Acute Vertigo

Question 1

Describe the vestibular system

Answer 1

Input from the inner ear
Circuits in the brainstem
Pathways ascend

Question 2

What is vestibular-motion perception

Answer 2

Sensation of motion

self or environment

Question 3

What is oscillopsia

Answer 3

Seeing environmental motion

Indicates a nystagmus

Question 4

How do you distinguish between dizziness and vertigo

Answer 4

dizziness - illusionary self motion e.g. rocking like a boar, spinning like a merry go round, floating

Vertigo - illusionary environmental motion

Question 5

What can vertigo be a symptom of

Answer 5

Benign paroxysmal positional vertigo
Vestibular neuritis
Migrainous Vertigo 
Stroke (cerebellar)
Meniere's

Question 6

Describe the core examination of vertigo

Answer 6

Eyes
Cover 
GAze 
VOR 
Hallpike
Fundoscopy 

Ears
Otoscopy

Legs
Gait (+tandem)

Question 7

What do you look for on a fundoscopy for vertigo investigation

Answer 7

Position of disc and macula on retina
Spontaneous nystagmus
Effect of visual fixation on nystagmus

Question 8

What do you look for in the legs for vertigo investigation

Answer 8

Gait (narrow based)
Tandem walking (count how many mistakes)
Romberg (see if eye closure affects balance - 20s)

Question 9

Describe the signs for Benign paroxysmal positional vertigo

Answer 9

Lying back in bed (differentiates from postal hypotension)

Brief - seconds

Question 10

What are the red flags for Benign paroxysmal positional vertigo

Answer 10

Headache

Atypical nystagmus

Question 11

Describe the treatment for Benign paroxysmal positional vertigo

Answer 11

Epley
Semont
Right hall pike + semont

Question 12

Describe vestibular neuritis

Answer 12

Subacute onset (minutes to hours)
Continuous vertigo 
Obvious vestibular nystagmus
Positive head impulse test
Normal gait

Question 13

Describe the treatment for vestibular neuritis

Answer 13

Vestibular sedatives for 24-36 hours
Mobilise at day 2 or 3
Treat any BPPV or migraine

Question 14

What are the red flags for vestibular neuritis

Answer 14

Headache 
Gait ataxia 
Hyperacute onset
Vertigo and hearing loss
Prolonged symptoms (>4 days)

Question 15

What does a headache in vestibular neuritis suggest

Answer 15

40% posterior circulation stroke

Question 16

What does gait ataxia in vestibular neuritis suggest

Answer 16

only non-vertiginous manifestation or cerebellar stroke

Question 17

What does hyper acute onset of vestibular neuritis suggest

Answer 17

vascular origin

Question 18

What does vertigo+hearing loss in vestibular neuritis suggest

Answer 18

anterior inferior cerebellar artery or urgent ENT problem

Question 19

What do prolonged symptoms of vestibular neuritis suggest

Answer 19

Floor of the 4th ventricle problem

Question 20

Describe acute vestibular migraine

Answer 20

History of migraine
Can have acute vertigo without prominent headache Recurrent
Main differential diagnosis is cerebellar stroke

Question 21

What are the red flags for acute vestibular migraine

Answer 21

Headache
Gait problems
Hyperacute onset
Hearing loss
Prolonged symptoms (>4 days)

Question 22

Describe cerebellar stroke

Answer 22

Thunderclap onset vertigo
Poor balance - unable to walk or sit
Headache

Question 23

What are the red flags for cerebellar stroke

Answer 23

Headache
Gait problems
Hyperacute onset
Hearing loss
Prolonged symptoms(>4days)

Question 24

Which conditions do you have to exclude on acute vertigo

Answer 24

Presyncope
Pulmonary embolism
Cardiac dysrhythmia

Question 25

What is nystagmus

Answer 25

Consists of fast phase and slow phase (when you turn your head and the eyes move with it)