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SPC- ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

What is vertigo?

A

Sensation the everything is sinning

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2
Q

What are the features of vestibular (peripheral vertigo)

A

Often severe and may be accompanied by loss of balance, nausea and vomiting

Often coexisting hearing loss and tinnitus

Hearing loss and tinnitus do not feature as much in central vertigo

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3
Q

How can vertigo causes be divided?

A

Peripheral- damage of the vestibular apparatus or to the vestibular nerve
Central- damage to the vestibular structures in the brainstem or cerebellum

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4
Q

What are some peripheral causes of vertigo?

A

Meniere’s disease
BPPV
Vestibular failure
Labrynthitis

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5
Q

What are some central causes of vertigo?

A

Acoustic neuroma
Multiple sclerosis
Head injury
Migraine associated

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6
Q

What should you ask about when assessing for vertigo?

A

Ask did the world appear to spin (it is much more severe than just dizziness)

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7
Q

How can the duration of vertigo influence what might be causing it?

A

Seconds to minutes = BPPV
30 minutes to 30 hours= Meniere’s or migraine
Weeks= acute vestibular failure

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8
Q

If a patient presents with symptoms of vertigo, what should you examine?

A 
Cranial Nerves
Hearing tests
Test cerebellar function and reflexes
Check for nystagmus
Do Romberg's Test- can be positive with vestibular dysfunction
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9
Q

What does BPPV stand for?

A

Benign paroxysmal positional vertigo

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10
Q

What is the most common cause of vertigo?

A

BPPV

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11
Q

Describe the features of BPPV?

A

Episodes of vertigo lasting for at least 30 seconds
Attacks provoked by suddenly turning the head
Other otological sx (e.g tinnitus/hearing loss) are rare

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12
Q

What must you do to diagnose BPPV?

A

Rule out other potential causes of vertigo
Is there any speech, visual, motor or sensory problems
Is there any tinnitus, headache, ataxia, facial numbness or dysphagia

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13
Q

What is the treatment for BPPV?

A

It is usually self limiting
Epley maneuver- also can teach patients how to do this at home
Rarely surgery vestibular nerve section (rarely done)

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14
Q

What in Meniere’s disease?

A

Meniere’s disease occurs when there is dilation of the endolymphatic spaces that causes sudden attacks of vertigo lasting for 2-4 hours

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15
Q

How long do attacks of Vertigo last in Meniere’s disease?

A

2-4 hours

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16
Q

What are the feautres of Meniere’s disease?

A 
Vertigo lasting for 2-4 hours
Nystagmus
Feeling of fullness in the ears
Tinnitus
Sensorineural hearing loss is common

Meniere’s disease is due to dilation of the endolymphatic spaces

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17
Q

What investigations should be done for meniere’s disease?

A

Electrocochleography

Posterior fossa MRI

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18
Q

What treatment is available for Meniere’s disease?

Give answer for acute attack, prophylaxis and definitive

A

Acute attack:
Prochlorperazine (reduces nausea, it is a typical antipsychotic that reduces nausea) or an anti-histamine (cyclizine, promethazine)

Prophylaxis:
Betahistine (thought to reduce pressure in the endolymph)

Surgical:
Sac decompression, labyrinthectomy, vestibular neurectomy, gentamicin injections (as ototoxic)

Surgical options can cause permanent hearing loss in the affected ear.

19
Q

What is acute vestibular failure also called?

A

Labyrinthitis

Acute Vestibular neuronitis

20
Q

What are the symptoms of labyrinthitis?

A

Sudden attacks of unilateral vertigo
Nausea and vomiting
Previously well person
Often preceded by an URTI

21
Q

How long does labrynthitis last?

A

Typically lasts 1-2 days and improves over a week

22
Q

What signs may you seen with labrynthitis/acute vestibular failure?

A

Nystagmus- away from the affected side

Romberg’s positive

23
Q

What typically precedes acute vestibular failure?

A

A upper respiratory tract infection

Typically lasts 1-2 days and improves within a week

24
Q

What is the treatment for labrynthitis?

A

Buccastem- Prochlorperazine (Typical AP)

Cyclizine, Promethazine (Antihistamine)

25
Q

What are some causes of peripheral vertigo?

A

BPPV
Vestibular neuritis/Labyrinthitis
Meniere’s disease
Acoustic neuroma

26
Q

What are some causes of ventral vertigo?

A

Posterior circulation stroke
Brainstem tumour
Migraine
Multiple sclerosis

27
Q

What optical sign might be seen with vertigo?

A

Nystagmus

28
Q

How can nystagmus be used to identify if vertigo is central or peripheral?

A

Central Vertigo- nystagmus is horizontal, torsional or rotary and vertical. Nystagmus lasts for > 1 minute.

Peripheral- Never vertical nystagmus, horizontal or torsional. Nystagmus lasts for less than 1 minute.

29
Q

What maneuver can be used to provoke nystagmus with vertigo?

A

Dix-Hallpike maneuver

30
Q

What 4 ds often suggest central vertigo?

A

Diplopia
Dysphagia
Dysarthria
Dysmetria

31
Q

What tends to co-exist with peripheral vertigo?

A

Tinnitus

Hearing loss

32
Q

What causes BPPV?

A

Calcium carbonate crystals entering the endolymph and disrupting flow and sensation

33
Q

What triggers BPPV?

A

Sudden movements of the head

34
Q

How long do episodes last of BPPV?

A

Typically less than 1 minute

35
Q

Are tinnitus and hearing loss usually present in BPPV?

A

No they’re not- they are in meniere’s disease

36
Q

What can be done to treat BPPV?

A

Epley Maneuver- patients can be taught to do a modified version of this themselves.

37
Q

What does vestibular neuritis cause?

A

This is also labrynthitis and acute vestibular failure

It causes acute vertigo which can last for 1-2 days (usually subsides within a week). Often preceded by an upper respiratory tract infection. May be some associated hearing loss.

38
Q

What causes Meniere’s disease?

A

Due to dilation of endolymphatic spaces with excess endolymph fluid

39
Q

Who is generally affected by meniere’s disease?

A

Elderly- aged over 60

40
Q

What are some symptoms of Meniere’s disease?

A 
Recurrent episodic vertigo
Episodes last for 2-4 hours
Hearing loss
Tinnitus
Sense of ear fullness (feeling of pressure in the ear)
41
Q

What tumour can cause peripheral vertigo?

A

Acoustic neuroma

This can also be a cause of acute unilateral sensorineural hearing loss which requires urgent referral

42
Q

What type of stroke can cause vertigo?

A

Posterior circulation stroke

Ask about weakness, sensory changes, dysphagia, dysarthria, diplopia. Look for nystagmus too.

Do a brain MRI in case posterior circulation stroke.

43
Q

What is the natural history of Meniere’s disease?

A

Symptoms will resolve in the majority of patients after 5-10 years
Majority will be left with some degree of hearing loss

SPC- ENT (12 decks)

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