2: Vertigo

Question 1

What is vertigo

Answer 1

False perception that either self or room is spinning

Question 2

How can the aetiology of vertigo be divided

Answer 2

Peripheral vertigo

Central vertigo

Question 3

What is central vertigo

Answer 3

CNS Dysfunction

Question 4

What is peripheral vertigo

Answer 4

Inner ear dysfunction

Question 5

Give 3 causes of peripheral vertigo

Answer 5

• Acute vestibular failure
• Meniere’s disease
• BPPV

Question 6

What does acute vestibular failure include

Answer 6

Acute neuritis

Acute labrynthitis

Question 7

What is the difference between vestibular neuritis and vestibular labriynthitis

Answer 7

Neuronitis = just involves the vestibular nerve. Whereas labrynthitis also involves labryinths.

Meaning neuritis - is just vertigo. Labrythitis also presents with hearing loss

Question 8

What are 4 causes of central vertigo

Answer 8

1. MS
2. Posterior stroke
3. Migraine
4. Acoustic neuroma

Question 9

What causes vertigo

Answer 9

imbalance between systems responsible for posture including eyes, proprioception and vestibular system

Question 10

What is dizziness

Answer 10

light-headedness/faintness

Question 11

Explain vestibular system

Answer 11

the semi-circular canals are organised at 90’ from one another. Change in head position causes a shift in fluid in these canals - which stimulates stercocilia in the ampulla. This signals the vestibular. N. Vestibular nucleus then can signal abducens, trochlea, vestibular - all responsible for controlling eye movements

Question 12

Explain how peripheral vertigo tends to present

Answer 12

• Severe
• Loss of balance
• N+V
• Hearing loss and tinnitus
• Horizontal nystagmus

Question 13

What type of nystagmus is present in peripheral vertigo

Answer 13

Horizontal

Question 14

How does central vertigo tend to present

Answer 14

• Less severe
• No hearing loss or tinnitus
• Horizontal or vertical nystagmus

Question 15

What type of nystagmus is present in central vertigo

Answer 15

Horizontal or vertical nystagmus

Question 16

What tends to exacerbate peripheral vertigo

Answer 16

Closing eyes or movement

Question 17

If a persons symptoms are worse on moving or closing their eyes - what type of vertigo do they have

Answer 17

Peripheral vertigo

Question 18

List 7 investigations used in work-up of vertigo

Answer 18

1. Otoscopy
2. CN3,4,6 = Eye movements
3. Gait - Rhombergs, unterbergers, tandem
4. Cerebellar
5. CN5, 7
6. Lying-Standing BP
7. Head thrust

Question 19

What is the head thrust test used to elicit

Answer 19

Vestibular- Occular Reflex

Question 20

Explain what normally happens in the vestibular-ocular reflex

Answer 20

compensatory saccade of the eyes is made in an equal and opposite direction - so eyes stay in the centre

Question 21

What is the head thrust test used for

Answer 21

To elicit the vestibular-ocular reflex

Question 22

What is the name of the test used to differentiate stroke and vestibular problems

Answer 22

Head Impulse, Nystagmus, Test Of Skew

Question 23

What are the two types of acute vestibular failure

Answer 23

Vestibular neuritis

Vestibular labyrinthitis

Question 24

What is vestibular neuritis

Answer 24

Inflammation vestibular nerve

Question 25

What is vestibular labryinthitis

Answer 25

Inflammation membranous labyrinth

Question 26

what typically triggers acute vestibular failure

Answer 26

viral infection

Question 27

Explain the clinical presentation of vestibular neuritis

Answer 27

URTI followed by: - Severe vertigo - Falling to affected side - Horizontal nystagmus - N+V - No hearing loss or tinnitus Recurrent attacks lasting hours-days

Question 28

How can vestibular neuritis be differentiated from posterior circulation stroke

Answer 28

Head Impulse, Nystagmus, Test of Skew

Question 29

What is used to treat acute mild attacks of vestibular neuritis

Answer 29

Anti-histamine (Cyclizine)

