disorders of balance: dizziness and vertigo

Question 1

define vertigo

Answer 1

the illusion of movement (usually rotational movement or “true vertigo” so SCC movement)

Question 2

define dizziness

Answer 2

quite vague-patient “feels giddy/wobly– differs from vertigo in that vertigo is present even when the eyes are closed,

Question 3

define oscillopsia

Answer 3

the visual world is seen to lag behind during rapid head movements due to impairment of eye stabilisation

Question 4

what are the 2 forms of vestibular disorders

Answer 4

central vestibular disorder: -affects CNS (ie brainstem and cerebellum

peripheral vestibular disorder: -affects labyrinth and VIII cranial nerve

Question 5

give an example of a cause of central vestibular disorder

Answer 5

Acute: brainstem or cerebellar lesion (eg MS or vascular)

Chronic/ progressive: cerebellar degeneration (eg huntington’s or parkinson’s??)

Question 6

what are the different classifications of vestibular disorders

Answer 6

Acute (and doesn’t stop): Vestibular neuritis, labyrinthine concussion

Intermittent: BPPV- benign paroxysmal positional vertigo

Recurrent: meniere’s disease (very rare) , migraine

Progressive: acoustic neuroma- affecting CN VIII

Question 7

if there is a catch up saccade only on ONE side what is it like due to

Answer 7

a peripheral cause

Question 8

what do catch up saccades on both sides indicate

Answer 8

a bilateral loss of vestibular function ie oscillopsia

Question 9

if the nystagmus changes direction what does this indicate

Answer 9

that the cause is almost certainly CNS

Question 10

what is visual suppression of nystagmus

Answer 10

visual fixation can suppress peripheral nystagmus but not central nystagmus

Question 11

what is the manoeuvre done to treat BPPV

Answer 11

Hallpike and Semont manoeuvre-

patient sits off edge of bed- lean them to the side so the back of they head is almost touching the bed, then after a few seconds move them quickly to the other side so then face is almost touching the other side of the bed

this removes debris from ampulla

Question 12

what is menieres disease

Answer 12

build up of endolymphatic pressure (in ear- hydrops)

rupture of membrane separating endolymph and perilymph- mixing of the two and a possible raise in pressure in inner ear

classic triad of symptoms is VERTIGO, TINNITUS and DEAFNESS (low frequency hearing loss)

Question 13

how do you distinguish between migraines and menieres

Answer 13

in migraines hearing is spared and migraines usually respond to treatment