vertigo

Question 1

what is vertigo

Answer 1

false sensation of body, or environment moving

Question 2

differentials vertigo

Answer 2

labryinthitis // neuronitis // BPPV // mernieres // schwannoma // vertebrobasilar ischaemia // post circulation stroke // gentamicin // MS

Question 3

symptoms BPPV

Answer 3

triggered by changes in head position eg rolling over in bed // +/- nausea // lasts 10-20 seconds

Question 4

invx + findings BPPV

Answer 4

Dix-hallpike - vertigo + rotatory nystagmus (circular)

Question 5

mx BPPV (non-pharma)

Answer 5

epley manouvre // verstibular rehab exercises at home eg Brandt-Daroff

Question 6

mx BPPV (pharma)

Answer 6

maybe betahistine

Question 7

what is Labyrinthitis

Answer 7

inflammation of labryingth affecting vestibular and cochlear systems

Question 8

symptoms viral Labyrinthitis

Answer 8

vertigo (not triggered by anything, worse on movement) // N+V // hearing loss // tinnitus

Question 9

what can precede Labyrinthitis

Answer 9

URTI

Question 10

o/e Labyrinthitis

Answer 10

horizontal nystagmus towards affected side // webers: AC > BC, rinnes - heard in unaffected side) // abnormal head impulse (jerk) // gait disturbance

Question 11

mx Labyrinthitis

Answer 11

selflimiting // prochlorperazine or antihistamines

Question 12

what is vestibular neuronitis

Answer 12

following an infection - only vestibular nerve affected (no hearing loss)

Question 13

symptoms vestibular neuronitis

Answer 13

recurrent vertigo // horizontal nystagmus // maybe N+V // NO hearing loss and NO tinnitus

Question 14

what is an important differential to rule out in vestibular neurnoitis and how is this done

Answer 14

posterior circulation stroke - HiNTs exam

Question 15

mx for vestibular neuritis

Answer 15

buccal or IM prochlorperazine (rapid relief) // short course prochlorperazine (or antihistamine) // chronic = vestibular rehab

Question 16

what is mernieres

Answer 16

increased pressure and dilation of endolymph

Question 17

symptoms mernieres

Answer 17

recurrent vertigo // tinnitus + hearing loss // aural fullness // nystagmus + Romberg // last minutes –> hours

Question 18

how long does merniers take to resolve

Answer 18

5-10 years // distressing

Question 19

mx mernieres

Answer 19

ENT assessment // acute = buccal or IM prochlorperazine // prophylaxis = betahistine + vestibular rehab

Question 20

driving and mernieres

Answer 20

inform DVLA // stop until symptom control working

Question 21

symptoms verterbrobasilar ischaemia

Answer 21

elderly patients // dizziness + vertigo on extension of neck

Question 22

mx motion sickness

Answer 22

hyoscine transdermal patch // non-sedating antihistamine eg cyclizine or cinnarizine

Question 23

which part of the ears detect movement

Answer 23

otilith organs - utricle and saccule // 3 semi-circular canals