[16] Vertigo Flashcards
What is dizziness?
A general, non-specific term to indicate a sense of disorientation
Is vertigo the same as dizziness?
No, vertigo is a type of dizziness
What is vertigo?
A false sensation that oneself or the surroundings are moving or spinning
What is vertigo usually accompanied by?
- Nausea
- Loss of balance
What is vertigo the result of?
Mismatch between the vestibular, visual and somatosensory systems
What groups can the causes of vertigo be subdivided into?
- Central
- Peripheral
What structures can be affected in central vertigo?
- Cerebral cortex
- Cerebellum
- Brainstem
What structures can be involved in peripheral vertigo?
- Vestibular labyrinth
- Vesticular nerve
- Semicircular canals
What are the central causes of vertigo?
- Cerebrovascular disease
- Migraine
- MS
- Acoustic neuroma
- Diplopia
- Alcohol intoxication
What are the peripheral causes of vertigo?
- Viral labyrinthitis
- Vestibular neuritis
- BPPV
- Meniere’s disease
- Motion sickness
- Ototoxicitiy
- Herpes zoster (Ramsay Hunt)
What drug can cause ototoxicity?
Gentamicin
What does BPPV stand for?
Benign paroxysmal positional vertigo
What are the risk factors for vertigo?
- Older age
- Past episodes of dizziness
What sensation is experienced in vertigo?
Spinning whilst stationary
What other symptoms is vertigo commonly associated with?
- Nausea
- Vomiting
- Unsteadiness
- Falls
- Changes to person’s thought
- Difficulty walking
In what time frame can the symptoms of vertigo present?
- Insidious (persistent)
- Sudden (episodic)
What investigations are performed in primary care for vertigo?
Usually none
What investigatiosn can be performed for vertigo in secondary care?
- Audiometry
- Dix-Hallpike manoeuvre
- Electronystagmography
- CT or MRI
- EEG
- LP
- Syphilis serology
What is audiometry used for when testing for vertigo?
Assessing cochlear function
What is Dix-Hallpike used for in assessing vertigo?
Testing for BPPV
What can a CT or MRI be used to look for in a patient with vertigo?
Neurological causes
Why may an EEG be useful in assessing a patient with vertigo?
To look for epilepsy
What can an LP look for in a patient with vertigo?
MS
What are the differentials for vertigo?
- Postural hypotension
- Pre-syncope
- Non-specific dizziness
- Disequilibrium
What is disequilibrium?
When the brain receives inadequate information about the body’s position from the somatosensory, visual, and vestibular systems
What can cause disequilibrium?
- Peripheral neuropathy
- Eye disease
- Peripheral vestibular disorders
What does the management of vertigo depend upon?
The underlying cause
What general advice should be given to patients with vertigo?
- Don’t drive when dizzy or if likely to be dizzy
- Inform employer if dizziness makes work dangerous
- Discuss risk of falling and discuss measures to reduce this
What does the DVLA say with regards to vertigo?
People who are liable to sudden unprovoked attacks of disabling dizziness should stop driving
What drugs could be useful in managing associated symptoms of vertigo?
- Prochlorperazine
- Cyclizine
What are the potential complications of vertigo?
- Increased risk of falls
- Confinement to home
- Depression
