A scientific and clinical approach to acute vertigo

Question 1

Define dizziness

Answer 1

An illusion of self- +/or environmental motion

Question 2

Define vertigo

Answer 2

Illusory self-motion which is spinning in nature

A subset of dizziness

Question 3

Define oscillopsia

Answer 3

Visual world motion

Question 4

How does oscillopsia differ from vertigo?

Answer 4

Vertigo is present even with one’s eyes shut

Question 5

Which anatomical locations may be involved in vertigo?

Answer 5

Ear-peripheral vestibular apparatus or vestibular nerve
Subcortical-cerebellum
Vestibular nuclei (pontomedullary junction)
Cerebral, Temporal + parietal cortex

Question 6

Name 3 regions that may be effected causing vertigo

Answer 6

Ear: vestibular neuritis, Meniere’s disease
Subcortical: stroke (brain stem or cerebellar stroke), migraine
Cortical: epilepsy, migraine

Question 7

Name 9 causes of vertigo with prevalence of presentation

Answer 7

Very common: BPPV
Common: migraine, postural hypotension
Occasional: vestibular neuritis, cerebellar stroke, brainstem stroke
Rare: Meniere’s disease
Very rare: vestibular paroxysmia, vestibular epilepsy

Question 8

What 3 things would be used examined when suspecting vertigo?

Answer 8

Eyes: nystagmus, head impulse test, Hallpike test
Ears: otoscopy
Legs: gait ataxia

Question 9

What are the “red flags” indicating that stroke may be the cause of vertigo?

Answer 9

Headache
Gait ataxia
Hyperacute onset
Hearing loss

Question 10

List 3 examples of treatment of vertigo (as they are diagnosis dependent)

Answer 10

BPPV: Particle repositioning manoeuvre
Migraine (acute): aspirin
Migraine (chronic): prophylaxis (e.g. B blocker).
Vestibular neuritis: self-limiting, supportive then mobilisation.