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The dizzy patient Flashcards

(48 cards)

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1
Q

what is the prevalence of dizziness?

A

it is the most common cause of presentation to the primary care physician in people over 74 years old

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2
Q

what is the percentage of people in the community that suffer from dizziness?

A

17%

>25% of 50-64 year olds state that they currently suffer dizziness

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3
Q

how many people in the UK consult their GP with vertigo?

A

5/1000

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4
Q

by the age of 80…

A

2/3 women and 1/3 men will have experienced episodes of vertigo

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5
Q

what is etiology of dizziness?

A 
Cardiovascular system
Haematological and metabolic
Anxiety
Neurological conditions
Drug side-effects / interactions
Migraine
Otological
Trauma
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6
Q

what is the definition of dizziness?

A

non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc.

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7
Q

what is the definition of vertigo?

A

a sensation of movement, usually spinning

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8
Q

what are the central pathways of the balance systems of the body?

A 
visual
cardiovascular 
vestibular
vestibule-ocular reflex 
vestibulospinal tract 
proprioceptive
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9
Q

what are the conditions that affect the vestibular balance system?

A

BPPV
menieres
vestibular
neuronitis

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10
Q

what are the conditions that affect the vestibulospinal tract and vestibule-ocular reflex?

A

stress
migraine
SOL
MS

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11
Q

what are the conditions that affect the proprioceptive balance systems?

A

DM
arthritis
neurology

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12
Q

what are conditions that affect the visual balance system?

A

cataracts

DM

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13
Q

what are the conditions that affect the cardiovascular balance systems?

A

arrthymias

postural hypotension

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14
Q

how can we use history the differentiate between cardiac, neurological & vestibular?

A

Lightheadedness, syncope, palpitations

Blackouts, visual disturbance, paraesthesia, weakness, speech & swallow problems

Vertigo is a sensation of motion: spinning, falling, being pushed

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15
Q

things to ask in the history?

A 
Triggers?
Time Course?
Associated symptoms?
Precipitators?
Alleviating factors?
Medication?
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16
Q

vertigo episodes…

A

duration of episodes is the key

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17
Q

which condition has vertigo episodes that last seconds?

A

BPPV

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18
Q

which condition has vertigo episodes that last hours?

A

Menieres

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19
Q

which condition has vertigo episodes that last variable?

A

migraine associated vertigo

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20
Q

vertigo history:

Study These Flashcards
A

Associates symptoms also important:
Hearing loss , tinnitus, aural pressure
Migraines or sensory sensitivity
Sound or pressure induced symptoms

21
Q

Do you get dizzy rolling over in bed?

22
Q

Was your first attack severe, lasting hours with nausea & vomiting?

Study These Flashcards
A

Vestibular neuritis

23
Q

Do you get light-sensitive during the dizzy spells?

Study These Flashcards
A

Vestibular Migraine

24
Q

Does one ear feel full or do you get hearing loss before or during the dizzy spell?

25
Examination of dizzy patient:
``` Otoscopy Neurological Blood pressure including lying/standing Balance system Audiometry ```
26
what are vestibular end organs?
Ampullae of lateral, posterior & superior semicircular canals Maculae of the utricle & saccule Different functions
27
what is the vestibule-ocular reflex?
head movement to the right causes right side excitation and left Side inhibition
28
what are the common causes of dizziness?
``` Postural dizziness History, Hb, Na, BP lying/standing Side effect of medication History Psychogenic & interaction with imbalance ```
29
what is the commonest cause of vertigo on looking up?
BPPV
30
what are the causes of BPPV?
it is very common, | head trauma, ear surgery, idiopathic
31
what is the pathophysiology of BPPV?
otolith material from article displaced into semicircular canals most commonly in posterior SCC
32
what is BPPV confused with?
vertebrobasilar insufficiency
33
what is required for a diagnosis of VBI?
other symptoms of impaired circulation in posterior brain associated with the vertigo such as visual disturbance, weakness, numbness
34
BPPV causes vertigo on:
looking up turning in bed - often worse to one side first lying down in bed at night on first getting out of bed in the morning bending forward rising from bending moving head quickly – often only in one direction
35
what is the Dix hall pike test?
``` Sit up, enough room to lay down on couch Eyes open! Short latency Symptomatic or nystagmus Vertical/torsional geotropic They will be dizzy & maybe sick! ```
36
what are tests used to confirm BPPV?
Hallpike’s Test Epley Manoeuvre Semont Manoeuvre Brandt-Daroff Exercises
37
employ manoeuvre:
70-75% successfully treated with single manoeuvre. 90% symptom free after two manoeuvres Most easily & successfully treated ‘dizzy patient’
38
vestibular neuronitis:
prolonged vertigo (days) with no associated tinnitus or hearing loss probable viral etiology may be viral prodromal symptoms
39
labyrinthitis:
prolonged vertigo (days) may be associated with tinnitus or hearing loss probable viral etiology may be vial prodromal symptoms
40
management of vestibular neuritis/labyrinthitis
Supportive management with vestibular sedatives Generally self-limiting If prolonged or atypical may require further investigation May be helped by rehabilitation exercises if prolonged Rule of 3s: In bed 3 days, off work 3 weeks, off balance 3 months
41
Menieres disease:
cause unknown pathophysiology incidence - 50-200/100,000
42
how to diagnose menieres disease?
History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours) Occurrence of or worsening of tinnitus on the affected side Occurrence of aural fullness on the affected side Documented SNHL on at least one occasion Other causes excluded
43
what is the management of Menieres disease?
``` Supportive treatment during episodes Tinnitus therapy Hearing Aids Prevention Salt restriction / Betahistine / caffeine / alcohol / stress ``` Grommet insertion / Meniette Intratympanic Steroids / Gentamicin Surgery
44
what is the incidence of migraines?
15-20%
45
what is the estimated percentage of migraine sufferers that have spontaneous attacks of vertigo and ataxia?
25%
46
what is the most common auditory symptom?
photophobia
47
Fluctuating hearing loss and acute permanent hearing loss occur in a small percentage.
Migraine and Vertigo
48
migraine and vertigo:
Motion sensitivity with bouts of motion sickness occurs in about 2/3 of patients with migraine. Episodes of vertigo occur in about one quarter of patients

ENT (13 decks)

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