Vertigo Flashcards
(26 cards)
Vertigo Definition
Vertigo is a symptom of illusory movement, most commonly of spinning of oneself or of the environment. Elderly patients often have symptoms of dysequilibrium rather than vertigo, presbyastasis is a decline in vestibular processing that reduces the ability to combine vestibular, visual and proprioceptive signals
Vertigo Differentials
- Benign Paroxysmal Positional Vertigo (BPPV) (50%)
- Meniere’s Disease
- Acute Vestibulopathy
- Vestibular migraine
- Stroke (not to be missed)
- Acoustic neuroma
Differences in BPPV, Meniere’s Disease and Acute Vestibulopathy (for episodes, course & population)
Episodes
- BPPV - Seconds
- Meniere’s Disease - Hours
- Acute Vestibulopathy - Days
Course
- BPPV & Meniere’s Disease - Recurrent
- Acute Vestibulopathy - Single
Population
- BPPV - Old
- Meniere’s Disease - Middle aged
- Acute Vestibulopathy - Young
Define BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is a common type of acute vertigo that is caused by changing the head position, particularly tilting the head backwards, changing from a sitting position or turning to the affected side.
BPPV Epidemiology
It affects all ages, especially the elderly. There may be an association with trauma and viral vestibular neuronitis. In most cases there is no predisposing factor other than age.
BPPV Pathophysiology
The cause is idiopathic but there may be dislodged calcium debris in the posterior semicircular canal (otolith).
BPPV Clinical Presentation
BPPV is characterised by recurrent episodes of vertigo lasting one minute or less, provoked by specific types of head movements. Although individual episodes are brief, these typically reoccur periodically for weeks to months without therapy.
BPPV Diagnosis
Observing nystagmus or vertigo during the Dix-Hallpike manoeuvre (below) solidifies the diagnosis of BPPV
BPPV Management
The Epley manoeuvre. These manoeuvres encourage debris to migrate towards the common crus of the anterior and posterior canals and exit into the utricular cavity. This is a single treatment with good efficacy.
Define Meniere’s Disease
Meniere’s Disease is a condition that is thought to arise from abnormal fluid and ion homeostasis in the inner ear. There disease is named after Prospere Meniere (physician) who thought the inner ear could be the source of a syndrome manifesting episodic vertigo, tinnitus and hearing loss.
Meniere’s Disease Epidemiology
It is the commonest in the 30-50 years age group.
Meniere’s Disease Pathophysiology
The aetiology is unknown, but may be related to anatomic, immunologic, genetic and/or vascular factors. The result is that there is a build up of endolymph (fluid in the inner ear), known as endolymphatic hydrops in the labyrinthine system of the affected ear.
Meniere’s Disease Clinical Presentation
- Episodic vertigo
* A true spinning sensation that has an onset and an off set
* Lasts for 4-24 hours- Sensorineural hearing loss
- Tinnitus
Aural fullness (pressure or fullness in the ear) and nausea may be seen in conjunction with these symptoms.
Meniere’s Disease Course
The course of Meniere disease varies among individuals. Some have hearing fluctuating and progressive hearing loss with infrequent vestibular symptoms; some have severe and frequent vertigo with mild auditory symptoms. Approximately 2/3 of patients experience vertigo attacks in clusters, while 1/3 have sporadic attacks. The frequency of episodes may decline over time.
Meniere’s Disease Diagnosis
- 2 spontaneous episodes of rotational vertigo lasting > 20 minutes
- Audiometric confirmation of sensorineural hearing loss
- Tinnitus and/or a perception of aural fullness
Meniere’s Disease Management
Meniere disease is a chronic condition, patients should be given reasonable expectations of treatment which include symptom relief but not cure. A referral to an otologist should be sought
Acute and Prevention Management
Acute Meniere’s Disease Management
- Anticipation of attack
* Prochlorperzine (stemetil) - anti emetic
* Dopamine agonist
* Urea - quickly reduces bodily fluid (incl inner ear)- Treatment
- Diazepam IV - vestibular sedative
- Treatment
Meniere’s Disease Prevention Management
- Diet - reduce
* Salt diet
* Caffeine
* Nicotine
* Alcohol- Diuretics when diet is inadequate
- Betahistine dihydrochloride - Antivertigo drug
Define Acute Vestibulopathy
Acute vestibulopathy covers both vestibular neuronitis and labyrinthitis, which are considered to be a viral infection of the vestibular nerve and labyrinth respectively, causing a prolonged attack of vertigo that can last for several days, be severe enough to require hospital admission and cause repeated falls.
Analogous to a viral infection of the 7th nerve causing Bell’s palsy (See Ramsay Hunt Syndrome)
Acute Vestibulopathy Epidemiology
Commonly a disease of young adults and the middle aged
Acute Vestibulopathy Pathophysiology
Believe to be a viral or post viral inflammatory disorder, affecting the vestibular portion of the 8th cranial nerve. It is basically a diagnosis of exclusion.
Acute Vestibulopathy Clinical Presentation
The clinical features are an acute onset of vertigo with:
- Nausea
- Vomiting
- Gait impairment
These features overlap with acute vascular events in the cerebellum or brainstem.
Acute Vestibulopathy Management
Both disorders are self-limiting that usually settle over 5-7 days or several weeks. Labyrinthitis usually lasts longer and during recovery rapid head movements may bring on transient vertigo. In the acute phase, we can use:
- Anti-emetic
- Dimenhydrinate (Dramamine)
- Prochlorperzine (Stemetil)
- Diazepam - vestibular sedative
- Corticosteroids - short course may assist
Define Acoustic Neuroma
Vestibular schwannomas (acoustic neuromas) account for 80-90% of Cerebellopontine Angle Tumours (CPAs) in adults.
