Pathologies Flashcards
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
BPPV
Treatments: BPPV
canalith reposition
surgical procedures (rare)
no medication recommended
Site of Lesion: BPPV
Labyrinthine, posterior SCC
Findings:
Nystagmus during Dix-Hallpike, roll testing
May be secondary to other disorders of labyrinth
BPPV
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
Vestibular Neuritis
Findings:
Peripheral indication; no CNS involvement
Potentially related to cVEMP of vHIT of posterior canal
Common to have posterior canal BPPV after
Vestibular Neuritis
Treatment: Vestibular Neuritis
-Medication, as needed at onset
-Steroids at onset (within 2 weeks)
-Vestibular Balance Rehabilitation Therapy (VBRT), push central system compensation
Site of Lesion: Vestibular Neuritis
Neural / Vascular
Causes selected labyrinthine damage
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
Vestibular Migraine
Definite Criteria: Vestibular Migraine
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
Findings:
No specific pattern
Range from normal (most) to indications for either peripheral or central involvement
Vestibular Migraine
Site of Lesion: Vestibular Migraine
Not fully known
Possibly labyrinth and vestibular nuclei
+
Areas of brainstem and midbrain
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
Persistent Postural-Perceptural Dizziness (PPPD)
Common events that may trigger PPPD
Vestib migraines: acute/episodic, peripheral/central
Panic attacks
Generalized anxiety
Concussion
Whiplash injuries
Orthostatic intolerance
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
PPPD
Treatment: PPPD
SNRI, SSRI medications
Vestibular Behavioral Rehabilitation Therapy
-habituation exercises (head movement, visual sensitivities)
Treatment for other co-existing active disorder
Site of Lesion: PPPD
No defined organic site
Develop of disorder felt to be misinterpretation of natural threat assessment system related to posture and locomotion
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
Labyrinthitis
Findings:
Nonspecific with peripheral indications
No CNS
SNHL of varying degrees of severity
Labyrinthitis
Treatment: Labyrinthitis
Steroids within 2 weeks for hearing loss
Suppressive medications as needed, at onset
Vestibular Balance Rehabilitation Therapy as needed to push compensation
Can you recover hearing loss after labyrinthitis?
Depends on degree of initial loss (viral vs bacterial)
Site of Lesion: Labyrinthitis
Auditory and vestibular labyrinths
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)
Ramsay Hunt syndrome
What are the Ds?
Diplopia - double vision
Dysphagia - difficulty swallowing
Dysarthria - difficult with articulation
Dysmetria - difficult coordinating smooth movements
Asymmetric muscle weakness
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)
Ramsay Hunt syndrome
Treatment: Ramsay Hunt syndrome
Antiviral medications
Steroids
Vestibular Balance Rehabilitation Therapy, push central compensation
Site of Lesion: Ramsay Hunt syndrome
Cerebellarpontine angle (CPA),
CN VII and CN VIII
Cochlear nerve
Typically viral (form of shingles)
Prognosis: Ramsay Hunt Syndrome
Stabilization - good
Left with hearing loss and compensated vestib deficit
Degree of impairment varies (esp with facial weakness and hearing loss)
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
Meniere’s Disease
