Vertigo Flashcards
(1) Either a sensation of motion when there is no motion or an exaggerated sense of motion in response to movement.
Overview of vertigo
Onset is sudden; often associated with tinnitus and hearing loss; horizontal nystagmus may be present.
1) Etiologies:
a) BPPV
b) Herpes zoster
c) Otitis media
d) Aminoglycoside toxicity
Peripheral: Vertigo
Onset is gradual; no associated auditory symptoms; often presents with other neurologic signs and symptoms like ataxia stumbling, dysarthria, dysphagia, focal or lateralized weakness
1) Etiologies
a) Brainstem ischemia
b) Multiple sclerosis
c) Veistibular migraine
Central: Vertigo
(1) Vertigo is the cardinal symptoms of vestibular disease.
(a) Vertigo is typically experienced as a distinct “spinning” sensation or a sense of tumbling or of falling forward or backward.
(2) It should be distinguished from imbalance, light-headedness, and syncope, all of which are non-vestibular in origin.
(3) Nausea and vomiting are typical with acute vertigo
Symptoms and Signs
(1) A thorough history will often narrow down, if not confirm the diagnosis.
(2) Critical elements of the history include the duration of the discrete vertiginous episodes (seconds, minutes to hours, or days), and associated symptoms.
(3) The physical examination of the patient with vertigo includes evaluation of the ears,
observation of eye motion and nystagmus in response to head turning, cranial nerve
examination, and Romberg testing.
***(4) In acute peripheral lesions, nystagmus is usually horizontal with a rotatory component; the fast phase usually beats away from the diseased side.
(5) Visual fixation tends to inhibit nystagmus except in very acute peripheral lesions or with CNS disease.
***(6) In benign paroxysmal positioning vertigo, Dix-Hallpike testing (quickly lowering the patient to the supine position with the head extending over the edge and placed 30 degrees lower than the body, turned either to the left or right) will elicit a delayed
onset (~10 sec) fatigable nystagmus.
Evaluation Vertigo
***Non-fatigable nystagmus in this position indicates
CNS disease
(1) Peripheral vestibulopathy usually causes vertigo of sudden onset, may be so severe that the patient is unable to walk or stand, and is frequently accompanied by nausea and vomiting.
(a) Tinnitus and hearing loss may be associated and provide strong support for a
peripheral (i.e., otologic) origin.
Causes of Vertigo
Evaluation of central audiovestibular dysfunction requires
MRI of the brain.
(f) Cerebral lesions involving the temporal cortex may also produce vertigo; it is sometimes the initial symptom of a seizure.
(g) Finally, vertigo may be a feature of a number of systemic disorders and can occur as a side effect of certain anticonvulsant, antibiotic, hypnotic, analgesic, and tranquilizer medications or of alcohol.
Central disease of Vertigo
(1) Vertigo treatment can be divided into three categories: those specific to the underlying
vestibular disease, those aimed at the symptom of vertigo, and those aimed at promoting recovery.
(2) Medications to suppress vestibular symptoms are best used for alleviating acute episodes that last at least a few hours or days and are not as useful for brief episodes (Benign Paroxysmal Positional Vertigo), unless they occur with high frequency. Doses
should be started low and increased to positive effect or side effect.
(3) Recommend starting with low dose and increase to positive effect or side effect and stopping within 48 hours if the patient’s symptoms allow.
Vertigo treatment
(a) Meclizine (Antivert) - 1st generation antihistamine
1) Dose: 25 to 50mg q 6-12 hours PRN dizziness
(b) Diazepam (Valium) - Anticonvulsant, Benzodiazepine
1) Dosing: 1 mg PO q 12 hours as needed for dizziness
(c) Ondansetron (Zofran) – antiemetic
1) Dose: 4mg PO/IV q8 hours as needed
(d) Promethazine (Phenergan) - 1st generation antihistamine, anti- nausea and vomiting medication
1) Dose: 12.5 - 25mg PO/IM/IV/Rectal every 4-6 hours as needed
Vertigo Medications
in patients with peripheral vestibular disorders
to promote early recovery. Vestibular rehabilitation may be accomplished by a
series of sessions with a physical therapist, or the patient may be trained to do
these independently, at home. Most patients with vertigo prefer to lie with their
head still but vestibular rehabilitation forces them to perform challenging
balance exercises with several potential benefits.
Recommend vestibular exercises
