Pathologies

Question 1

Symptoms:

Sudden onset
Vertigo, short duration (secs)
Provoked by rolling from supine/sagittal movement
General imbalance standing/walking
One day or multiple days/weeks
Resolves spontaneously

Answer 1

BPPV

Question 2

Treatments: BPPV

Answer 2

canalith reposition
surgical procedures (rare)
no medication recommended

Question 3

Site of Lesion: BPPV

Answer 3

Labyrinthine, posterior SCC

Question 4

Findings:

Nystagmus during Dix-Hallpike, roll testing
May be secondary to other disorders of labyrinth

Answer 4

BPPV

Question 5

Symptoms:

Rapid onset
Constant, improves 1-4 days
Develops after flu or URI (not required for diagnosis)
BPPV
No hearing loss or sudden onset of auditory symptoms

Answer 5

Vestibular Neuritis

Question 6

Findings:

Peripheral indication; no CNS involvement
Potentially related to cVEMP of vHIT of posterior canal
Common to have posterior canal BPPV after

Answer 6

Vestibular Neuritis

Question 7

Treatment: Vestibular Neuritis

Answer 7

-Medication, as needed at onset
-Steroids at onset (within 2 weeks)
-Vestibular Balance Rehabilitation Therapy (VBRT), push central system compensation

Question 8

Site of Lesion: Vestibular Neuritis

Answer 8

Neural / Vascular
Causes selected labyrinthine damage

Question 9

Symptoms: not constant, but can be for several weeks

Episodic vertigo
Dizziness
Unsteadiness
Spontaneous or Evoked nystagmus
Primary symptoms significant for first 72 hours
Lasts 1-5 mins

Answer 9

Vestibular Migraine

Question 10

Definite Criteria: Vestibular Migraine

Answer 10

Frequency:
5 or more attacks of vestib symptoms, moderate severity

Duration:
1 min - 72 hours

Current or previous history of migraine headaches

1 out of 2 occurs after more than 50% of dizziness attacks:
1. migraine headache
photophobia or phonophobia or visual aura

Question 11

Findings:

No specific pattern

Range from normal (most) to indications for either peripheral or central involvement

Answer 11

Vestibular Migraine

Question 12

Site of Lesion: Vestibular Migraine

Answer 12

Not fully known
Possibly labyrinth and vestibular nuclei
+
Areas of brainstem and midbrain

Question 13

3 Principal Components:

Persistent dizziness unsteadiness throughout the day (wax and wane) for 3 months or more
-Prolonged throughout the day
-present more than 15 days, every 30 days
- increases throughout the day but may not be active entire day
-momentarily flares may occur spontaneously or with sudden movements

Present without specific provocation; made worse by upright posture, active/passive motions from all directions and positions, moving visual stimuli or complex visual patterns

Begins shortly after event that causes vestib symptoms/balance problems

Answer 13

Persistent Postural-Perceptural Dizziness (PPPD)

Question 14

Common events that may trigger PPPD

Answer 14

Vestib migraines: acute/episodic, peripheral/central
Panic attacks
Generalized anxiety
Concussion
Whiplash injuries
Orthostatic intolerance

Question 15

Findings:

May co-exist with other diseases or disorders
Peripheral or central involvement may be due to other disorder
Often will have pattern of Sensory Organization of Test of dynamic posturography
-show abnormal performance, easy conditions
show improved performance, difficult conditions

Answer 15

PPPD

Question 16

Treatment: PPPD

Answer 16

SNRI, SSRI medications
Vestibular Behavioral Rehabilitation Therapy
-habituation exercises (head movement, visual sensitivities)
Treatment for other co-existing active disorder

Question 17

Site of Lesion: PPPD

Answer 17

No defined organic site
Develop of disorder felt to be misinterpretation of natural threat assessment system related to posture and locomotion

Question 18

Symptoms:
Vestibular crisis, develops rapidly
Improves 1-4 days
Left with head movement sensitivity
Change in hearing with crisis event occur within a few days of dizziness onset

Answer 18

Labyrinthitis

Question 19

Findings:

Nonspecific with peripheral indications
No CNS
SNHL of varying degrees of severity

Answer 19

Labyrinthitis

Question 20

Treatment: Labyrinthitis

Answer 20

Steroids within 2 weeks for hearing loss
Suppressive medications as needed, at onset
Vestibular Balance Rehabilitation Therapy as needed to push compensation

Question 21

Can you recover hearing loss after labyrinthitis?

Answer 21

Depends on degree of initial loss (viral vs bacterial)

Question 22

Site of Lesion: Labyrinthitis

Answer 22

Auditory and vestibular labyrinths

Question 23

Symptoms:

Sudden onset, otalgia
Open vesicles that can appear in EAC, pinna, face, around pinna and TM
Can occur without vesicles but with subdermal pain
Hearing loss + vestib crisis, rapid onset each within days of each other
Facial muscle weakness on same side as hearing loss and vestib involvement
Can hear cranial nerve indications esp bulbar symptoms (Ds)

Answer 23

Ramsay Hunt syndrome

Question 24

What are the Ds?

Answer 24

Diplopia - double vision
Dysphagia - difficulty swallowing
Dysarthria - difficult with articulation
Dysmetria - difficult coordinating smooth movements
Asymmetric muscle weakness

Question 25

Findings:

Typically central indications
SNHL of neural origin (early on)
OAEs normal
ABR normal with waves I-III interval increase
Inflammation of CN VII, CN VIII complex (early MRI)

Answer 25

Ramsay Hunt syndrome

Question 26

Treatment: Ramsay Hunt syndrome

Answer 26

Antiviral medications
Steroids
Vestibular Balance Rehabilitation Therapy, push central compensation

Question 27

Site of Lesion: Ramsay Hunt syndrome

Answer 27

Cerebellarpontine angle (CPA),
CN VII and CN VIII
Cochlear nerve
Typically viral (form of shingles)

Question 28

Prognosis: Ramsay Hunt Syndrome

Answer 28

Stabilization - good
Left with hearing loss and compensated vestib deficit
Degree of impairment varies (esp with facial weakness and hearing loss)

Question 29

Symptoms:

(2) vertigo events lasting more than 20 mins, less than 12 hours
Unpredictable vertigo/dizziness
Fluctuating hearing loss + vertigo
Tinnitus and aural fullness localizing to impaired side
No CNS indications

Answer 29

Meniere’s Disease