Question 30

What is used to treat acute severe attacks of vestibular neuritis

Answer 30

Buccal prochlorperazine

Question 31

What is used to prevent recurring episodes of vestibular neuritis

Answer 31

Cawthorne-Cooksey Exercises

Question 32

What is vestibular labrynthitis

Answer 32

Inflammation vestibular labyrinth

Question 33

What age is vestibular labrynthitis more common

Answer 33

40-70

Question 34

What is the most common cause of vestibular labrynthitis

Answer 34

Viral

Question 35

Explain how vestibular labrynthitis will present clinically

Answer 35

- Vertigo exacerbated by movement - Falls to unaffected side - N+V - SNHL - Tinnitus

Question 36

What is a sign of vestibular labrynthitis

Answer 36

Patient will have spontaneous unidirectional nystagmus to the unaffected side

Question 37

What is used to treat acute attack of vestibular labrynthtitis

Answer 37

- Prochlorperazine or anti-histamine

Question 38

What is used for prevention of vestibular labrynthitis

Answer 38

Cawthorne-Cooksey exercises

Question 39

What is benign paroxysmal positional vertigo

Answer 39

Displacement of calcium carbonate (canaliths) in posterior semi-circular canal

Question 40

What is the most common cause of peripheral vertigo

Answer 40

BPPV

Question 41

In which gender is BPPV more common

Answer 41

Females

Question 42

In which age-group is BPPV more common

Answer 42

>60

Question 43

Explain the pathophysiology of BPPV

Answer 43

Dislodgement and collection of canaliths (calcium carbonate) in posterior semi-circular canal

Question 44

What is the main cause of BPPV

Answer 44

Idiopathic (50%)

Question 45

What are 3 other causes of BPPV

Answer 45

- Head trauma - Post-vestibular neuritis - Post-whiplash

Question 46

Explain clinical presentation of BPPV

Answer 46

Sudden-onset attacks lasting seconds-minutes triggered by head movement. Individuals may fall towards the affected side.

Question 47

What type of nystagmus occurs in BPPV

Answer 47

Horizontal nystagmus

Question 48

What is the investigation for BPPV

Answer 48

Dix-Hallpike Manoeuvre

Question 49

What is a positive dix-hallpike manoeuvre

Answer 49

Presence of rotational nystagmus for less than 30s and is fatiguable. On sitting may be more vertigo and nystagmus

Question 50

If not self-limiting what is first line management for BPPV

Answer 50

Brandt-Daroff Exercises

Question 51

Prior to Epley manoeuvre what may patients be advised to perform at home

Answer 51

Brandt - Daroff Exercises

Question 52

What is meniere's disease

Answer 52

failure of re-absorption of endolymph, resulting in accumulation and endolymphatic hydrops

Question 53

What is the triad of symptoms in meniere's disease

Answer 53

1. Tinnitus 2. SNHL 3. Vertigo

Question 54

what other symptoms may be present in meniere's disease

Answer 54

- Aural fullness | - Horizontal nystagmus

Question 55

how long do attacks last in meniere's disease

Answer 55

Minutes - Hours

Question 56

explain progression of meniere's disease

Answer 56

Usually SNHL improves after each attack. However, if recurrent attacks SNHL may progress over time. Usually frequency of attacks decreases with age

Question 57

what investigations are ordered for meniere's disease

Answer 57

- Rinne, Weber's - Pure tone audiometry - Tympanometry

Question 58

how does meniere's disease present on tympanomatry

Answer 58

type A (normal)

Question 59

what is used to manage acute meniere's disease

Answer 59

- Prochlorperazine

Question 60

what is used as prophylaxis for meniere's disease

Answer 60

- Bethistine

Question 61

if ineffective, what are 3 options for management of meniere's disease

Answer 61

1. Insert gentamicin via grommet 2. Vestibular larbyinthectomy 3. Vestibular neurectomy