Introduction to Vestibular Disease Flashcards
Vertigo and imblanace vs/ presyncope and syncope
Presynciope and syncope almost never have inner ear etiology
Duration of BPPV
Meiere’s
Vestbiular Neuritis
Migraine
BPPV - less than a minute associated with head movmts
Men - episodic attacks 20 min -hrs
Vestibular neuritis - hrs to days receding to imabalance over weeks
Migrain - varaible
Rapid alternating mvmts
FInger to nose
Tandem gait
oculomotor mvmts
Dysdiadochokineisa
Dysmetria
Truncal ataxia could be vermis
Abnormal smooth purusit - flocculus
Saccadic dysmetria - vermis
Widened or shuffling gait means
Central
Romberg
Tests central balance
Could be abormal between labyrintheine attakc but normal between
Pronator drift
UMN disorders
IN CVA will be contralateral to side of CVA
Fukuda step test
Patient will drift toward side of lesion
Peripheral nystagmus
Jerk
Direction fixed
SUppresses with visual fixation
Central nystagmus
Purely vertical and direction changing
BPPV
Most iwhtout warning
Caused by canalithiasis (90% post semicricular cnaal)
BPPV clinical
Nausea and vomiting may accompany
Make sure they don’t confuse clustering of episode with long duration
BPPV diagnosis
Posterior - geotropic rotary nystagmus with affected ear down (90%)
Horizontal - pure horizonal nystagmus direction changing
Posterior BPPV vs. central positioning nystagmus
Posterior has latency of 5-20 secs, duration <60, fatiguje with repeated testing and reversed sitting upright…cupulothiasis may cause no latency and porlonged duration
Central - no associated vertigo
Tx of BPPV
Canal particle repositiong manuevers
Epley for posterior and log roll for horizontal
Post CRP instruction
Sleep upright for 48 and use recliner or pilows
Vestibular neuritis
Superior divison of nerve more common
Due to inflammation of vestibular nerve or labyrtinth
Could be from HSV1 or vascular ischmie a
Presentation of vestibular neuritis
Acute - severe vertigo with n/v…lasts hrs - days…closing eyes may decrese but symptoms will still remain (unlike BPPV)
Subacute - more imbalance…especially pivoting and turing
Acute labyrnthitis
Vestibular neuritis with hearing loss
Vestibular neuritis exam
Acute phae will show nystagmus away from affected ear
No ataxia or other neurologic findings
Signs of vestibular hypofunction
Leaning toward side of decreased function during Romberg
Migrate toward side on Fukuda step test
Head impulse toward affected side with catch up saccades
Vest neuritis labs
Audiogram
VNG
Calorics
Vest neuritis tx
Early coriticosteroids
Antiemetics or vestibular suppressants for acute but don’t want long term
Meniere’s dz
Endolymphatic hydrops
Episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness
MRI to rule out retrocochlear lesion
Meniere’s dz timeline
Unpredictable
Hearing loss initially fluctuates but gets worse as time goes on
Burns out
Meniere’s dz bilateral
Not normal (10-15%)
Not simultaneously
Most likely manifest in first 2-5 years
Vestibular migraine
h/o Migraine headache
h/o Motion sensitivity
FH of migraine heacahde
Symptoms of vestbiular migraine
Imabalanced, staggering, sometimes vertigo
Visual triggers
Often is presenting symptoms of migrains
Vestibular migraine duration
Varibale but most are 5-60 minutes…never really longer than a fday
Tx of vestibular migraine
Beta blocker is first
TCA, Ca channel blockers, topiramate other options
Need prophylactic…abortinve does not work***
Million dollar questions for BPPV, Meniere’s, vest migraine
BPPV - dizziness lying down or out of bed?
Meniere’s - Hearing change during attack?
Vestbiular migraine - light sensitive?
