Dr Anderson: Dizziness
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The document discusses the evaluation and potential causes of dizziness in patients. It outlines important aspects of the history to obtain including triggers and associated symptoms. Acute causes mentioned include vestibular neuronitis which presents with sudden vertigo, nausea and vomiting that gradually improves over weeks. Recurrent episodic causes discussed are benign paroxysmal positional vertigo (BPPV), migraine, and Meniere's disease. Red flags are also noted that could indicate a posterior circulation stroke requiring urgent attention.
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The document discusses the evaluation and potential causes of dizziness in patients. It outlines important aspects of the history to obtain including triggers and associated symptoms. Acute causes mentioned include vestibular neuronitis which presents with sudden vertigo, nausea and vomiting that gradually improves over weeks. Recurrent episodic causes discussed are benign paroxysmal positional vertigo (BPPV), migraine, and Meniere's disease. Red flags are also noted that could indicate a posterior circulation stroke requiring further workup.
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This document discusses the evaluation of vertigo. It defines vertigo and classifies it according to duration. It describes the characteristics of peripheral vertigo such as associated hearing loss, episodic nature, and association with head movement. The document outlines tests used to investigate peripheral vertigo, including the caloric test and Fitzgerald-Hallpike test, and how to differentiate between peripheral vertigo and central vertigo based on features like nystagmus characteristics and neurological deficits.
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Dirar Aldabek provides an example from his aunt who experienced transient ischemic attacks based on symptoms of confusion and inability to understand spoken words that resolved within an hour. He also discusses a video he saw of a reporter experiencing a stroke live and exhibiting signs of expressive aphasia. This course on neurobiology of everyday life allowed Dirar to better analyze everyday phenomena and relate brain functions to expectations while inspiring him to study the roles of structures like the cerebellum and basal ganglia in decision making and evaluating emotions.
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Neurodegenerative diseases such as Alzheimer's, Huntington's, and Parkinson's cause the progressive loss of structure and function of neurons in the brain and spinal cord. Neurons cannot be replaced when damaged or died. Common symptoms include memory loss, movement difficulties, and behavioral changes. While there are currently no cures for these diseases, medications can help manage symptoms. Caregiving requires adapting to the patient's changing abilities from early to late stages of the disease.
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The document discusses an approach to evaluating and managing a patient presenting with altered sensorium, which can be caused by a wide range of reversible and non-reversible medical conditions. It outlines performing an initial ABCDE assessment to identify life-threatening issues and potentially reversible causes. A detailed history, physical exam, and assessment of level of consciousness using the Glasgow Coma Scale are recommended to help classify the altered sensorium and develop a differential diagnosis.
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This document provides information about epilepsy for healthcare staff. It begins with learning outcomes around recognizing seizure types, appropriate first aid, risks of epilepsy, and the role of staff caring for people with epilepsy. It then defines epilepsy as a neurological disorder characterized by unprovoked seizures. Several types of seizures are described, including focal and generalized seizures like tonic-clonic and absence seizures. Causes, diagnosis, treatment, triggers, classification, and first aid for different seizure types are outlined. The roles and responsibilities of healthcare staff in caring for people with epilepsy are also summarized.
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A 40-year-old female presented with a 3-day history of headaches and difficulty closing her right eye. Her symptoms progressed to include nausea, vomiting, dizziness, and transient visual disturbances in the right eye. Examination found right lower facial droop, weaker right eye closure, and limited ability to raise the right eyebrow, indicating a seventh nerve palsy. Brain imaging showed a stenosis in the transverse sinus and mild papilledema. A lumbar puncture found elevated opening pressure and protein levels. She was diagnosed with pseudotumor cerebri (also called benign intracranial hypertension or idiopathic intracranial hypertension) and started on steroids and acetazolamide, which
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Huntington
Huntington's disease is a neurodegenerative genetic disorder that causes the progressive breakdown of nerve cells in the brain, especially in the basal ganglia. It affects movement, cognition, and psychiatric functions and is caused by a defective gene inherited from a parent. Symptoms typically appear between ages 30-50 and include involuntary movements, cognitive decline, and psychiatric issues like depression. While there is no cure, treatment aims to reduce symptoms and complications through medications, speech/occupational/physical therapy, and supportive care.
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This document discusses benign paroxysmal positional vertigo (BPPV). It begins with an overview of the anatomy and physiology of the vestibular system. It then defines BPPV and discusses its pathogenesis, symptoms, types, differential diagnosis, investigations and treatment modalities. The most common treatment is canalith repositioning procedures like the Epley maneuver which aims to move otoliths out of the semicircular canals.
vertigo-150822143553325-lva1-app6892.pptx
Here are the answers to the quiz questions:
1. Nystagmus is away from the lesion side in peripheral vertigo.
2. Fitzgerald-Hallpike Test
3. Canalith repositioning maneuvers like Epley maneuver or Semont maneuver.
4. Vestibular neuronitis
5. Aminoglycoside antibiotics, loop diuretics, chemotherapeutic agents etc. can cause vestibulotoxicity leading to vertigo.
