Dizziness :: PLAB 2 Symptomatic Differential Stations

• Vestibular Neuritis

  • Other presenting symptoms: 

    • 3 Vs

    • Acute True vertigo (room spinning around)

    • Nausea

    • Recent fever, flu-like illness

  • Past history and PMAFTOSA: 

  • Social:

    • Work

    • Living situation

    • Driving

  • Exam and Invs:

    • GPE, vitals

    • Ear examination

    • Neurological examination

    • Romberg’s test

    • Routine bloods, ESR, CRP

  • Referral:

    • None

  • Treatment: 

    • Cyclizine/Ondansetron

    • Self-limiting

    • Avoid alcohol

  • Warning signs:

    • Worsening symptoms

    • Headache, photophobia, neck stiffness

    • Don’t drive

• BPPV

  • Other presenting symptoms: 

    • True vertigo

    • Nausea

    • Episodic

    • Worsened by head movements

  • Past history and PMAFTOSA: 

    • Dont forget allergy history

    • Rule out meningitis

  • Social:

    • Driving, work, ADLs

  • Exam and Invs:

    • GPE, vitals

    • Ear examination

    • Neurological examination

    • Hallpike manoeuvre

  • Referral:

    • None

  • Treatment: 

    • Reassurance

    • Self-limiting

    • Epley’s manoeuvre

  • Warning signs:

    • Worsening symptoms

    • FAST

    • Avoid heights

    • Avoid driving

    • Avoid sudden head movements 

• Meniere’s

  • Other presenting symptoms: 

    • (DVT+fullness)

    • True vertigo

    • Comes in spells 

    • Associated with nausea

    • Unilateral hearing loss

    • Similar episodes in the past

  • Past history and PMAFTOSA: 

  • Social:

    • Driving, work, ADLs

  • Exam and Invs:

    • GPE, vitals

    • Ear examination

    • Neurological examination

    • Hallpike maneuvre

  • Referral:

    • ENT referral (urgent/routine based on life impact)

  • Treatment: 

    • Prochlorperazine

    • Symptomatic management:

      • Hearing aids

      • Physiotherapy

      • Occupational therapy

  • Warning signs:

    • Worsening symptoms

    • FAST