{"id":350,"date":"2017-03-26T13:10:19","date_gmt":"2017-03-26T13:10:19","guid":{"rendered":"http:\/\/papergp.com\/index.php\/ent\/vertigo\/"},"modified":"2024-01-20T09:17:34","modified_gmt":"2024-01-20T09:17:34","slug":"vertigo","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/ent\/vertigo\/","title":{"rendered":"Vertigo"},"content":{"rendered":"\n<p>Reference: North Central London Dizziness Pathway 2019<\/p>\n\n\n<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>acute onset hearing loss + vertigo -&gt; contact ENT on call<\/li>\n<li>CN symptoms, limb weakness, cerebellar signs, severe headache -&gt; urgent HASU review<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>\u00a0History<br \/>\n<ul>\n<li>Menieres &#8211; ear fullness, tinnitus<\/li>\n<li>BPPV &#8211; head movement triggers vertigo<\/li>\n<li>Vestibular neuronitis &#8211; prodromal viral URTI, continuous spinning, vomiting<\/li>\n<li>Vestibular migraine &#8211; recurrent episodes of vertigo, nausea, photophobia, phonophobia, often normal examination<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Dysequilibrium (unsteadiness)\n<ul>\n<li>multisensory imbalance &#8211; elderly patient, vision, proprioception<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<hr \/>\n<div class=\"content-box-blue\">\n<ul>\n<li>Examine\n<ul>\n<li>ENT exam<\/li>\n<li>CN exam<\/li>\n<li>Cerebellar exam<\/li>\n<li>L\/S BP<\/li>\n<li>Dix-Hallpike<\/li>\n<li>Head impulse test (negative in central causes)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Bloods &#8211; FBC, U+Es, TFTs, HbA1c<\/li>\n<li>Bedside BM<\/li>\n<li>Audiometry<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>BPPV\n<ul>\n<li>Epley manoeuvre, Brandt-Daroff exercises, refer if not settled after 4 weeks<\/li>\n<\/ul>\n<\/li>\n<li>Vestibular neuronitis\n<ul>\n<li>Prochlorperazine (max 3 days), refer if not settled after 4 weeks<\/li>\n<\/ul>\n<\/li>\n<li>Vestibular migraine\n<ul>\n<li>Only treat if known vestibular migraine &#8211; prochlorperazine 5mg TDS, refer if symptoms persist more than 6 weeks<\/li>\n<\/ul>\n<\/li>\n<li>Multisensory imbalance\n<ul>\n<li>Refer to falls clinic<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<div class=\"content-box-blue\">\n<h4>Notes<\/h4>\n<ul>\n<li>Cerebellar examination\n<ul>\n<li>DANISH\n<ul>\n<li>Dysdiadochokinesia<\/li>\n<li>Ataxia (gait and posture)<\/li>\n<li>Nystagmus<\/li>\n<li>Intention tremor<\/li>\n<li>Slurred, staccato speech<\/li>\n<li>Hypotonia\/Heel-shin test<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Dix-Hallpike test for BPPV\n<ul>\n<li>Patient in a sitting position<\/li>\n<li>Rapidly lay the patient down flat on a couch with head turned to the side and neck extended (ensure no neck pathology)<\/li>\n<li>A nystagmus occurs if BPPV present<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<ul>\n<li>Long term use of prochlorperazine, cinnarizine\n<ul>\n<li>generally recommended to avoid as slows central compensation and creates psychological dependence &#8211; advise patients to mobilise as much as possible to compensate quicker<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>\u00a0<\/p>","protected":false},"excerpt":{"rendered":"<p>Reference: North Central London Dizziness Pathway 2019 Data gathering Red flags acute onset hearing loss + vertigo -&gt; contact ENT on call CN symptoms, limb weakness, cerebellar signs, severe headache -&gt; urgent HASU review \u00a0History Menieres &#8211; ear fullness, tinnitus BPPV &#8211; head movement triggers vertigo Vestibular neuronitis &#8211; prodromal viral URTI, continuous spinning, vomiting &hellip; <a href=\"https:\/\/papergp.com\/index.php\/ent\/vertigo\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Vertigo<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":346,"menu_order":140,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-350","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/350","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=350"}],"version-history":[{"count":13,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/350\/revisions"}],"predecessor-version":[{"id":2594,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/350\/revisions\/2594"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/346"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=350"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}