10 Vertigo Flashcards
What is vertigo
Perception of movement when none exists that results from a mismatch between the visual, vestibular, and proprioceptive sensory systems
Some features of peripheral vertigo
- Intense spinning
- Abnormal head impulse test
- Peripheral signs on all three bedside tests of HINTS
Some features of central vertigo
- Headache more likely
- Vertical nystagmus
- Head impulse test usually normal
- Central signs on at least one of 3 bedside tests of HINTS
What is Ramsay Hunt syndrome?
“Herpes zoster oticus”
Varicella-zoster virus reactivation in the geniculate ganglion of CN VII
Sometimes with involvement of the vestibular (Scarpa’s) ganglion of CN VIII
Presents with deafness, veritigo, facial nerve palsy, and vesicles in side the external auditory canal
What is Ménière’s syndrome?
Characterized by vertigo, unilateral tinnitus, sense of fullness, and diminished hearing
Due to endolymph buildup in the labyrinth
What is BPPV?
Benign paroxysmal positional vertigo
Caused by loose otoconia that most commonly enter the posterior semicircular canal
Veritigo results from head movement
Maneuvers done in BPPV
Dx: Dix-Hallpike maneuver
Tx: Epley maneuver
How to perform Dix-Hallpike maneuver?
- Begin with the patient seated with the head turned 45 deg to the right
- Rapidly lower the patient to a supine position, with the head hanging over the edge of the bed and the neck in 20 degrees of extension
- A positive test is when the patient experience a short-lived rotatory nystagmus, with rapid eye beating toward the affected (dependent) ear that ‘s associated with an acute episode of vertigo
- If positive, proceed with the Epley maneuver
- If negative, repeat the maneuver with the the head turned 45 degrees to the left.
How to perform the Epley maneuver?
- After a positive Dix-Hallpike and after nystamus and symptoms resolve (30-60 seconds, patient is currently in supine position with the head hanging 20º below the examining table), gently rotate the head 90º to the unaffected side
- After nystagmus and symptoms resolve, roll the patient on the the shoulder of the unaffected side as the head turns another 90º so it is nearly facedown.
- After nystagmus and symptoms resolve, return the patient to a sitting position with legs dangling off the side of the table and the head to the midline
Remaks on the Epley maneuver
- The patient may experience vertigo during any step of this procedure.
- The Epley maneuver may be repeated if necessary.
- If the Epley maneuver is not successful in relieving symptoms, consider instructing the patient in vestibular rehabilitation exercises
Most common cause of peripheral vertigo
BPPV
2nd most common cause of peripheral vertigo
Vestibular neuritis
Most common cause of central vertigo
Vestibular migraine
but much underdiagnosed
Vertigo with no hearing loss
Consider vestibular neuronitis
- sudden onset of severe vertigo
- thought to be viral in nature
- tx: antihistamine/antiemetics
Vertigo + Hearing loss
No tinnitus
Consider acoustic neuroma
