Dizziness

Question 1

need to work out if it is vertigo or dizzy?

what is true vertigo?

when is it non-vertigo?

Answer 1

True vertigo is the sensation that the environment is spinning around, hallucination of movement. The floor may tilt, sink or rise.

• Faint: feel clammy, start to feel sick
• Or Light headedness
• Or: Unsteady (cerebellar/mechanical.

Question 2

Most common causes of dizziness in primary care settings is (these all present with vertigo)?

Answer 2

1) BPPV
2) Meniere’s Disease,
3) Acute Vestibular Neuronitis (Acute labyrinthitis

Question 3

how long does BPPV last?

character of attack?

how is it precipitated?

Dx?

Answer 3

<30 seconds

sudden onset of severe vertigo with repeated attacks over weeks and months

sudden/specific head movements (looking up/bending down

• normal neurological examination
• positive Dix-Hallpike test

Question 4

Meniere’s Disease

how long do the vertigo attacks last?

features?

Tx?

Answer 4

recurrent attacks of vertigo lasting >20mins

• Tinnutis, sense of aural fullness +/- falling to one side.
• Tx: bed rest and reassurance in acute attacks, antihistamine if prolonged (cinnarizine).

Question 5

Acute Labyrinthitis (Vestibular neuronitis)

length of attacks?

features?

Tx?

Answer 5

• Abrupt onset of severe vertigo, nausea, vomiting. - Severe vertigo subsides in days, full recovery in 3-4 weeks.
• No deafness or tinnitus.
• Tx: Reassure.

Question 6

Tinnitus

• what drugs can cause it ?
• cause?
• Tx?

Answer 6

Aspirin (reversible ) and loop diuretics

inner ear damage and hearing loss, wax, excess noise, Meniere’s disease, otitis media.

Psychological support is important – reassure that tinnitus doesn’t mean madness. Cognitive therapy helps, masking may give relief (white noise
Drugs don’t really help – misoprostol appears to help