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Approach to dizziness

What we shall discuss. Defining the problemHistory and examination Vertigo Management of vertigo. Doctor, I get dizzy!". VertigoFaintness-presyncope ImbalanceMiscellaneous head sensations. History . OnsetDurationProgressionAggravating/relieving factorsAssociated symptomsGeneral auton

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Approach to dizziness

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    1. Approach to dizziness Vaishali Sinha GPST3, Northgate Medical Practice Canterbury

    2. What we shall discuss Defining the problem History and examination Vertigo Management of vertigo

    3. Doctor, I get dizzy! Vertigo Faintness-presyncope Imbalance Miscellaneous head sensations

    4. History Onset Duration Progression Aggravating/relieving factors Associated symptoms General autonomic Otological Neurological

    5. History contd Past medical history Drug history Alcohol Family history Psychosocial

    6. Examination Cardiovascular ENT Neurological Psychiatric

    7. Vertigo Central Horizontal/vertical/purely torsional nystagmus Fatiguability Associated symptoms Less severe nausea/vomiting Consider secondary care referral early Peripheral

    8. Peripheral Vertigo With deafness or tinnitus: Menieres Disease Labyrinthitis Without deafness or tinnitus Vestibular neuronitis Benign Paroxysmal Positional Vertigo(BPPV) Unexplained Episodic Vertigo

    9. Menieres disease Raised endolymph pressure Triad of vertigo/hearing loss/tinnitus Spontaneous onset of symptoms Last 30mins to several hours

    10. Management Early referral to confirm diagnosis and exclude other diagnoses Treatment options: Betahistine: 6-12months Labyrinthine sedatives-short term In-hospital for severe symptoms Surgery Driving advice Multidisciplinary team involvement

    11. Labyrinthitis Inflammation of the labyrinth and the vestibular nerve Often due to viral infection Refer urgently

    12. Vestibular neuronitis Usually acute onset Symptoms last days to weeks Most commonly follows viral infection

    13. Management of vestibular neuronitis Wait and watch is an option Bed rest followed by early resumption of activity Symptomatic treatment- 3days regular then prn Safety advice- driving, work, falls Review in 1week-refer urgently if symptoms persistent Vestibular rehabilitation exercises

    14. BPPV Occurs only in certain head positions Abnormal dense particles in semicircular canals Residual from previous insult Hallpikes manoeuvre

    15. Management of BPPV Wait and watch possibly several weeks; can recur Advice on gentle head movement Epley manoeuvre Physiotherapy- check with ENT deptt Brandt-Daroff exercises Symptomatic drug treatment not useful

    16. BPPV contd Advice: driving, work, falls Review in 4-6weeks Specialist referral if: Epley manoeuvre is not available in primary care. Symptoms persist inspite of repeated Epley manoeuvre Symptoms or signs are atypical. Three or more episodes

    17. Urgent referral In any kind of vertigo if: Unable to tolerate oral fluids Very sudden onset of vertigo that persists Sudden hearing loss Neurlogical symptoms Chronic dizziness- symptoms >4weeks

    18. Unexplained episodic vertigo Possible causes: Migraine without aura BPPV Early menieres disease Recurrent vestibular neuronitis

    19. Management Symptomatic drug treatment- 1week max Safety advice Further assessment by specialist

    20. To summarise 4 basic forms of dizziness Vertigo- central and peripheral vertigo Management of various forms of vertigo Antihistamincs, phenothiazines, exercises Urgent referral criteria

    21. Thank you!

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