Vertigo Flashcards
1
Q
What’s the differential diagnosis for vertigo?
A
- vestibular neuronitis
- meniere’s disease
- BPPV
2
Q
What are the symptoms of vestibular neuronitis?
A
- severe vertigo
- N&V
- gait instability
- nystagmus
- falling towards the affected side
- sever Sx 1-2 days
- mild symptoms for weeks or months
-other neuro Sx think of central cause (stroke, LMS)
3
Q
What examination tests can you use to clincally diagnose vestibular neuronitis?
A
- head impulse test - maintain fixed central point vision and rapidally move the head to one side.
- +ve if can’t maintain fixed central point = peripheral cause of vertigo
- nystagmus interrogation - H test and observe for gaze-evoked nystagmus
- peripheral cause = horizontal, unidirectional. fast component beats away from affected side
- skew test - fixed central point then cover and uncover one eye at a time
- refixation saccade to the central point upon uncovering = central cause
4
Q
Management for vestibular neuronitis?
A
-supportive
acute phase - buccal/IM prochlorperazine for N&V
-regular antihistamine there after at least 3 days
-vestibular rehab
5
Q
What is the Meniere triad?
A
-recurrent episodes of acute…. unilateral Sx…. minutes to hours.
- peripheral vertigo
- tinnitus
- asymmetrical SNHL
+/- N&V, ear fullness, a nystagmus
6
Q
What is the management of meniere’s disease?
A
- acute vestibular suppression - benzo or antihistamines
- +/- antiemetic
recurrence prevention:
- reduce stress
- low Na diet
- identification + avoidance of triggers (caffeine, alcohol, nicotine, stress)
- diruetics - thiazide like
- chemical ablation of the middle ear
7
Q
What are the symptoms for BPPV?
A
- sudden episodic vertigo
- lasting only seconds <1 minute
- triggered by moving head in a certain direction
8
Q
What is the diagnostic test for BPPV?
A
- dix-halpike manoeuvre
- provoke an attack
9
Q
What is the treatment for BPPV?
A
- epley manoeuvre
- return otolith’s to their rightful homes magic
