Elderly; acute-onset; recurrent vertigo; tinnitus; hearing OK
Brainstem dysfunction/ cerebellar dysfunction
Symptoms of brainstem/vertebrobasilarvascular abnormality: ataxia, double vision; lack of coordination; sensory/ motor deficits; vertical, lateral, rotary nystagmus; hearing normal; cerebellar: impaired RAM, finger-to-finger testing
Brainstem dysfunction/ cerebellar dysfunction
DIAGNOSTIC STUDIES OF Brainstem dysfunction cerebellar dysfunction?
MRI
Onset is often in third or fourth decade of life
Multiple sclerosis
Can have no other findings or can have other neurological symptoms
Multiple sclerosis
DIAGNOSTIC STUDIES OF Multiple sclerosis?
MRI
Headache history; other migraine symptoms
Migraine headache
Can have symptoms of vertebrobasilarvascular abnormalities, as above
Migraine headache
DIAGNOSTIC STUDIES OF Migraine headache?
None
Adults:associated with positional changes; recurrent episodes; lasts seconds to minutes; some relief if motionless
Benign paroxysmal positional vertigo (BPPV)
Lateral or rotary nystagmus; no tinnitus or hearing loss
Benign paroxysmal positional vertigo (BPPV)
DIAGNOSTIC STUDIES OF Benign paroxysmal positional vertigo (BPPV)
Provoke nystagmus and vertigo by position that causes response; Dix-Hallpike maneuver; ENG
Children: usually 2-3 yr old, sudden onset with crying by child
Benign paroxysmal vertigo of childhood
Vomiting, pallor, sweating, and nystagmus common; no loss of consciousness; neurological and audiological examination can be normal
Benign paroxysmal vertigo of childhood
DIAGNOSTIC STUDIES OF Benign paroxysmal vertigo of childhood?
Can have hypoactive or absent response to caloric testing
Sudden onset; lasts hours, recurrent; tinnitus and fullness in ears
Meniere disease
Lateral or rotary nystagmus; fluctuating hearing loss: low tones; sensorineural
Meniere disease
DIAGNOSTIC STUDIES OF Meniere disease?
Positional maneuvers, positive VOR test, audiometry, ENG
Sudden onset; antecedent viral infection
Vestibular neuronitis
Nausea andvomiting; nystagmus; no hearing loss, lossofequilibriumalwaysto the same side
Vestibular neuronitis
DIAGNOSTIC STUDIES OF Vestibular neuronitis?
Positional maneuvers; positive VOR test
Sudden onset, lasts hours to days
Labyrinthitis
Can currently be ill; lateral nystagmus; hearing loss; rarely tinnitus; nausea and vomiting can be present
Labyrinthitis
DIAGNOSTIC STUDIES OF Labyrinthitis?
Positional maneuvers, positive VOR test, audiometry
Adults; gradual onset; mild vertigo; persistent tinnitus; facial numbness, weakness
Acoustic neuroma
Unilateral hearing loss, poor speech discrimination
Acoustic neuroma
DIAGNOSTIC STUDIES OF Acoustic neuroma?
MRI; audiometry
History of trauma; hearing loss
Perilymph fistula
Nystagmus and vertigo with pneumatic otoscopy; sensorineural hearing loss
Perilymph fistula
DIAGNOSTIC STUDIES OF Perilymph fistula?
Audiometry
Pain in ear or face; history of ear or sinus infections; gradual onset of vertigo
Otitis/sinusitis
Serous otitis, otitis media; tenderness over sinuses; purulent nasal discharge; no nystagmus
Otitis/sinusitis
History of chronic middle ear infections
Cholesteatoma
Shiny white irregular mass on otoscopic examination; foul-smelling discharge can be present; bone destruction can be visible; conductive hearing loss can be present
Cholesteatoma
DIAGNOSTIC STUDIES OF Cholesteatoma?
Audiometry
Vague symptoms; recurrent; can describe self as anxious; can have other psychiatric diagnoses
Psychogenic
Normal neurological and auditory examinations
Psychogenic
DIAGNOSTIC STUDIES OF Psychogenic?
Hyperventilation to reproduce the vertigo
Cardiovascular history; antihypertensive medications
Cardiovascular
Orthostatic blood pressure; dysrhythmias; carotid or temporal bruits
Cardiovascular
DIAGNOSTIC STUDIES OF Cardiovascular?
Depends on client condition and symptoms
Vertigo, tinnitus, fullness in ears
Neurosyphilis
Various clinical symptoms; papilledema, aphasia, monoplegia or hemiplegia, central nervous palsies, pupillary abnormalities, Argyll Robertson pupil; focal neurological deficits
Neurosyphilis
DIAGNOSTIC STUDIES OF Neurosyphilis?
Serology for syphilis
Medication history: steroids, phenylbutazone, ethacrynic acid, aspirin, streptomycin, gentamicin, aminoglycosides, furosemide, psychotropic drugs
Ototoxic and salt- retaining drugs
Sensorineural hearing loss
Ototoxic and salt- retaining drugs
DIAGNOSTIC STUDIES OF Ototoxic and salt- retaining drugs?
Audiometry
History of trauma to head or ear
Trauma
Depends on nature and location of injury; can exhibit peripheral or central symptoms
Trauma
DIAGNOSTIC STUDIES OF Trauma?
MRI/CT