Vertigo

Question 1

What is the location of CNS pathology that causes “central vertigo”?

Answer 1

Posterior circulation (vertebrobasilar)
Brainstem: vestibular nuclei
—> PICA/LMS/Wallenberg
Cerebellum

Question 2

What are the DDx causes of PERIPHERAL vertigo?

Answer 2

BPPV
Vestibulitis
Labrynthitis
Vestibular neuronitis
Meniere’s

Ramsay Hunt
Ototoxicity
Perilymph fistula (between mid/inner ear)
Neuroma

Question 3

Differentiate the main causes of peripheral vertigo:
- BPPV
- Labrynthitis
- Vestibular neuronitis
- Meniere’s

Answer 3

Question 4

Describe DIX-HALLPIKE and expected findings:

Answer 4

• Sit upright
• Turn head 45 degr
• Lay briskly back until head is dropped over back of bed (30degr further)
• Observe for nystagmus 30 seconds

POSITIVE (BPPV)
Latency of seconds
Horizontal or horizontal+torsional nystagmus
Unidirectional

Question 5

Describe EPLEY’s:

Answer 5

• From final position of Dix Hallpike (lying on bed, head hanging down over bed turned to 45 degr)
• Turn head 90degr other way. Hold 30 secs.
• Get patient to roll onto their side. As they do, turn head all the way to floor. Hold 30secs.
• Sit upright SIDEWAYS, maintaining head rotation
• Once sitting up, head to midline, tuck chin down. Hold 30 secs.
• Repeat 2-3

Question 6

Clinical approach to suspected vertigo:

Answer 6