Acute Vertigo Flashcards
Describe the vestibular system
Input from the inner ear
Circuits in the brainstem
Pathways ascend
What is vestibular-motion perception
Sensation of motion
self or environment
What is oscillopsia
Seeing environmental motion
Indicates a nystagmus
How do you distinguish between dizziness and vertigo
dizziness - illusionary self motion e.g. rocking like a boar, spinning like a merry go round, floating
Vertigo - illusionary environmental motion
What can vertigo be a symptom of
Benign paroxysmal positional vertigo Vestibular neuritis Migrainous Vertigo Stroke (cerebellar) Meniere's
Describe the core examination of vertigo
Eyes Cover GAze VOR Hallpike Fundoscopy
Ears
Otoscopy
Legs
Gait (+tandem)
What do you look for on a fundoscopy for vertigo investigation
Position of disc and macula on retina
Spontaneous nystagmus
Effect of visual fixation on nystagmus
What do you look for in the legs for vertigo investigation
Gait (narrow based)
Tandem walking (count how many mistakes)
Romberg (see if eye closure affects balance - 20s)
Describe the signs for Benign paroxysmal positional vertigo
Lying back in bed (differentiates from postal hypotension)
Brief - seconds
What are the red flags for Benign paroxysmal positional vertigo
Headache
Atypical nystagmus
Describe the treatment for Benign paroxysmal positional vertigo
Epley
Semont
Right hall pike + semont
Describe vestibular neuritis
Subacute onset (minutes to hours) Continuous vertigo Obvious vestibular nystagmus Positive head impulse test Normal gait
Describe the treatment for vestibular neuritis
Vestibular sedatives for 24-36 hours
Mobilise at day 2 or 3
Treat any BPPV or migraine
What are the red flags for vestibular neuritis
Headache Gait ataxia Hyperacute onset Vertigo and hearing loss Prolonged symptoms (>4 days)
What does a headache in vestibular neuritis suggest
40% posterior circulation stroke
What does gait ataxia in vestibular neuritis suggest
only non-vertiginous manifestation or cerebellar stroke
What does hyper acute onset of vestibular neuritis suggest
vascular origin
What does vertigo+hearing loss in vestibular neuritis suggest
anterior inferior cerebellar artery or urgent ENT problem
What do prolonged symptoms of vestibular neuritis suggest
Floor of the 4th ventricle problem
Describe acute vestibular migraine
History of migraine
Can have acute vertigo without prominent headache Recurrent
Main differential diagnosis is cerebellar stroke
What are the red flags for acute vestibular migraine
Headache Gait problems Hyperacute onset Hearing loss Prolonged symptoms (>4 days)
Describe cerebellar stroke
Thunderclap onset vertigo
Poor balance - unable to walk or sit
Headache
What are the red flags for cerebellar stroke
Headache Gait problems Hyperacute onset Hearing loss Prolonged symptoms(>4days)
Which conditions do you have to exclude on acute vertigo
Presyncope
Pulmonary embolism
Cardiac dysrhythmia
What is nystagmus
Consists of fast phase and slow phase (when you turn your head and the eyes move with it)
