vertigo Flashcards
what
descriptive term for sensation of movement between patient and environment
often horizontal spinning sensation
pathophysiology
mismatch between sensory inputs for maintaining balance
- vision
- proprioception
- vestibular system
vestibular apparatus
3x semicircular canals filled with endolymph
as head turns, endolymph shifts. Shifting fluid is detected by stereocilia in ampulla
sensory input of shifting endolymph is transmitted by vestibular nerve
vestibular nerve
carries signals from vestibular apparatus to vestibular nucleus in brainstem and cerebellum
vestibular nucleus
sends receving signals from vestibular nerve to CN 3, 4 + 6
and
thalamus spinal cord and cerebellum
coordinating eye movements and other body movements
vertigo can be caused by either…
peripheral problem - vestibular system
central problem - brainstem or cerebellum
most common causes peripheral (vestibular) vertigo
benign paroxysmal positional vertigo
Meniere’s disease
vestibular neuronitis
labrynthitis
most common causes central vertigo
posterior circulatory stroke
tumour
MS
vestibular migraine
Vestibular migraine
symptoms lasting mins-hrs
assoc with visual aura and headache
Vestibular migraine - triggers
stress bright lights strong smells certain food e.g. cheese, chocolate, caffine dehydration menstruation abnormal sleep pattern
what is important to establish in the history
between vertigo and dizziness
is room moving or is it more lightheadedness?
peripheral vs central: onset
P: sudden
C: gradual (except stroke)
peripheral vs central: duration
P: short
C: persistent
peripheral vs central: hearing loss or tinnitus
P: often present (except BPPV)
C: usually not
peripheral vs central: coordination
P: intact
C: impaired
peripheral vs central: nausea
P: more severe
C: mild
what to do examination wise
ear examination
neurological examination inc cerebellar
CVS exam
special tests
cerebellar examination
Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Heel shin test
special tests
rombergs test
Dix Hallpike manoevre
HINTS examination
HINTS examination
Head Impule
Nystagmus
Test of Skew
Head impulse test
- patient sit upright, gaze fixed examiners nose
- examiner rapidly jerks patients head 10-20º one direction
- head moved slowly to centre before repeat opposite direction
Head impulse test - results
normal vestibular system - eyes stay fixed examiner’s nose
abnormally function - eyes will nystagmus until eventually fix back on examine
normal if peripheral but no current symptoms
normal if central vertigo
test of skew
patient upright, gaze fixed examiner’s nose
examiner coers one eye at time, alternating
eyes should remain fixed on examiner’s nose.
If there is vertical correction then indicated central cause vertigo
Mx - central
referral
CT, MRI
Mx - peripheral
prochloperazine
antihistamine: clyclizine, promethazine
DVLA
patient must not drive and inform DVLA if have sudden unprovoked episodes diasbling dizziness
