vertigo Flashcards
what is vertigo ?
a false sensation of rotation or spinning and movement of the surrounding environment
broadly, what are the types of vertigo ?
peripheral and central
what is the difference between central and peripheral vertigo ?
central vertigo is to do with a brain lesion
peripheral involves the ear and the mechanisms of balance in the ear
what are the causes of peripheral vertigo ?
benign paroxysmal positional vertigo
vestibular neeuritis
Menieres disease
Labrynthitis
what are the causes of central vertigo ?
vestibular migranes
acoustic neuroma
brainstem or cerebellar lesions
what is the other name for an acoustic neuroma ?
vestibular schwannoma
what is the aetiology of benign paroxysmal positional vertigo ?
free floating otoliths that continue movement even without any head movement
what is the presenting picture of BPPV ?
sudden onset
episodic
rotatory vertigo
lasts for seconds to a few minutes
NO HEARING LOSS
what test is used to diagnose BPPV ?
Dix-Hallpike test
what is the presentation of Vestibular neuritis ?
sudden onset
rotatory vertigo
severe
persistent for more than 24 hours
can’t get off bed for days
improves in several days to weeks
NO HEARING LOSS
what is the other term also used to describe Menieres disease ?
Endolymphatic hydrops
what is the presentation of meniere’s disease ?
gradual onset
rotatory vertigo that may last up to hours
nausea and vomiting
fluctuating sensorineural hearing loss with a low frequency threshold
tinnitus
aural fullness usually felt before onset of vertigo
what is labrynthitis ?
inner ear inflammationn
what is the presentation of labrynthitis like ?
gradual onset
vertigo
nausea and vomiting
nystagmus
SNHL or mixed
what is the presentation of a vestibular migrane ?
sudden rotatory severe vertigo can last minutes to hours
classically associated with:
headache/migrane
photophobia/visual disturbancees
Phonophobia
not always present
where do acoustic neuromas arise from ?
schwann cells of vestibular nerves
in the cerebellopontine angle
what is the presentation of acoustic neuroma ?
unilateral or asymmetrical SNHL
very poor speech discrimination
normal otoscopy
how is an acoustic neuroma diagnosed ?
MRI
what is the presentation of central veertigo secondary to brainstem or cerebellar ischemia ?
usually lasts for 20 minutes to 24 hours and associated with other brainstem characteristics such as diplopia and autonomic disturbances
what investigations aree required for cases of vertigo ?
full neurological examination
pure tone audiometry
Dix-hallpike test
Videonystagmography
MRI
what is the treatment for BPPV ?
first localization through the DDix-Hallpike test then treat with Epley’s manoeuver
what is the management for cases of BPPV that are resistant where Epley’s maneuver was ineffective ?
Brandt-Daroff exersices
what is the treatment of vestibular neuritis ?
rest
antivertigo drugs
Antiemetics
Steroids
Benzodiazepams in acute stages
what is the management for menieres disease ?
pressure reducing therapies :
low salt diets
Betahistines
diuretics
what are betahistines ?
anti-vertigo drugs
what is the best next step in management in cases of persistent Menieres disease ?
intratympanic injection of steroid and gentamicin
what is the management of vestibular migranes ?
avoid triggers:
chocolate
nuts
dehydration
high salt diets
old cheese
anxiety
disturbed sleep pattern
what are the migraine preventative medications ?
topiramate
rizatriptan ( selective serotonin receptor agonist)
what medications can be taken during an attack of vestibular migraine ?
triptans
ergotamine
what is the function of ergotamine ?
preventing blood vessel expansion
what is the commonest cause of central vertigo ?
vestibular migranes
what is the commonest cause of peripheral vertigo ?
benign paroxysmal positional vertigo
