Common Vestibular Disorders and Presentations

Question 1

Signs of peripheral involvement:

Answer 1

Sudden Memorable onset
Typically true vertigo on onset
Paroxysmal Spontaneous Events

Question 2

Signs of central involvment:

Answer 2

Sudden onset of Vertigo, lightheadedness/ imbalance with on of the D’s
Slow onset imbalance standing and walking
Vague sx of any character
Slow vertigo lasting 24/7 (anxiety, etc)

Question 3

Peripheral Disorders:

Answer 3

Vestibular Neuritis/labryinthitis
Acoustic Neuroma: grows around peripheral nerve
Meniere’s Disease
BPPV
Toxicity

Question 4

Central Disorders:

Answer 4

Disequilibrium of Aging
CVA
Migraine
Head Trauma (TBI/Concussion)

Question 5

BPPV Symptoms:

Answer 5

lying down, rolling over in bed, bending over, and looking up. Women may report problems in hair salon, men while changing oil under car.

Question 6

Vestibular Neuritis Symptoms:

Answer 6

Vestibular crisis (vertigo, imbalance, nausea) improving over 1-4 days, absence of associated auditory symptoms, left with head movement sensitivity
Usually affects those 30-60
Gradual and complete recovery is expected

Question 7

Viral Endolymphatic Labryinthitis:

Answer 7

Acute vestibular crisis lasting 1-4 days with a history and recovery similar to vestibular neuritis
Key feature is a sudden hearing loss accompanied with vertigo. Hearing loss within a few hours before or after the onset of vertigo

Question 8

Acoustic Neuroma

Answer 8

Nerve sheath benign tumors arise from Schwann cells lining the axons of the cochleovestibular n.
Causes progressive unilateral hearing loss or tinnitus without vestibular symptoms. Balance issues (if present) tend to be mild and intermittent

Question 9

Options for acoustic neuroma:

Answer 9

watchful waiting, radiosurgery and surgical resection

Question 10

Meniere’s Disease

Answer 10

A disorder of the inner ear function resulting in devastating hearing loss and vestibular symptoms

Question 11

Key Features of Meniere’s Disease:

Answer 11

recurrent, spontaneous spells intense rotational vertigo lasting several hours, postural imbalance, nystagmus, nausea, vomiting, hearing loss, tinnitus and aural fullness. Vertigo will persist anywhere from 30 mins to 24 hours

Question 12

Symptoms of Toxicity:

Answer 12

Oscillopsia – only occur when head is moving
Can cause difficulties with driving and with walking
imbalance and visual symptoms
Imbalance worse in dark or where footing is uncertain
Spinning vertigo is unusual

Question 13

Vertebrobasilar Vascular Insufficiency

Answer 13

Blockages of one or more of the following aa;
Posterior Inferior Cerebellar (PICA)
Vertebral aa.
Anterior Inferior Cerebellar (AICA)
Basilar a
Superior Cerebellar (SCA)

Question 14

Migraine without Aura

Answer 14

consists of periodic headaches that are usually throbbing and one sided, worse with activity, and associated with nausea and increased sensitivity to light and noise. Vertigo can occur before, during or separately from the episodes of migraine headache

Question 15

Migraine with Aura

Answer 15

associated with short lived symptoms (noises, flashes of light, tingling, numbness, vertigo and others) known as the aura. Symptoms usually precede the headache and usually last 5-20 mins

Question 16

Basilar migraine

Answer 16

symptoms include vertigo, tinnitus, decreased hearing and ataxia (loss of coordination)

Question 17

Orthostatic Hypotension or Intolerance

Answer 17

Faintness or lightheadedness which appear only in standing, and which are caused by low blood pressure
Only rarely is spinning vertigo caused by orthostatsis
Chest pain
Sweating/nausea

Question 18

Cervico-Genic Dizziness

Answer 18

Vascular Compromise
Abnormal sensory input from neck proprioceptors
Cervical Cord Compression
High Cervical Disease
Neck’s interaction with other types of vertigo
Cervicogenic Migraine

Question 19

Ramsay Hunt Syndrome

Answer 19

Sudden onset of pain with open sores, loss of hearing with a vestibular crisis event, facial mm weakness

Question 20

What cranial nerves are affected with Ramsay Hunt syndrome?

Answer 20

CN VII and CN VIII

Question 21

Arnold Chiari

Answer 21

Episodic to continuous imbalance and lightheadedness exacerbated by hyperextension of neck, double vision on lateral gaze

Question 22

Mal De Debarquement Syndrome (MDDS)

Answer 22

“sickness of disembarkment”

Prolonged and inappropriate sensations of movement after exposure to motion

Question 23

Who does MDDS usually affect?

Answer 23

Mainly affects women in their mid 40’s