Dizziness and Vertigo Flashcards
Describe the following terms
- Vertigo
- Imbalance
- Oscillopsia
- Dizziness
- Sensation of spinning – you spinning or the room spinning around you.
- Feeling of unsteadiness of the lower limbs and feet.
- Sensation of objects jumping about.
Dizziness is everything else:
* Lightheadedness
* Whooziness
* Muzzy-headedness
* Sensation of moving without actual spinning
Compare and contrast peripheral and central vertigo.
- PERIPHERAL - Caused by problems in vestibular system e.g hearing loss/tinnitus
- CENTRAL - Neurological problems
What causes BPPV?
- Dislodgement of otoconia from the otolithic organs
(utricle and saccule) which then float around the semi- circular canals causing positional vertigo
Posterior canal is most commonly affected
Describe BPPV aetiology.
- More common in the elderly
- Most cases idiopathic (unknown cause)
- Head trauma
- Post-viral (usually upper respiratory tract infection)
- Positional (post-surgical)
- Other inner ear patholog
How would you treat BPPV?
EPLEY MANOUEVRE
Describe history findings in BPPV.
- Brief, episodic vertigo lasting seconds
- May cause nausea and vomiting
- Associated with changes in head. position, typically rolling over in bed.
- Comes on in spates lasting weeks to months.
- Self-limiting condition – gets better on its own, but can re-occur
EXAMINATION - Dix-Hallpike manoeuvre – look for nystagmus
Describe aetiology of Meniere’s disease.
- IDIOPATHIC
- More common in females
Describe history findings of Meniere’s disease.
- Moderate episodic vertigo lasting 20 mins to several hours
- Often causes nausea and vomiting
- Feeling of fullness in the ear (aural fullness)
- Usually preceded by hearing loss and tinnitus
- Waxes and wanes over many years
- Eventually burns out after 8-10 years, with permanent hearing loss and
disequilibrium in many cases
Describe examination findings of Meniere’s disease.
- Usually normal in between episodes
- During episodes - nystagmus
Describe investigation findings of Meniere’s disease.
- Audiogram – low frequency SNHL (may be normal
in early stages); this is needed to make the
diagnosis - MRI internal auditory meatuses to rule out vestibular schwannoma (aka acoustic neuroma)
Hearing loss is at first reversible, but becomes permanent over time
Describe treatments for Meniere’s Disease
- Low salt diet
- Betahistine/bendroflumethiazide
- Intratympanic steroid/gentamicin injections (former stabilises cell membrane - latter is a vestibulotoxin)
Surgical:
* Endolymphatic sac decompression
* Section (cutting) of the vestibular nerve
Describe vestibular neuritis and labyrinthitis.
- VN - inflammation of nerves
- Labyrinthitis - inflammation of inner ear
Describe aetiology of vestibular neuritis and labyrinthitis.
- Mainly post-viral, usually following upper respiratory tract infection
- Bacterial – labyrinthitis only, rare
- Mainly in adults of all ages
Describe history findings of vestibular neuritis and labyrinthitis.
- Prolonged non-episodic vertigo lasting days (up to 7-10)
- Nausea and vomiting are salient features
- Permanent hearing loss can occur in labyrinthitis only due to cochlear involvement
- Followed by a period of vestibular compensation where patient feels unsteady and dizzy (no vertigo) for weeks
- Full recovery is usual
Describe examination findings of vestibular neuritis and labyrinthitis.
- During episode: nystagmus
After episode: - During compensatory phase: abnormal VOR
- After full compensation: normal exam
Describe investigation findings of vestibular neuritis and labyrinthitis.
- Audiogram – may show SNHL if hearing loss has occured
- MRI internal auditory meatuses to rule out vestibular schwannoma (aka acoustic neuroma)
