Vertigo Flashcards
What is vertigo
Sensation that there is movement between the patient and their environment
What symptoms is vertigo associated with
Nausea, vomiting, sweating and feeling generally unwell
Pathophysiology of vertigo
Vision, proprioception and signals from vestibular system. Mismatch between these systems
What is the vestibular system made up of
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.
Two categories which cause vertigo
Peripheral problem - affecting vestibular system
Central problem - affecting the brainstem or cerebellum
Four main causes of peripheral vertigo
Benign paroxysmal positional vertigo (BPPV)
Meniere’s disease
Vestibular neuronitis
Labyrinthitis
Less common causes of peripheral vertigo
Trauma to vestibular nerve
Vestibular nerve tumours (acoustic neuromas)
Otosclerosis
Hyperviscosity syndromes
Varicella zoster infection
Central causes of vertigo
Posterior circulation infarction (stroke)
Tumour
Multiple sclerosis
Vestibular migraine
What will all central causes of vertigo cause
Sustained, non-positional vertigo
Presentation of central causes of vertigo
Gradual onset (except stroke)
Persistent
Usually no hearing loss or tintitus
Coordination usually impaired
Mild nausea
Presentation of peripheral causes of vertigo
Sudden onset
Short duration
Hearing loss or tinnitus often present (except BPPV)
Coordination usually intact
Nausea more severe
Symptoms of vestibular migraine
Symptoms lasting minutes to hours, often associated with visual aura and headache.
Triggers for vestibular migraine
Stress, bright lights, strong smells, certain foods, dehydration, menstruation, abnormal sleep patterns
Symptoms of posterior circulation infarction
Sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms
Symptoms of tumours causing vertigo
Tumours in cerebellum or brainstem will have gradual onset with associated symptoms of cerebellar and brainstem dysfunction
Four things to examine when assessing a patient with vertigo
Ear examination, neurological examination, cardiovascular examination and special tests
Special tests to perform in patient with vertigo
Rombergs test
Dix-Hallpike manoeuvre
HINTS examination
What is HINTS examination
HI - Head Impulse
N - Nystagmus
TS - Test of Skew
What is the head impulse test
Patient sits upright fixing gaze on examiners nose. Patients head is moved rapidly in one direction while continuing to look at examiners nose.
What is an abnormal head impulse test
In a patient with a peripheral cause of vertigo, the eyes will saccade as they eventually fix back on the examiner
What is the test of skew
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
Abnormal test of skew
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