Vertigo and dizziness Flashcards
What is vertigo
Hallucination of movement often rotary of the patient or their surroundings
What symptoms may be associated with vertigo
Difficulty standing or walking Relief on lying or sitting still Vertigo is worsened on movement Nausea Vomiting Pallor Sweating Associated hearing loss or tinnitus
What does vertigo with associated hearing loss or tinnitus suggest?
Labyrinth or 8th cranial nerve involvement
What is benign positional vertigo?
Occurs on head movement due to disruption of debris in the semi-circular canals of the ears (canalothiasis)
How is BPPV diagnosed?
Hallpike manoeuvre
How is BPPV treated?
Epley manoeuvre clears the debris
Describe acute labyrinthitis (vestibular neuronitis)
Abrupt onset of severe vertigo, nausea and prostration
No deafness or tinnitus
What causes acute labyrinthitis
Viral
Vascular lesion
Describe the prognosis of acute labyrinthitis
Severe vertigo subsides in days, complete recovery takes 3-4 weeks
What is the treatment for acute labyrinthitis
Reassure
Sedate
Describe Meniere’s disease
Increased pressure in the endolymphatic system of the inner ear causes recurrent attacks of vertigo lasting >20mins, fluctuating sensorineural hearing loss and tinnitus (with sense of aural fullness and falling to one side)
How is Meniere’s treated?
Bed rest and reassurance in acute attacks An antihistamine (cinnarizine) is useful if prolonged or buccal prochlorperazine if severe for up to 7 days
Which drugs can cause ototoxicity
Aminoglycosides
Loop diuretics
Cisplatin
Describe the symptoms of ototoxicity
Deafness
Vertigo
Describe acoustic neuroma (schwannoma)
Arises from the vestibular nerve
Often present with unilateral hearing loss with vertigo occurring late
Slow growth rate (1-2mm/year)
Growth can be predicted by serial MRIs
With progression, ipsilateral 5gth, 6th, 9th and 10th nerves may be affected, also ipsilateral cerebellar signs)
Signs of increased ICP occur late indicating a large tumour
