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ENT > 2: Vertigo > Flashcards

2: Vertigo Flashcards

1
Q

What is vertigo

A

False perception that either self or room is spinning

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2
Q

How can the aetiology of vertigo be divided

A

Peripheral vertigo

Central vertigo

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3
Q

What is central vertigo

A

CNS Dysfunction

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4
Q

What is peripheral vertigo

A

Inner ear dysfunction

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5
Q

Give 3 causes of peripheral vertigo

A
  • Acute vestibular failure
  • Meniere’s disease
  • BPPV
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6
Q

What does acute vestibular failure include

A

Acute neuritis

Acute labrynthitis

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7
Q

What is the difference between vestibular neuritis and vestibular labriynthitis

A

Neuronitis = just involves the vestibular nerve. Whereas labrynthitis also involves labryinths.

Meaning neuritis - is just vertigo. Labrythitis also presents with hearing loss

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8
Q

What are 4 causes of central vertigo

A
  1. MS
  2. Posterior stroke
  3. Migraine
  4. Acoustic neuroma
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9
Q

What causes vertigo

A

imbalance between systems responsible for posture including eyes, proprioception and vestibular system

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10
Q

What is dizziness

A

light-headedness/faintness

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11
Q

Explain vestibular system

A

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

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12
Q

Explain how peripheral vertigo tends to present

A
  • Severe
  • Loss of balance
  • N+V
  • Hearing loss and tinnitus
  • Horizontal nystagmus
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13
Q

What type of nystagmus is present in peripheral vertigo

A

Horizontal

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14
Q

How does central vertigo tend to present

A
  • Less severe
  • No hearing loss or tinnitus
  • Horizontal or vertical nystagmus
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15
Q

What type of nystagmus is present in central vertigo

A

Horizontal or vertical nystagmus

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16
Q

What tends to exacerbate peripheral vertigo

A

Closing eyes or movement

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17
Q

If a persons symptoms are worse on moving or closing their eyes - what type of vertigo do they have

A

Peripheral vertigo

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18
Q

List 7 investigations used in work-up of vertigo

A
  1. Otoscopy
  2. CN3,4,6 = Eye movements
  3. Gait - Rhombergs, unterbergers, tandem
  4. Cerebellar
  5. CN5, 7
  6. Lying-Standing BP
  7. Head thrust
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19
Q

What is the head thrust test used to elicit

A

Vestibular- Occular Reflex

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20
Q

Explain what normally happens in the vestibular-ocular reflex

A

compensatory saccade of the eyes is made in an equal and opposite direction - so eyes stay in the centre

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21
Q

What is the head thrust test used for

A

To elicit the vestibular-ocular reflex

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22
Q

What is the name of the test used to differentiate stroke and vestibular problems

A

Head Impulse, Nystagmus, Test Of Skew

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23
Q

What are the two types of acute vestibular failure

A

Vestibular neuritis

Vestibular labyrinthitis

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24
Q

What is vestibular neuritis

A

Inflammation vestibular nerve

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25
Q

What is vestibular labryinthitis

A

Inflammation membranous labyrinth

26
Q

what typically triggers acute vestibular failure

A

viral infection

27
Q

Explain the clinical presentation of vestibular neuritis

A

URTI followed by:

  • Severe vertigo
  • Falling to affected side
  • Horizontal nystagmus
  • N+V
  • No hearing loss or tinnitus

Recurrent attacks lasting hours-days

28
Q

How can vestibular neuritis be differentiated from posterior circulation stroke

A

Head Impulse, Nystagmus, Test of Skew

29
Q

What is used to treat acute mild attacks of vestibular neuritis

A

Anti-histamine (Cyclizine)

30
Q

What is used to treat acute severe attacks of vestibular neuritis

A

Buccal prochlorperazine

31
Q

What is used to prevent recurring episodes of vestibular neuritis

A

Cawthorne-Cooksey Exercises

32
Q

What is vestibular labrynthitis

A

Inflammation vestibular labyrinth

33
Q

What age is vestibular labrynthitis more common

A

40-70

34
Q

What is the most common cause of vestibular labrynthitis

A

Viral

35
Q

Explain how vestibular labrynthitis will present clinically

A
  • Vertigo exacerbated by movement
  • Falls to unaffected side
  • N+V
  • SNHL
  • Tinnitus
36
Q

What is a sign of vestibular labrynthitis

A

Patient will have spontaneous unidirectional nystagmus to the unaffected side

37
Q

What is used to treat acute attack of vestibular labrynthtitis

A
  • Prochlorperazine or anti-histamine
38
Q

What is used for prevention of vestibular labrynthitis

A

Cawthorne-Cooksey exercises

39
Q

What is benign paroxysmal positional vertigo

A

Displacement of calcium carbonate (canaliths) in posterior semi-circular canal

40
Q

What is the most common cause of peripheral vertigo

A

BPPV

41
Q

In which gender is BPPV more common

A

Females

42
Q

In which age-group is BPPV more common

A

> 60

43
Q

Explain the pathophysiology of BPPV

A

Dislodgement and collection of canaliths (calcium carbonate) in posterior semi-circular canal

44
Q

What is the main cause of BPPV

A

Idiopathic (50%)

45
Q

What are 3 other causes of BPPV

A
  • Head trauma
  • Post-vestibular neuritis
  • Post-whiplash
46
Q

Explain clinical presentation of BPPV

A

Sudden-onset attacks lasting seconds-minutes triggered by head movement. Individuals may fall towards the affected side.

47
Q

What type of nystagmus occurs in BPPV

A

Horizontal nystagmus

48
Q

What is the investigation for BPPV

A

Dix-Hallpike Manoeuvre

49
Q

What is a positive dix-hallpike manoeuvre

A

Presence of rotational nystagmus for less than 30s and is fatiguable. On sitting may be more vertigo and nystagmus

50
Q

If not self-limiting what is first line management for BPPV

A

Brandt-Daroff Exercises

51
Q

Prior to Epley manoeuvre what may patients be advised to perform at home

A

Brandt - Daroff Exercises

52
Q

What is meniere’s disease

A

failure of re-absorption of endolymph, resulting in accumulation and endolymphatic hydrops

53
Q

What is the triad of symptoms in meniere’s disease

A
  1. Tinnitus
  2. SNHL
  3. Vertigo
54
Q

what other symptoms may be present in meniere’s disease

A
  • Aural fullness

- Horizontal nystagmus

55
Q

how long do attacks last in meniere’s disease

A

Minutes - Hours

56
Q

explain progression of meniere’s disease

A

Usually SNHL improves after each attack. However, if recurrent attacks SNHL may progress over time. Usually frequency of attacks decreases with age

57
Q

what investigations are ordered for meniere’s disease

A
  • Rinne, Weber’s
  • Pure tone audiometry
  • Tympanometry
58
Q

how does meniere’s disease present on tympanomatry

A

type A (normal)

59
Q

what is used to manage acute meniere’s disease

A
  • Prochlorperazine
60
Q

what is used as prophylaxis for meniere’s disease

A
  • Bethistine
61
Q

if ineffective, what are 3 options for management of meniere’s disease

A
  1. Insert gentamicin via grommet
  2. Vestibular larbyinthectomy
  3. Vestibular neurectomy

ENT (16 decks)

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