Vestibular dysfunction Flashcards by Hannah Nolan

Cause of BPPV

Mostly idiopathic
Can follow vestibular neuritis
Crystals come out of semicicular canals and enter utricles

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Symptoms of BPPV

Worsened by head movements, often in a particular direction
Rotational vertigo less commonly nausea, light headedness
Vertigo - 30s to 1 minute. Episodes can last months
Episodic
Rotational vertigo, less commonly naursea, light headedness

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Treatment BPPV symptomatic

H1 receptor agonist - vasodilation ear

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ABCD2 what is used for

Chances of stroke after TIA

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Investgiation BPPV

Dix Hallpike test

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Symptoms of labyrinthitis

Nausea, vomitting
Vertigo
Unsteady

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What is vestibular neuritis?

Disorder causing acute isolated, spontaneous, prolonged vertigo of peripheral origin

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What causes vestibular neuritis?

Inflammation of the vestibular nerve, often after a viral infection

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How is hearing affected in labyrinthitis vs vestibular neuritis?

vestibular neuritis - hearing not affected
Labyrinthtis - hearing loss

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What can develop after vestibular neuritis?

BPPV - 1 in 10
Phobic postural vertigo - persistent dizziness and feelings of unsteadiness + fear of falling

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Symptoms of vestibular neuronitis

Rotational vertigo occurs spontaneously
Exacerbated when move head
Initially constant when head is still
Nausea +/- vomitting, + other autonomic symptoms eg malaise, pallor, sweating
Balance

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Test for differentiating vestibular neuritis and central lesion

Head impulse test

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What is a positive on the head impulse test?

Corrective saccade - abnormal movement as eyes move to fix back on examiner
Disrupted vestibulo-ocular reflex
Moderate to severe loss of function horizontal semi-circular canal on side to which test is positive

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How to do head impulse test

dvise the person to sit upright and to fix their gaze on the examiner.
Then rapidly turn the head 10–20 degrees to one side and watch the person’s eyes. In a normal response (indicating a normal peripheral vestibular system), the eyes stay fixed on the examiner. If the eyes are dragged off target by the head turn, a corrective abnormal movement (saccade) occurs as the eyes move back to fix on the examiner.

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What is the prognosis of vestibular neuritis?

Worse for first few days, resolves in 2-6 weeks
Bed rest may be necessary

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What factors can worsen balance in vestibular neuritis?

Alchool, tiredness, intercurrent illness

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What med rapidly relieves severe nausea or vomitting ass with vertigo?

Buccal Prochloperazine
IM injection of above or cyclizine

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Medications for nausea, vommitting, vertigo (longer term)

short oral course (3 days) porchlorperazone OR
antihistamine - cinnarizine, cyclizine (50mg), promethazine teoclate

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Why should meds for vestibular neuritis be taken for as short as possible?

May delay recovery by affecting bodys compensatory mechanisms

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Cyclizine contraindications

Prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction.
Hepatic disease.
Epilepsy.
Severe heart failure or acute myocardial infarction — cyclizine may cause a fall in cardiac output associated with increases in heart rate, mean arterial pressure, and pulmonary wedge pressure.
Phaeochromocytoma.

What is the difference between first and second gen antihistamines?

2nd gen don’t cause drowsiness and interact better with other medications

Examples of first gen anithistmaines

chlorphenamine (Piriton), cinnarizine, diphenhydramine, hydroxyzine and promethazine

Examples of 2nd gen antihistamines

acrivastine, cetirizine, fexofenadine and loratadine

Why do you do an MRI in Mennieres?

Rule out acoustic neuroma

What is Meniere's disease?

disorder of the inner ear that causes vertigo, tinnitus, hearing loss, and a feeling of fullness or congestion in the ear

Risk factors for Menieres disease

Autoimmunity Genetic susceptibility Metabolic disturbances - balance of circulating levels of Na and K in fluid inner ear Vascular factors - migraine Viral infection Head trauma

Complciations of Menieres

Falls, psychological effects - anxiety, depression, agrophobia , social effects - work, driving, limitations

Symptoms of Menieres

Episodes of spontaneous vertigo Tinnitus - during attacks, later is permanent Fluctuating sensorineural hearing loss - initally low then higher + permanent Aural fullness - Sensation pressure in ear, in advance of vertigo attack

Features of acute attacks of Menieres disease

Preceded by chnage in tinitus, increased hearing loss, aural fullness Vertigo At least 20 mins, normally a few hours, not beyond 24 hours Can occur in clusters over a few weeks Can have months or years of remission

What is an otholitic crisis of tumarkin?

Drop attacks without LOC occur without warning

Exam in menieres

Head and neck Rombergs test +VE Unterbergers test - march on spot with eyes closed - move to side During episode vertigo, nystagmusA Audiometry - sensorineural hearing loss

What does a definite diagnosis of Menieres require?

Vertigo - at least 2 spontaneous episodes 20 mins to 12 hojurs Fluctuating hearing, tinnitus, aural fullness mHearing loss confirmed by audiometry to be sensorineural, low to mid frequency No other more likely vestibular dysfunction Refer to ENT to confirm

How does hearing loss start in Menireres?

Low to mid frequency Progresses to high Initially can regain, then becomes permanent

Differentials menieres

Acoustic neuroma MS Perilymph fistula Vascular events - TIA Migraine BPPV Vestibular neuitis/labyrinthis=tis

What medications use for alleviating nausea, vomitting + vertigo in Menieres?

7 dyas of prochlorperazine or antihistamine cinnarizine, cyclizine, or promethazine teoclate 14 if required previosuly

When admit someone with menieres

If severe that need IV labyrinthine sedatives and assessment of hydration and nutrition + maintenacnce of these with fluids

Preventation of recurrent arracks of Menieres disease?

Betahistines - reduce frequency and severity of attacks of hearing loss, tiniitis and vertigo

Betahistine amount and whne for menieres

16mg orally 3 times daily Maintenance dose - 24-48 mg

What is acoustic neuroma?

Benign slow groiwing tumour of Schwann cells in vestibular nerve Also known as vestibular schwannoma

Cuase of acoustic neuroma

Often unknown, 1 in 10 its Neurfobromatosis type 2 (causes bilateral)

Symptoms of acoustic neuroma what depend on?

Cna damage CNV,CNVII, CNVIII, CNIX X+XI - depends which one effected Size - if small often asymptomatic

Symtpoms of acoustic neuroma

Sensorineural Hearing loss unilateral (unless NF2) Tinnnitus Vertigo Facial numbness, tingling or pain - due to effect on other CNs Less commonly: Headache Earache Visual probelms, due to hydrocephalus Fatigue

Why can acoustic neuromas cause a headache?

(blocks CSF fluid in brain -> raised ICP + hydrocephalus Can lead to brain damage

Treatment for acoustic neuroma

Surgery - remove, dependring on size location on VC nerve Small part left behind -> radiotherapy Biologics new potential

Complications of acoustic neuroma treatment eg surgery

Damge to CNVII 0 facial nerve -> facial nerve palsy - one side of face droops Damage to vestibulocochlear nerve -> deafness Damage to CNV - facial numbness

What cranial nerve if damaged would cause facial numbness?

CNV - trigeminal

What cranial nerve if damaged would cause facial weakness?

CNVII - facial nerve

Treatment for hydrocephalus

Shunt inserted into brain - relieve pressure, reintroduce CSF flow