Vertigo and Dizziness - Virtual GP

Question 1

What are some possible causes of vertigo?

Answer 1

• Benign positional paroxysmal vertigo (BPPV)
• Acute labyrinthitis
• Meniere’s disease,
• Acoustic neuroma
• Ramsay Hunt Syndrome
• Ototoxicity

Question 2

Describe features of BPPV

Answer 2

• It is the presence of debris in the semi-circular canals of the ears.
• It causes vertigo upon head movement.
• The dix hallpike manoeuvre is diagnostic.
• Epley manoeuvres are used to treat BPPV by clearing debris

Question 3

Describe features of acute labyrinthitis

Answer 3

• Acute inflammation of the labyrinth which causes acute severe vertigo which may be associated with vomiting.
• Can be present with hearing loss and tinnitus (vestibular neuritis does not)
• Associated with recent viral infection or vascular lesion,
• Often resolves completely within a month

Question 4

Describe features of Meniere’s disease

Answer 4

• The endolymphatic system pressure increases which can cause recurrent vertigo, sensorineural hearing loss, tinnitus and feeling of aural fullness.
• Typically only affects one ear
• Treatment is antihistamines and bed rest

Question 5

Describe features of acoustic neuroma

Answer 5

• Actually vestibular schwannoma
• Presents with unilateral hearing loss and can progress to involve CN 5,6,9, 10 and ipsilateral cerebellum

Question 6

Describe features of Ramsay Hunt Syndrome

Answer 6

• Herpetic infection of facial nerve which can cause facial nerve palsy with or without vertigo, tinnitus and hearing loss.
• Treated with aciclovir and prednisolone

Question 7

Describe features of ototoxicity

Answer 7

Can be cause by aminoglycosides and loop diuretics

Question 8

What are some causes of dizziness

Answer 8

• Migraine,
• Stress or anxiety,
• Hypoglycaemia,
• Postural hypotension,
• Dehydration.
• Vertebrobasilar insufficiency (commonly caused by atherosclerosis)