Differential Diagnosis Flashcards
room spins when turning in bed
BPPV
oscillopsia, constant imbalance
Bilateral vestibular hypofunction
turning head or turning around in standing
Unilateral vestibular hypofunction
feeling “off” with negative vestibular signs
Cervicogenic dizziness, psychologic
dizzy/lightheaded standing up first thing in morning
Orthostatic hypotension
visual motion sensitivity
Concussion, TBI, central dysfunction
Disequilibrium, spontaneous nystagmus, nausea, hearing unaffected, vertigo present when still, no UMN signs
Vestibular neuritis
Tinnitus, hearing loss, severe acute vertigo duration >30min, nausea/vomiting, sensation of fullness in ear
Meniere’s disease
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
Perilymph fistula
Central vestibular disorder
mild vertigo with nausea and vomiting lasting >3 days, sensorimotor loss, diplopia, dysarthria (eg. Vertebrobasilar ischemia, brainstem tumor, MS, arnold-chiari malformation, etc)
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
BPPV- repositioning maneuver, vestibular therapy for persistent imbalance, surgery for refractory cases (rare)
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
BPPV- repositioning maneuver, vestibular therapy for persistent imbalance, surgery for refractory cases (rare)
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
Vestibular neuritis
Acute unilateral vestibulopathy
- vestibular suppressants, corticosteroids
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
Vestibular neuritis - chronic
- vestibular therapy to improve gaze stability, postural control, decrease residual feelings of dizziness
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
Labyrinthitis - acute
- treat underlying cause (bacteria, viral)
- vestibular suppressants, steroids, antiviral medical
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
Labyrinthitis - chronic
- vestibular suppressants, steroids, antiviral medical
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
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
Speed of unset acute, duration of incident < 2minutes
Bppv
Signs- elicited by changes in head position
Prognosis- if untreated improves in weeks or months: repositioning maneuver often cures immediately
Bppv
Speed of onset- acute
Duration: severe for 2-3 days, gradual improvement over 2 weeks
Vestibular neuritis
Speed of onset: chronic
Duration: 0.5-24hr
Associated with hearing loss, tinnitus, feeling fullness in the ear
Ménière’s disease
Severe acute vertigo, nausea, vomiting, hearing loss
Associated with abnormal fluid pressure in inner ear
Menieres disease
Abrupt onset hearing loss with tinnitus and vertigo
Mostly secondary to trauma
Opening between middle and inner ear
Requires incision and endoscopic exam
Perilymph fistula
Oscillopisa- objects bounce when moving
Over time nervousness system adapts
Bilateral lesión of vestibular nerve
Brainstem signs – somatosensory and or motor loss, double vision, Horner’s syndrome, ataxia when trunk is supported (sitting, lying down), dysarthria
Central vestibular disorder
Continuous lasting all day severe dizziness persisting longer than three days with mild nausea and vomiting
Central vestibular disorder
Pure vertical nystagmus and Horizontal or vertical double vision
Central lesion