Vertigo
Here are the answers to the quiz questions:
1. Nystagmus is away from the lesion side in peripheral vertigo.
2. Fitzgerald-Hallpike Test
3. Canalith repositioning maneuvers like Epley maneuver or Semont maneuver.
4. Vestibular neuronitis
5. Aminoglycoside antibiotics, quinine, aspirin, etc. can be vestibulotoxic.
A Case of Progressive Supranuclear Palsy
Mr. Vembuli, a 56-year-old male, presented with recurrent falls, slowness in activities, and uncontrollable crying. He was diagnosed with progressive supranuclear palsy (PSP) based on MRI findings of midbrain atrophy, the hummingbird sign, and features including vertical gaze palsy, pseudobulbar palsy, parkinsonism, and poor response to levodopa. PSP is a rare neurodegenerative disorder characterized by tau protein abnormalities in the brainstem, basal ganglia and cerebellum. It differs from Parkinson's disease in its early gait impairment, symmetrical onset, and lack of tremor. Treatment options are limited but may
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This document discusses the assessment of a 62-year-old male patient presenting with acute vertigo. On examination, he displayed nystagmus, trunk instability, and loss of hearing in his right ear. Imaging showed a transverse petrous fracture involving the labyrinth and semicircular canals. The differential diagnosis includes peripheral vestibular disorders like vestibular neuritis and central causes like stroke. A careful history and examination can help differentiate between peripheral and central causes of vertigo.
VERTIGO.pptx
This document provides information on various causes of vertigo including peripheral and central causes. It discusses conditions like benign paroxysmal positional vertigo (BPPV), Meniere's disease, and vestibular neuritis. Diagnostic tests and treatments for different vertigo conditions are outlined, such as the Dix-Hallpike test for BPPV and Brandt-Daroff exercises or Epley maneuver for treatment. Surgical options are mentioned if conservative treatments are unsuccessful.
Approach to vertigo
Balance requires input from sensory systems like vision and vestibular, processing in the cerebellum and brainstem, and motor output. Disorders can occur from problems with input, processing, or motor function. A careful history is needed to determine the exact nature and location of dizziness or vertigo. Physical exam may reveal sensory issues, eye movement abnormalities, or weakness depending on the site of lesion. Common causes of vertigo include vestibular disorders like acute vestibular failure, benign paroxysmal positional vertigo, and Meniere's disease.
Approach to dizziness
This document outlines the approach to evaluating a patient presenting with dizziness. It discusses the overview, epidemiology, major etiologies including vertigo, disequilibrium, syncope, and nonspecific dizziness. For each etiology, the summary includes defining the condition, taking a relevant history, performing a physical exam including special maneuvers, generating a differential diagnosis, ordering appropriate investigations, management, identifying red flags, providing health education, follow up, and the role of family medicine. The approach emphasizes taking a thorough history to determine the type and characteristics of dizziness and using physical exam findings to distinguish peripheral from central causes of vertigo.
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Vertigo and Nystagmus - Clinical approach part-2.pptx
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Dr Anderson: Dizziness
- 2. There can be no physician so dedicated to their art that they do experience a slight decline of the spirits when they learn that their patients chief complaint is of dizziness
- 3. • History – “head rush” or – “like being on a roundabout” – Other focal neurological features – Hearing loss – If episodic – duration of episodes and provoking features – If chronic – variability ?
- 4. • Acute – Vestibular neuronitis • Single acute attack of continuous vertigo often with nausea and vomiting for several days • Positive head impulse test, unidirectional nystagmus horizontal and rotational • No other neurological deficit, furniture walking • Rx – bed rest, antiemetics for 3 days only and strong encouragement to mobilise • Gradual recovery over weeks but 50% will have canal paresis detectable on vestibular function testing at 1 year Head Impulse Test
- 5. • Red flags (for posterior circulation stroke) – Normal head impulse – Can’t walk – Focal neurological signs – Hearing loss, abnormal otoscopy – New headache
- 6. • Recurrent episodic – NOT vestibular neuronitis – BPPV • Attacks lasting seconds to a minute • Positional, turning over in bed – Migraine • Attacks lasting 10-30 minutes to a minute with associated migraine features • The commonest cause of recurrent dizziness we see – Menieres • Attacks lasting minutes to several hours with roaring tinnitus, ear fullness and unilateral deafness
- 7. • Dizziness: A practical approach to diagnosis and management. Bronstein and Lempert.
- 8. • Epley (following a positive Dix-Hallpike) – Youtube (accurate and safe)