Vertigo Flashcards
most common causes of vertigo
- benign paroxysmal vertigo
- acute peripheral vestibulopathy (vestibular neuritis or labyrinthitis)
- meniere’s disease
- migraine
- psychogenic
central vertigo
(central nervous system)
- TIA or stroke
- migrainenous veritgo
- MS
- cerebellopontine angle tumour
how to check on history if a patient has vertigo
confirm the patient experiences spinning sensation not just light headedness
dizzyness of vestibular origin will be provoked by
aggrevated by movement and releived by rest
drugs causing dizzyness
antihypertensives
anticonvulsants
antidepressants
sedatives
purely vertical nystagmus
central lesion
may change direction eg. beata to the left on left gaze and beat to the right on right gaze
horizontal nystagmus
peripheral vestibular nystagmus
beats in the same direction regardless of the eye positon
what does the vestibulo occular reflex test look for
confirms peripheral origin of the vertigo symptoms
vestibulo-ocular reflex
get patient to fix eyesight on examiners nose
shake head after excluding neck pathology
eyes will move toward direction of vestibular lesion and quickly dart back
or healthy response will be to maintain eye contact with the examiners nose
dix-hallpike manouvre
used to confirm benign paroxysmal positional vertigo
also locates the affected side and demonstrates the canalith mobility
success rate of the epley monouvre depends on the mobility of the canalith
vestibular neuritis and labrynthitis
best rest and short ter symptom relief treatments
high dose steroids and then taper
drugs for symptomatic treatment of vertigo
vestibular sedatives: benzodiazepines, antihiistamines
antiemetics and bed rest also helpfull
pathophysiology benign paroxysmal positional vertigo
most common underying cause of vertigo
lodgement of a canalith insiite the posterior semicircular canal
made up of small crystals of calcium carbonate that have detatched from the urticle in the vestibule of the inner ear
movement of the canalith activates the vestibular haair cells to create asymmetrical vestibular input
menieres syndrome
typically presents with vertigo, fluctuating low frequency hearing loss/tinnitus and aural pressure
managed with low salt diet and diuretics
vestibular sedatives and antiemetics fro acute attacks
treatment for refrectory meniers
tympanic gentamycin and surgery
history of upper respiratory tract or ear infection suggests the presence of
vestibular neuritis or labrynthitis
vertigo duration of seconds
vertigo duration of minutes to hours
vertigo duration of hours to days
vertigo duration of days to weeks
examination of the ear may reveal
vessicles of herpes zoster may be visible on external ear
otoscopic examination may reveal signs of inflammation associated with acute vestibulopathy, scarring of eardrum from chronic suppurative otitis media, or an erosive cholesteatoma
vestibular neuritis and labrynthitis
vestibulaar neuritis: inflammation of the vestibular nerve which results in severe vertigo for several days, thought to be due to HSV1 reactivation
labrynthitis has hearing loss as an additional feature
give high dose prednisolone and taper dose down over 18 days
symptoms of meniere’s disease
idiopathic abnormal dilatation of endolymphatic organ producing symptoms of progressive vertigo, tinnitus, aural fullness and fluctuating low frequency hearing loss
no specific cure, treatment aimed at symptom control: low salt diet and diuretics
migrainous vertigo
typical migrainous headache may be absent
lifestyle changes, migraine treatment and prophylaxis
driving
acute symtpoms for meniere’s disease, acute laabrynthitis, acute vestibular neuritis, acute BPPV
