Differentiate vestibular from non-vestibular causes of dizziness Vestibular causes of dizziness Vestibular system: Responsible for sense of balance and position. Controlled by semicircular canals, utricle and saccules. Semicircular canals -> detect rotational/circular movements of the head. Utricle and saccule -> detect linear motions of the heads -> forwards and backwards. Causes May be central or peripheral. Central: Brain and brainstems. Vestibular migraine: Recurrent episodes associated with migraines. Abnormal brain processing. Sensitivity ot light and voice. Multiple sclerosis Inflammatory demyelination affecting central vestibular pathways. Clinical features: Optic neuritis Visual changes Muscle weakness Altered sensations Autonomic dysfunction -> bladder and defecation dysregulation. Cerebrally disorders. Intension tremors Dysdiadochokinesia Dysmetria Ataxia of the extremities -> unsteadiness of gait towards the side of lesion. Poor muscle coordination Dementia Slow and slurred speech Peripheral Inner ear, nerves and pathways connected the inner ear to the central vestibular system. Benign paroxysmal positional vertigo (BPPV) Most common peripheral cause. Otoconia displacement within the semicircular canals. Vertigo is triggered by: Head positions Certain body movements. Determine affected side by the Dix-Hallpike manoeuvre and signs of nystagmus. Sudden and recurrent episodes Lasts for several minutes. Labyrinthitis Inflammation of the inner ear. Usually a viral cause. Vertigo Nausea Vomit Tinnitus Hearing loss Meniere’s disease Fluid build-up in the inner ear -> vertigo, hearing loss and tinnitus Triad: Peripheral vertigo Tinnitus Asymmetrical fluctuating sensorineural loss Tuning fork tests: Weber’s test -> lateralisation to the healthy ear. Rinne test -> bilaterally positive. Additional symptoms: Spontaneous horizontal or horizontal rotatory nystagmus. Direction of nystagmus is variable and can change. Can be supressed by visual fixation. Nausea and vomit. Ear fullness. Vestibular neuritis Viral infection affecting the vestibular nerve. Acute or subacute onset. Nausea Vomit Gait instability Increased risk of falling towards affected side. Nystagmus. Progression and duration of symptoms: Severe symptoms usually last for 1 to 2 days. Mild symptoms may persist for weeks or even months. Non vestibular causes of dizziness Orthostatic hypertension Cardiac arrythmias Anxiety or panic attacks Anaemia Dehydration Differentiating based on history and physical examinations History Vestibular causes Triggered by specific head movements or position changes. Non vestibular causes Boarder triggers -> e.g. dehydration, stress etc. Physical examination Vestibular causes Nystagmus Dix-Hallpike Balance tests Non vestibular causes Checking blood pressure Checking heart rate Neurological examination.