Vertigo and associated disorders Flashcards
What is vertigo?
Vestibular impairment which makes it feel like the room is spinning or they are spinning
Peripheral vertigo:
What is it due to?
Causes?
Pathology in the semicircular canals or trickles or vestibular nerve
BPPV Vestibular labyrinthitis Meniere's disease Vestibular migraine Herpes zoster optics
Central vertigo:
What is it due to?
Causes?
Lesions of the vestibular nuclei in the pons and medusa
Lesions in the cerebellum
Posterior stroke (typically cerebellar)
Tumour - acoustic neuroma
MS
Drugs - alcohol, gentamicin
Examinations/Tests
Assess CN’s and ears
Test cerebellar function and reflexes
Assess nystagmus, gait, Romberg’s test (positive implies impaired vestibular function)
BPPV:
What does it stand for?
Pathophysiology?
Characteristic symptoms
Benign paroxysmal positional vertigo
Displacement of otoliths
Vertigo for 20-30 seconds and vertical nystagmus by head movements - rolling over in bed
BPPV:
What manoeuvre is used to diagnose it and what would you see?
What else needs to be done to ensure the right diagnosis has been made?
What from a patients presentation would steer you towards this diagnosis?
Dik-Hallpike Manoeuvre - Nystagmus
Everything else is ruled out - no speech, visual, motor or sensory problems, no tinnitus etc.
No ongoing dizziness or nystagmus at rest
BPPV Management:
What usually happens?
Manoeuvre that can be used?
Anything else?
Self limiting
Epley manoeuvre
Hope repositioning manoeuvres/vestibular habituation exercises
Meniere’s Disease
What is it?
A long term, progressive condition affecting the balance and hearing parts of the inner ear.
Meniere’s Disease
Presentation - 4
How else could the ear feel?
Vertigo (2-4 hrs)
Tinnitus
Unilateral sensorineural hearing loss
Nystagmus during attacks
Fullness in ear
Meniere’s Disease
Management:
What can be given buccal or IM during an attack?
Why is betahistine given?
What can be offered for chronic vertigo?
What needs to be ruled out by an MRI?
Prochlorperazine
To prevent attacks and help with vertigo
Vestibular rehabilitation
Acoustic neuroma
Acute vestibular failure:
2 types
How long does the vertigo last?
When does it improve?
What gaze do you find some nystagmus?
Associated symptoms?
Vestibular neuronitis/labyrinthitis
Continuous - hours to days after sudden or gradual onset - 1-2 days
Lateral gaze - away from affected side
N&V
Unsteady gait
Vestibular neuritis
What is the cause?
What might precede it?
What term is used when it affects your hearing or you get tinnitus?
Treatment
Viral infection of the vestibular nerve
Viral URTI
Labyrinthitis
Prochlorperazine (Buccastem)
Antihistamine (cyclazine)
What other symptoms would indicate a stroke?
Presence of additional neurological symptoms:
Facial droop
Dysphasia etc
What needs to be ruled out when you meet someone with sudden onset dizziness?
Posterior circulation stroke
