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ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

What is vertigo?

A

The false sensation that the body or environment is moving/spinning

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2
Q

What are the causes of vertigo? How can these causes be classified anatomically?

A

Peripheral lesions (pathology affecting the inner ear):

  • BPPV (most common)
  • Meniere’s disease
  • Vestibular neuronitis
  • Labyrinthitis
  • Acoustic neuroma

Central lesions (pathology affecting the brainstem or cerebellum):

  • Multiple sclerosis
  • Posterior circulation stroke
  • Cerebellar/brainstem tumour
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3
Q

For each of the following causes of vertigo, is the vertigo typically episodic or continuous…

  1. BPPV
  2. Meniere’s disease
  3. Labyrinthitis
  4. Vestibular neuronitis
  5. Acoustic neuroma
A
  1. Episodic
  2. Episodic
  3. Continuous
  4. Continuous
  5. Continuous
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4
Q

How long do attacks of BPPV typically last?

A

A few seconds to a minute

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5
Q

How long do attacks of Meniere’s disease typically last?

A

20 minutes to several hours

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6
Q

Is the onset of labyrinthitis acute or gradual? How long does this condition typically last?

A

Acute onset, typically lasting a few weeks

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7
Q

Is the onset of vestibular neuronitis acute or gradual? How long does this condition typically last?

A

Acute onset, typically lasting a few weeks

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8
Q

Is the onset of acoustic neuroma typically acute or gradual?

A

Gradual (slow-growing tumour)

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9
Q

What does BPPV stand for?

A

Benign paroxysmal positional vertigo

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10
Q

Describe the pathophysiology of BPPV

A

Crystals of calcium carbonate (called otoconia) become displaced within the semi-circular canals, which disrupts the normal flow of endolymph

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11
Q

Typically, what can trigger an attack of BPPV?

A

Specific types of head movements, e.g. turning over in bed

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12
Q

BPPV is most common in which age group?

A

Older adults

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13
Q

Which manoeuvre is used to diagnose BPPV?

What does this manoeuvre trigger?

A

Dix-Hallpike manoeuvre (Dix for Dx - diagnosis)

This manoeuvre will trigger:

  • Rotational nystagmus
  • Symptoms of vertigo
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14
Q

Which manoeuvre is used to treat BPPV?

A

Epley manoeuvre

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15
Q

Describe the pathophysiology of Meniere’s disease

A

Excessive build up of endolymph in the inner ear

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16
Q

What is the typical triad of symptoms in Meniere’s disease?

A
  • Vertigo
  • Hearing loss
  • Tinnitus
17
Q

Describe the pharmacological management of Meniere’s disease

A

Acute attacks:

  • Prochlorperazine
  • Antihistamines, e.g. cyclizine, cinnarizine

Prophylaxis:
- Betahistine

18
Q

Describe the pathophysiology of labyrinthitis

A

Inflammation of the inner ear

19
Q

Labyrinthitis is typically preceded by…

A

A viral URTI

20
Q

Describe the pathophysiology of vestibular neuronitis

A

Inflammation of the vestibular nerve

21
Q

Vestibular neuronitis is typically preceded by…

A

A viral URTI

22
Q

How can you distinguish between labyrinthitis and vestibular neuronitis?

How do you remember this?

A

Labyrinthitis is associated with hearing loss and tinnitus (whereas VN is not)

Labyrinthitis = Loss (of hearing)

23
Q

Describe the pharmacological management of labyrinthitis and vestibular neuronitis

A

Both conditions are self-limiting and typically resolve within a few weeks.
Acute symptoms can be managed as follows for both conditions:
- Prochlorperazine
- Antihistamines, e.g. cyclizine, cinnarizine

24
Q

What is an acoustic neuroma?

A

Benign tumour of the Schwann cells surrounding the vestibular nerve

25
Q

An acoustic neuroma is also known as…

A

Vestibular schwannoma

26
Q

In addition to the vestibulocochlear nerve, which other cranial nerves can be affected by an acoustic neuroma?

A

Trigeminal nerve (CN V) and facial nerve (CN VII)

27
Q

How is a suspected acoustic neuroma investigated?

A
  • MRI (cerebellopontine angle)

- Audiometry

28
Q

Describe the management options for acoustic neuroma

A
  • Observation
  • Radiotherapy
  • Surgery
29
Q

Acoustic neuroma is typically associated with which other condition?

A

Neurofibromatosis type 2 - patients with this condition have been known to have bilateral acoustic neuromas

ENT (10 decks)

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