuver when Dix-Hallpike is positive.. Just continue on!

Question 12

What are you trying to move w/Epley’s Manuever and to where?

Answer 12

Otoconia will hopefully move into the utricle from the posterior canal

Question 13

What are symptoms of Meniere’s Disease?

Answer 13

Recurrent attacks of severe vertigo WITH HEARING LOSS

Onset of vertigo lasts hours (long time)

Nausea, vomiting, fullness/pressure/pain in the ear, tinnitus

Question 14

What is Meniere’s disease?

Answer 14

Sensorineural hearing loss possibly from excess endolymph (fluid) in the inner ear

Question 15

Do we treat Meniere’s Disease?

Answer 15

Nope, refer out to ENT

Question 16

Which type of vertigo is associated with one-sided hearing loss?

Answer 16

Acoustic Neuroma (CN VIII tumour)

Question 17

Which of the causes of vertigo occur after a viral illness?

Answer 17

Acute labyrinthitis/vestibular neuronitis

Question 18

Which type of vertigo is due to medications?

Answer 18

Ototoxicity due to medications

Question 19

How frequent is dizziness in cases of whiplash?

Answer 19

41%-48%

Question 20

What will come up during the exam to suggest cervicogenic vertigo?

Answer 20

Positive swivel chair test

Sore neck

Question 21

What would an abnormal neuro finding tell you about the patient’s dizziness?

Answer 21

It is a form of central vertigo

Question 22

Patient walks in with a staggering gait, motor weakness and difficulty articulating what they are experiencing but they can let you know they are dizzy. What do they have?

Answer 22

Central Vertigo

Question 23

What is nystagmus?

Answer 23

The eyes involuntarily look away from the point of gaze

Question 24

What is the main difference between central and peripheral vertigo?

Answer 24

Peripheral has a normal neuro exam except hearing loss and unidirectional nystagmus

Central has neuro exam abnormalities and nystagmus changes direct w/gaze (gaze fixation may make it worse!)

Question 25

What may cause central vertigo?

Answer 25

Transient Ischemic Attack (TIA) Posterior Fossa Tumour MS (autoimmune demyelination)

Question 26

Dysarthria

Answer 26

Speech difficulties

Question 27

Dysmetria

Answer 27

Past-pointing

Question 28

Gaze evoked nystagmus

Answer 28

Asking patient to focus their gaze evokes oscillations of their eyes or asking the patient to following your finger and their eyes move in different directions

Question 29

Presyncope

Answer 29

Feeling faint or almost fainting

Question 30

Syncope

Answer 30

Fainting/loss of consciousness

Question 31

Causes of Presyncope dizziness

Answer 31

1. Vasovagal reaction (most common) dizziness often for minutes before fainting 2. Orthostatic hypotension 3. Cardiogenic - dizziness prodrome is very brief (

Question 32

Vasovagal reaction

Answer 32

Vagal "over-reaction" Recover within a few seconds

Question 33

Orthostasis

Answer 33

Brief dizziness from sitting to standing - or from dehydration, eating, medications, autonomic dysfunction

Question 34

Cardiogenic Presyncope

Answer 34

Prodrome

Question 35

Cardiogenic syncope from exertion because?

Answer 35

Aortic stenosis Heart failure Pulmonary emboli Anemia

Question 36

Causes of dysequilibrium

Answer 36

Medications Sensory deficits Motor abnormalities Orthopedic disorders

Question 37

Vertigo

Answer 37

False sense of spinning or motion

Question 38

T/F There is no need to instruct the patient on where to look during Dix-Hallpike

Answer 38

False - if they look at one point, their nystagmus may go away

Question 39

What are 3 signs of Meniere's disease?

Answer 39

Sensorineural hearing loss Lasts a long time Ringing in the ears (tinnitus)

Question 40

Patient had presyncope for under 5 seconds and then they passed out. They have also been having heart palpitations. Should you be worried?

Answer 40

Yes - could be arrhythmia and you want to send them to their PCP

Question 41

Pt had presyncope for a couple of minutes and then passed out when their blood was being drawn. Should you be worried?

Answer 41

No, this is probably a vasovagal reaction?