1 / 16

Dizziness PBL ST1 session

Learn about the different causes of dizziness, from vertigo to lightheadedness, and the examinations used to diagnose them. Discover common conditions like labyrinthitis and BPPV, and how they can be managed.

mwolfe
Download Presentation

Dizziness PBL ST1 session

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DizzinessPBL ST1 session Jo Swallow May 2009

  2. DIZZY • dizziness is a non-specific term used to describe a sensation of altered orientation in space • vertigo is the hallucination of rotation or movement of one's self or one's surroundings. Dizziness is of little diagnostic value without trying to elaborate further information. However, when vertigo, postural hypotension or other types of unsteadiness are less severe or chronic, it may be impossible to describe the sensation more accurately than "dizziness". If there is loss of consciousness then this defines the term syncope

  3. vertigo • more than 50 percent of cases of dizziness in primary care • it is frequently horizontal and rotatory • may be associated with nausea, emesis, and diaphoresis

  4. cause may be central or peripheral • when associated with nausea and vomiting, should look for a peripheral rather than central cause • Central-due to a disorder of the brainstem or the cerebellum • Peripheral-due to a disorder in the inner ear or the VIIIth cranial nerve

  5. lightheadedness • this is non-specific • sometimes difficult to diagnose • may be associated with panic attacks

  6. presyncope • is due to cardiovascular conditions that reduce cerebral blood flow

  7. dysequilibrium • feeling of unsteadiness and instability • peripheral neuropathy • eye disease • peripheral vestibular disorders

  8. Or any of below • psychiatric disorders, • seizure disorders, • motion sickness, • otitis media, • cerumen impaction

  9. Ramsay Hunt • The Ramsay Hunt Syndrome is characterised by sensorineural deafness, vertigo and facial paralysis following Herpes Zoster infection. The patient is usually elderly. • Herpes zoster infects the geniculate ganglion, more rarely the IXth and Xth nerves and, very occasionally, nerves V, VI or XII. • Recovery of facial nerve function is less likely than in Bell's palsy. • The prognosis may be improved by treatment with acyclovir.

  10. Ramsay hunt • sensorineural deafness, • vertigo • facial paralysis • following Herpes Zoster infection. • The patient is usually elderly

  11. Jo’s 5 minute dizzy examination • History dependant • Neuro • Cardio • Entry to the room (gait) • Blood pressure + Pulse (standing if low/hx suggestive) • Cranial nerves – fundoscopy, perla?eye movements ?nystagmus, fields by confrontation, • Can they hear me? Any hearing complaints?

  12. Dizzy 2 • Otoscopy • ? Lymph nodes • ?cervical spine tenderness • Finger nose test • Rombergs • Dicks hallpike +/- rebook for epley • Listen to heart sounds and ?bruits when on the bed

  13. Who to refer • recurrent separate episodes • neurological symptoms eg dysphasia, paraesthesiae, or weakness • associated sensorineural deafness • abnormality of the eardrum (especially cholesteatoma) or inadequate visualisation • atypical nystagmus eg non-horizontal, persisting for weeks, changing in direction or differing in each eye • If the patient has hearing problems in addition to vertigo then referral should be made to an ENT specialist. Other cases should be referred to a neurologist.

  14. My 2 minute explanation of labyrinthitis • This is a very common VIRAL ailment therefore…… • It often follows an URTI and may occur repeatedly • Unfortunately if you are prone to it you may get it again • It causes vertigo, nausea and sometimes vomiting • It is self limiting but can be helped symptomatically by prochlorperazine or domperidone. • Buccal/suppository if vomiting. • Usually settles in 7-14 days. • If it perseveres do come back. • There is unlikely to be any serious cause for this, it certainly doesn’t sound like a developing stroke or a brain tumour at all

  15. My 2 minute explanation of BPPV • This condition causes brief episodes of recurring vertigo on turning the head • We all have crystals in our inner ear which are floating they control our balance, miniscule position changes create the illusion of movement. When the position is disrupted it can cause dizziness. • There is a manouvere which attempts to redistribute these crystals • Epley manouvere • Vomit bowl handy • We can teach patients to do this themselves

  16. Epley manouvere • http://www.youtube.com/watch?v=ZqokxZRbJfw • Science fiction? • Placebo • ?crystal repositioning

More Related