Vertigo Flashcards by Fred Kelting

What normally precedes labyrinthitis?

usually an URTI

However also:

middle ear infection
intrcranial sepsis
bactereamia

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What are the main symptoms of labyrinthitis?

Disabling vertigo lasting days to weeks

Residual vertigo due to rapid movements for some months

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What is the worst outcome in labyrinthitis?

Total destruction of the vestibule (the bit between the labyrinth and cochlea)

causing deafness

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What is the treatment of labyrinthitis?

antibiotics

vestibular sedatives (Prochlorperazine)

rest

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What is vestibular neuronitis?

Inflammation of the vestibular portion of the 8th nerve

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What is thought to be the cause of vestibular neuronitis?

Viral infection

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What is the treatment for vestibular neuronitis?

Same as for labyrinthitis:

antibiotics

vestibular sedatives (Prochlorperazine)

rest

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In vestibular neuronitis how is hearing affected?

It is usually NOT

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Describe the characteristics of benign paroxysmal positional vertigo (BPPV).

episodic vertigo

occurring when the head is moved in a certain position;

classically by turning in bed or

looking up at an object

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How long to episodes in benign paroxysmal positional vertigo (BPPV) usually last?

usually a few minutes

can remain for hours

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How often do episodes in benign paroxysmal positional vertigo (BPPV) usually occur?

Weeks or months

before settling

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How common is benign paroxysmal positional vertigo (BPPV) and which age group is it most common in?

most common cause of vertigo

occurs at any age

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How is benign paroxysmal positional vertigo (BPPV) diagnosed?

Clinically:
Hallpike manoeuvre

Nystagmus

Vertigo symptoms

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How does one perform the Hallpike manoeuvre?

sitting up to lying down

and tilting head down 30 degrees quickly

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Describe the nystagmus seen in benign paroxysmal positional vertigo (BPPV).

rotary towards affected ear

has a latent period before starting

It then: fatigues (slowly settles)

and shows adaptation (lessens with consecutive tests)

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What is thought to be the cause of benign paroxysmal positional vertigo (BPPV)?

dislodged otoliths

settling in the posterior semicircular canal

and causing irritation with particular movements

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How is benign paroxysmal positional vertigo (BPPV) treated?

Reassurance

Special head excercises (Epsley’s manoeuvre or cooksey-cawthorne exercises)

Rarely surgery on semi-circular canal

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When should vestibular sedatives (e.g. prochlorperazine) be used in BPPV?

They SHOULDNT be as they slow the compensation process

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What is presbystasis also known as?

disequilibrium

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What is presbystasis?

a momentary feeling of unsteadiness

particularly in elderly people

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What is thought to be the cause of presbystasis?

Small vessel disease in the brain

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Which symptoms can rule out a potential diagnosis of presbystasis?

N+V

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What is the prognosis of presbystasis and how is it treated?

Study These Flashcards

Usually self-limiting

There are no good treatments

What is vestibular migraine?

Study These Flashcards

Essentially a migrane

with vestibular symptoms (e.g. dizziness)

How long do symptoms of vestibular migraine usually last?

5 - 20 mins

How is vestibular migraine diagnosed?

It is a diagnosis of exclusion. Must rule out things like BPPV

What is the relationship of vestibular migraine and auditory symptoms?

They do not normally occur in vestibular migraine

How is vestibular migraine normally treated?

Same as normal migraines (Pizotifen – this is an antihistamine and 5-HT antagonist)

What are the three types of dizziness?

Central CV Peripheral

Which bits of anatomy are included in central dizziness?

vestibular nuclei, brainstem and upwards can be of a central nervous system or cardiovascular origin (probably small vessel disease)

What does central dizziness essentially equate to and what is it due to?

presbystasis ischemic small vessel disease of the brain

What are CV dizziness symptoms like?

General syncopal symptoms

What are some causes of CV dizziness?

postural hypotension arrhythmias vasovagal

What parts of anatomy are related to peripheral dizziness?

The labyrinth and vestibular nerve

What are the symptoms of peripheral dizziness?

Sudden episodes of vertigo almost always associated with N+V Hearing loss Tinnitus

Which symptoms of peripheral dizziness point towards a cochlear issue (with regards to peripheral dizziness)?

Hearing loss and tinnitus

What are some examples of peripheral dizziness?

BPPV Meniere’s disease (triad of vertigo, tinnitus and hearing loss) vestibular neuronitis

What is nystagmus a clinical sign of?

vestibular abnormality (i.e. inner ear except the cochlear)

What type of nystagmus points towards a peripheral cause?

rotary or horizontal nystagmus

What type of nystagmus ALWAYS points towards central causes?

vertical nystagmus or nystagmus that changes direction

How can you tell that there is a DESTRUCTIVE lesion in the labyrinth (regarding nystagmus)?

the nystagmus is always AWAY FROM the damaged ear

How can you tell that there is a IRRITATIVE lesion in the labyrinth (regarding nystagmus)?

the nystagmus is always TOWARDS the damaged ear

How many degrees of nystagmus are there?

Describe the degress of nystagmus using examples and what do they indicate?

(they indicate the acuteness of the lesion, with 3rd being the most acute) 1st: when looking left (1 direction) 2nd: when looking left and straight ahead (2 direction) 3rd: nystagmus when looking left, right and straight ahead (3 direction)

What are the symptoms of Meniere’s disease?

triad of vertigo (15mins-24hrs) tinnitus flucutant hearing loss

What are the 3 inputs for balance?

Proprioceptors Vision Labyrinth

What is the nature of nystagmus due to a cerebellar lesion?

Nystagmus is only the ispilateral side

What happens to nystagmus over time?

It reduces as the body compensates

How can you tell is someones labyrinth has ever been damaged?

Use Frenzel's glasses and this will elicit the first degree nystagmus that was caused when the labyrinth was originally damaged.

How long does it take for BPPV to get better?

Over 12-18 months

How common is Meniere’s disease?

Rare (ENT doctors see about 2-5 per year)

What is the typical age of onset of Meniere’s disease?

Middle age

What is the treatment of Meniere’s disease?

Reassurance, should spontaneously resolve (in 70%) Bendroflumethiaze is first line treatment too Can ablate the labyrinth surgically in extreme cases

What is an important differential to Meniere’s disease and how should it be investigated?

Acoustic neuroma, investigate using MRI.

What is benign vestibulopathy?

Like Meniere’s disease but: without hearing loss or tinnitus and benign vestibulopathy takes about 2 years to spontaneously resolve

What is the most common cause of acute labyrinthine faliure?

Fracture of temporal bone through labyrinth

What are the symptoms of vestibular neuronitis (and what symptoms does it not have)?

Sudden onset vertigo N+V nystagmus (No hearing loss or tinnitus)

Vertigo Flashcards

(57 cards)