Vertigo Flashcards
Geotropic nystagmus
Subset of rotatory nystagmus in which the fast phase of rotation is coincident with the direction of head turn
(counterclockwise with head turned left, clockwise with head turned right)
Electronystagmogram
A recording of eye movements that provides objective documentation of induced and spontaneous nystagmus
This includes recording of: Spontaneous nystagmus, positional nystagmus, gaze-induced nystagmus, smooth pursuit, random saccades, optokinectic stimulation, Dix-Hallpike testing, caloric testing
Otolith
Small calciferous granule within the gelatinous membrane of the saccule and utricle
Cause of BPPV
Dix-Hallpike maneuver
Sequential head position and turning test with high PPV for BPPV
A positive test occurs if symptoms are elicited and/or nystagmus is reproduced
Very brief episodes of vertigo brought on by some positional change should raise suspicion for. . .
. . . peripheral vertigo
Classic sings of choleasteatoma
Foul smelling otorrhea
Whitish mass in the middle ear
Conductive hearing loss
Migraine with brainstem aura
A familial migraine syndrome
Characterised by vertigo as part of migraine aura
Vertebrobasilar insufficiency
Cause of vertigo characterized by repeated episodes of seconds-minutes duration along with dysphagia, dysarthria, or cerebellar symptoms in the context of a history of vascular disease
Due to a posterior circulation (vertebral artery/basilar artery) TIA induced by neck rotation or extension
Physical exam is often normal, but may reveal cranial nerve findings, cerebellar signs, and/or carotid bruits
Treat w/ antiplatelet therapy, management of risk factors
Vertigo + fever, ear pain, conductive hearing loss
Labyrinthitis
Vertigo in the setting of VZV
Vertigo may occur as part of Ramsay Hunt syndrome
Therapy for BPPV
- First-line:
- Canalith repositioning maneuvers (Epley, Semont)
- Vestibular rehab may be necessary
What does an otolith repositioning maneuver really do?
It puts the otolith back into the saccule
