Vertigo

Question 1

What is vertigo

Answer 1

Sensation that there is movement between the patient and their environment

Question 2

What symptoms is vertigo associated with

Answer 2

Nausea, vomiting, sweating and feeling generally unwell

Question 3

Pathophysiology of vertigo

Answer 3

Vision, proprioception and signals from vestibular system. Mismatch between these systems

Question 4

What is the vestibular system made up of

Answer 4

Three semicircular canals that are filled with endolymph. These are in the inner ear. They together detect head movements by tiny hairs (stereocilia) found in ampulla.

Question 5

Two categories which cause vertigo

Answer 5

Peripheral problem - affecting vestibular system
Central problem - affecting the brainstem or cerebellum

Question 6

Four main causes of peripheral vertigo

Answer 6

Benign paroxysmal positional vertigo (BPPV)
Meniere’s disease
Vestibular neuronitis
Labyrinthitis

Question 7

Less common causes of peripheral vertigo

Answer 7

Trauma to vestibular nerve
Vestibular nerve tumours (acoustic neuromas)
Otosclerosis
Hyperviscosity syndromes
Varicella zoster infection

Question 8

Central causes of vertigo

Answer 8

Posterior circulation infarction (stroke)
Tumour
Multiple sclerosis
Vestibular migraine

Question 9

What will all central causes of vertigo cause

Answer 9

Sustained, non-positional vertigo

Question 10

Presentation of central causes of vertigo

Answer 10

Gradual onset (except stroke)
Persistent
Usually no hearing loss or tintitus
Coordination usually impaired
Mild nausea

Question 11

Presentation of peripheral causes of vertigo

Answer 11

Sudden onset
Short duration
Hearing loss or tinnitus often present (except BPPV)
Coordination usually intact
Nausea more severe

Question 12

Symptoms of vestibular migraine

Answer 12

Symptoms lasting minutes to hours, often associated with visual aura and headache.

Question 13

Triggers for vestibular migraine

Answer 13

Stress, bright lights, strong smells, certain foods, dehydration, menstruation, abnormal sleep patterns

Question 14

Symptoms of posterior circulation infarction

Answer 14

Sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms

Question 15

Symptoms of tumours causing vertigo

Answer 15

Tumours in cerebellum or brainstem will have gradual onset with associated symptoms of cerebellar and brainstem dysfunction

Question 16

Four things to examine when assessing a patient with vertigo

Answer 16

Ear examination, neurological examination, cardiovascular examination and special tests

Question 17

Special tests to perform in patient with vertigo

Answer 17

Rombergs test
Dix-Hallpike manoeuvre
HINTS examination

Question 18

What is HINTS examination

Answer 18

HI - Head Impulse
N - Nystagmus
TS - Test of Skew

Question 19

What is the head impulse test

Answer 19

Patient sits upright fixing gaze on examiners nose. Patients head is moved rapidly in one direction while continuing to look at examiners nose.

Question 20

What is an abnormal head impulse test

Answer 20

In a patient with a peripheral cause of vertigo, the eyes will saccade as they eventually fix back on the examiner

Question 21

What is the test of skew

Answer 21

Also the alternal cover test, where the patient fixes their eyes on examiners nose while covering up one eye at a a time and alternating, the eyes should remain fixed on nose

Question 22

Abnormal test of skew

Answer 22

When an eye is uncovered it would have drifted up or down and needs to fix on the nose again. This indicates a cental cause of vertigo