Differential Diagnosis

Question 1

room spins when turning in bed

Answer 1

BPPV

Question 2

oscillopsia, constant imbalance

Answer 2

Bilateral vestibular hypofunction

Question 3

turning head or turning around in standing

Answer 3

Unilateral vestibular hypofunction

Question 4

feeling “off” with negative vestibular signs

Answer 4

Cervicogenic dizziness, psychologic

Question 5

dizzy/lightheaded standing up first thing in morning

Answer 5

Orthostatic hypotension

Question 6

visual motion sensitivity

Answer 6

Concussion, TBI, central dysfunction

Question 7

Disequilibrium, spontaneous nystagmus, nausea, hearing unaffected, vertigo present when still, no UMN signs

Answer 7

Vestibular neuritis

Question 8

Tinnitus, hearing loss, severe acute vertigo duration >30min, nausea/vomiting, sensation of fullness in ear

Answer 8

Meniere’s disease

Question 9

Vertigo, possible history of head trauma, exacerbated by changes in air pressure (eg. Flying at altitude, ascending elevator), sensitive hearing/hearing loss, sense of ear fullness, tinnitus, no UMN signs

Answer 9

Perilymph fistula

Question 10

Central vestibular disorder

Answer 10

mild vertigo with nausea and vomiting lasting >3 days, sensorimotor loss, diplopia, dysarthria (eg. Vertebrobasilar ischemia, brainstem tumor, MS, arnold-chiari malformation, etc)

Question 11

Vertigo provoked with head movement, lasts few seconds up to a minute, general imbalance with walking and standing, nystagmus has short latency and fatigues with repetition

Answer 11

BPPV- repositioning maneuver, vestibular therapy for persistent imbalance, surgery for refractory cases (rare)

Question 12

Vertigo provoked with head movement, lasts few seconds up to a minute, general imbalance with walking and standing, nystagmus has short latency and fatigues with repetition

Answer 12

BPPV- repositioning maneuver, vestibular therapy for persistent imbalance, surgery for refractory cases (rare)

Question 13

Acute onset, Persistent constant rotational vertigo, postural imbalance, nystagmus, nausea, no hearing loss- lasts 24-72hours
- horizontal nystagmus (away from affected ear), significant postural instability

Answer 13

Vestibular neuritis
Acute unilateral vestibulopathy
- vestibular suppressants, corticosteroids

Question 14

chronic varying degrees of dizziness or imbalance with head movement

• unilateral head thrust test may be positive
• reduce caloric response unilateral
• audiogram negative for hearing loss

Answer 14

Vestibular neuritis - chronic

- vestibular therapy to improve gaze stability, postural control, decrease residual feelings of dizziness

Question 15

Acute onset, Persistent constant rotational vertigo, postural imbalance, nystagmus, nausea, hearing loss, tinnitus- lasts 24-72hours

• horizontal nystagmus (away from affected ear), significant postural instability
• associated with otitis media (bacterial or viral)
• audiogram positive for sensorineural hearing loss

Answer 15

Labyrinthitis - acute

• treat underlying cause (bacteria, viral)
• vestibular suppressants, steroids, antiviral medical

Question 16

chronic varying degrees of dizziness or imbalance with head movement

• unilateral head thrust test may be positive
• reduce caloric response unilateral
• audiogram positive for sensorineural hearing loss

Answer 16

Labyrinthitis - chronic

- vestibular suppressants, steroids, antiviral medical

Question 17

repeated spontaneous attach of rotational vertigo lasts at least 20min-several hours

• attacks with sensation of fullness in ear, reduced hearing, tinnitus, postural imbalance, nausea, and/or vomiting
• may have progressive hearing loss and imbalance if permanent loss of vestibular function
• horizontal nystagmus (away from affected ear)
• reduced caloric response unilateral
• over time progressive hearing loss
• may have bilateral involvement

Answer 17

meniere’s disease

• vestibular suppressants for acute attacks
• surgery if attacks more frequent or debilitating
• NO vestibular therapy during attack, education about disease
• YES vestibular therapy after surgery, if balance impaired, permanent loss of vestibular function

Question 18

Speed of unset acute, duration of incident < 2minutes

Answer 18

Bppv

Question 19

Signs- elicited by changes in head position

Prognosis- if untreated improves in weeks or months: repositioning maneuver often cures immediately

Answer 19

Bppv

Question 20

Speed of onset- acute

Duration: severe for 2-3 days, gradual improvement over 2 weeks

Answer 20

Vestibular neuritis

Question 21

Speed of onset: chronic
Duration: 0.5-24hr
Associated with hearing loss, tinnitus, feeling fullness in the ear

Answer 21

Ménière’s disease

Question 22

Severe acute vertigo, nausea, vomiting, hearing loss

Associated with abnormal fluid pressure in inner ear

Answer 22

Menieres disease

Question 23

Abrupt onset hearing loss with tinnitus and vertigo
Mostly secondary to trauma
Opening between middle and inner ear
Requires incision and endoscopic exam

Answer 23

Perilymph fistula

Question 24

Oscillopisa- objects bounce when moving

Over time nervousness system adapts

Answer 24

Bilateral lesión of vestibular nerve

Question 25

Brainstem signs – somatosensory and or motor loss, double vision, Horner’s syndrome, ataxia when trunk is supported (sitting, lying down), dysarthria

Answer 25

Central vestibular disorder

Question 26

Continuous lasting all day severe dizziness persisting longer than three days with mild nausea and vomiting

Answer 26

Central vestibular disorder

Question 27

Pure vertical nystagmus and Horizontal or vertical double vision

Answer 27

Central lesion