2: Vertigo Flashcards
What is vertigo
False perception that either self or room is spinning
How can the aetiology of vertigo be divided
Peripheral vertigo
Central vertigo
What is central vertigo
CNS Dysfunction
What is peripheral vertigo
Inner ear dysfunction
Give 3 causes of peripheral vertigo
- Acute vestibular failure
- Meniere’s disease
- BPPV
What does acute vestibular failure include
Acute neuritis
Acute labrynthitis
What is the difference between vestibular neuritis and vestibular labriynthitis
Neuronitis = just involves the vestibular nerve. Whereas labrynthitis also involves labryinths.
Meaning neuritis - is just vertigo. Labrythitis also presents with hearing loss
What are 4 causes of central vertigo
- MS
- Posterior stroke
- Migraine
- Acoustic neuroma
What causes vertigo
imbalance between systems responsible for posture including eyes, proprioception and vestibular system
What is dizziness
light-headedness/faintness
Explain vestibular system
the semi-circular canals are organised at 90’ from one another. Change in head position causes a shift in fluid in these canals - which stimulates stercocilia in the ampulla. This signals the vestibular. N. Vestibular nucleus then can signal abducens, trochlea, vestibular - all responsible for controlling eye movements
Explain how peripheral vertigo tends to present
- Severe
- Loss of balance
- N+V
- Hearing loss and tinnitus
- Horizontal nystagmus
What type of nystagmus is present in peripheral vertigo
Horizontal
How does central vertigo tend to present
- Less severe
- No hearing loss or tinnitus
- Horizontal or vertical nystagmus
What type of nystagmus is present in central vertigo
Horizontal or vertical nystagmus
What tends to exacerbate peripheral vertigo
Closing eyes or movement
If a persons symptoms are worse on moving or closing their eyes - what type of vertigo do they have
Peripheral vertigo
List 7 investigations used in work-up of vertigo
- Otoscopy
- CN3,4,6 = Eye movements
- Gait - Rhombergs, unterbergers, tandem
- Cerebellar
- CN5, 7
- Lying-Standing BP
- Head thrust
What is the head thrust test used to elicit
Vestibular- Occular Reflex
Explain what normally happens in the vestibular-ocular reflex
compensatory saccade of the eyes is made in an equal and opposite direction - so eyes stay in the centre
What is the head thrust test used for
To elicit the vestibular-ocular reflex
What is the name of the test used to differentiate stroke and vestibular problems
Head Impulse, Nystagmus, Test Of Skew
What are the two types of acute vestibular failure
Vestibular neuritis
Vestibular labyrinthitis
What is vestibular neuritis
Inflammation vestibular nerve
What is vestibular labryinthitis
Inflammation membranous labyrinth
what typically triggers acute vestibular failure
viral infection
Explain the clinical presentation of vestibular neuritis
URTI followed by:
- Severe vertigo
- Falling to affected side
- Horizontal nystagmus
- N+V
- No hearing loss or tinnitus
Recurrent attacks lasting hours-days
How can vestibular neuritis be differentiated from posterior circulation stroke
Head Impulse, Nystagmus, Test of Skew
What is used to treat acute mild attacks of vestibular neuritis
Anti-histamine (Cyclizine)
What is used to treat acute severe attacks of vestibular neuritis
Buccal prochlorperazine
What is used to prevent recurring episodes of vestibular neuritis
Cawthorne-Cooksey Exercises
What is vestibular labrynthitis
Inflammation vestibular labyrinth
What age is vestibular labrynthitis more common
40-70
What is the most common cause of vestibular labrynthitis
Viral
Explain how vestibular labrynthitis will present clinically
- Vertigo exacerbated by movement
- Falls to unaffected side
- N+V
- SNHL
- Tinnitus
What is a sign of vestibular labrynthitis
Patient will have spontaneous unidirectional nystagmus to the unaffected side
What is used to treat acute attack of vestibular labrynthtitis
- Prochlorperazine or anti-histamine
What is used for prevention of vestibular labrynthitis
Cawthorne-Cooksey exercises
What is benign paroxysmal positional vertigo
Displacement of calcium carbonate (canaliths) in posterior semi-circular canal
What is the most common cause of peripheral vertigo
BPPV
In which gender is BPPV more common
Females
In which age-group is BPPV more common
> 60
Explain the pathophysiology of BPPV
Dislodgement and collection of canaliths (calcium carbonate) in posterior semi-circular canal
What is the main cause of BPPV
Idiopathic (50%)
What are 3 other causes of BPPV
- Head trauma
- Post-vestibular neuritis
- Post-whiplash
Explain clinical presentation of BPPV
Sudden-onset attacks lasting seconds-minutes triggered by head movement. Individuals may fall towards the affected side.
What type of nystagmus occurs in BPPV
Horizontal nystagmus
What is the investigation for BPPV
Dix-Hallpike Manoeuvre
What is a positive dix-hallpike manoeuvre
Presence of rotational nystagmus for less than 30s and is fatiguable. On sitting may be more vertigo and nystagmus
If not self-limiting what is first line management for BPPV
Brandt-Daroff Exercises
Prior to Epley manoeuvre what may patients be advised to perform at home
Brandt - Daroff Exercises
What is meniere’s disease
failure of re-absorption of endolymph, resulting in accumulation and endolymphatic hydrops
What is the triad of symptoms in meniere’s disease
- Tinnitus
- SNHL
- Vertigo
what other symptoms may be present in meniere’s disease
- Aural fullness
- Horizontal nystagmus
how long do attacks last in meniere’s disease
Minutes - Hours
explain progression of meniere’s disease
Usually SNHL improves after each attack. However, if recurrent attacks SNHL may progress over time. Usually frequency of attacks decreases with age
what investigations are ordered for meniere’s disease
- Rinne, Weber’s
- Pure tone audiometry
- Tympanometry
how does meniere’s disease present on tympanomatry
type A (normal)
what is used to manage acute meniere’s disease
- Prochlorperazine
what is used as prophylaxis for meniere’s disease
- Bethistine
if ineffective, what are 3 options for management of meniere’s disease
- Insert gentamicin via grommet
- Vestibular larbyinthectomy
- Vestibular neurectomy
