vertigo

Question 1

what

Answer 1

descriptive term for sensation of movement between patient and environment

often horizontal spinning sensation

Question 2

pathophysiology

Answer 2

mismatch between sensory inputs for maintaining balance

• vision
• proprioception
• vestibular system

Question 3

vestibular apparatus

Answer 3

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

Question 4

vestibular nerve

Answer 4

carries signals from vestibular apparatus to vestibular nucleus in brainstem and cerebellum

Question 5

vestibular nucleus

Answer 5

sends receving signals from vestibular nerve to CN 3, 4 + 6
and
thalamus spinal cord and cerebellum

coordinating eye movements and other body movements

Question 6

vertigo can be caused by either…

Answer 6

peripheral problem - vestibular system

central problem - brainstem or cerebellum

Question 7

most common causes peripheral (vestibular) vertigo

Answer 7

benign paroxysmal positional vertigo
Meniere’s disease
vestibular neuronitis
labrynthitis

Question 8

most common causes central vertigo

Answer 8

posterior circulatory stroke
tumour
MS
vestibular migraine

Question 9

Vestibular migraine

Answer 9

symptoms lasting mins-hrs

assoc with visual aura and headache

Question 10

Vestibular migraine - triggers

Answer 10

stress
bright lights
strong smells 
certain food e.g. cheese, chocolate, caffine 
dehydration 
menstruation
abnormal sleep pattern

Question 11

what is important to establish in the history

Answer 11

between vertigo and dizziness

is room moving or is it more lightheadedness?

Question 12

peripheral vs central: onset

Answer 12

P: sudden

C: gradual (except stroke)

Question 13

peripheral vs central: duration

Answer 13

P: short

C: persistent

Question 14

peripheral vs central: hearing loss or tinnitus

Answer 14

P: often present (except BPPV)

C: usually not

Question 15

peripheral vs central: coordination

Answer 15

P: intact

C: impaired

Question 16

peripheral vs central: nausea

Answer 16

P: more severe

C: mild

Question 17

what to do examination wise

Answer 17

ear examination
neurological examination inc cerebellar
CVS exam
special tests

Question 18

cerebellar examination

Answer 18

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor 
Slurred speech 
Heel shin test

Question 19

special tests

Answer 19

rombergs test
Dix Hallpike manoevre
HINTS examination

Question 20

HINTS examination

Answer 20

Head Impule
Nystagmus
Test of Skew

Question 21

Head impulse test

Answer 21

• 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

Question 22

Head impulse test - results

Answer 22

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

Question 23

test of skew

Answer 23

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

Question 24

Mx - central

Answer 24

referral

CT, MRI

Question 25

Mx - peripheral

Answer 25

prochloperazine

antihistamine: clyclizine, promethazine

Question 26

DVLA

Answer 26

patient must not drive and inform DVLA if have sudden unprovoked episodes diasbling dizziness