vertigo

Question 1

what is vertigo

Answer 1

Sensation of movement, typically horizontal spinning in nature
Associated with nausea, vomiting, sweating and general unwellness

Question 2

vertigo is Caused by a mismatch between….

Answer 2

the sensory input that is responsible for maintaining your posture and your vision, proprioception and vestibular system

Question 3

vestibular apparatus function and location

Answer 3

in the inner ear, filled with fluid, to help detect movement of the head
As the head moves, the fluid in the ear shifts, providing the head with proprioception, sending the signal to the brain via the vestibular nerve to the cerebellum and spinal cord

Question 4

Vertigo can be caused by a…..

Answer 4

PERIPHERAL problem (the inner ear) or a CENTRAL problem in the brain

Question 5

The three main vestibular causes are

Answer 5

benign paroxysmal positional vertigo, meniere’s disease and vestibular neuronitis

Question 6

BPPV is caused by

Answer 6

crystals of calcium carbonate that become displaced in the canals of the inner ear.

Question 7

symptoms of BENIGN PAROXYSMAL POSITIONAL VERTIGO are…

Answer 7

usually positioned as movement is required to confuse the system
No symptoms when still

Question 8

what is MENIERS DISEASE

Answer 8

Caused by an excessive buildup of fluid in the inner ear, causing too high pressure, thus disrupting the normal flow of fluid

Question 9

presentation of meniers disease

Answer 9

Causes hearing loss, tinnitus, vertigo, fullness in the ear
Usually last for several hours and is not associated with movement
Spontaneous nystagmus during the attacks

Question 10

what is ACUTE VESTIBULAR NEURONITIS

Answer 10

Inflammation of the vestibular nerve
Usually due to viral infection, due to mismatch of signals to the brain

Question 11

presentation of acute vestibular neuritis

Answer 11

Usually presents with an acute onset of vertigo, lasts fro several weeks prior to resolving

Question 12

most common central causes

Answer 12

The most common causes are posterior infarct, tumours, MS and vestibular migraine

Question 13

Central causes will all cause a

Answer 13

sustained, non- positional vertigo because they are not caused by a disruption of the movement of fluid in the inner ear

Question 14

presentation of posterior stroke

Answer 14

Sudden onset of vertigo, can be associated with ataxia, double vision, cranial nerve issues or FAST pos

Question 15

presentation of vestibular migrane

Answer 15

Symptoms last minutes to hours
Associated with visual aura and headache

Question 16

vertigo red flags

Answer 16

Signs of stroke.
Headache.
Unable to walk unaided.
Neck pain.
Visual disturbance.
Abnormal coordination during the finger-nose test.
Nystagmus that persists for more than 10 seconds with the head still.
Altered level of consciousness.
Abnormal vital signs.
History of recent trauma, especially head or neck injury.
Symptoms that do not improve when the head is still.
Acute loss of hearing.

Question 17

The symptoms of cerebellar stroke usually come on suddenly (over a few minutes) and are associated with:

Answer 17

Vertigo that is not altered by head position.
Nausea and vomiting.
Loss of coordination with an abnormal finger-nose test.
Loss of balance with an inability to walk unaided.

Question 18

The symptoms of BPPV usually come on slowly over 12-24 hours and are associated with:

Answer 18

Brief but very intense periods of vertigo that occur with changes in head position, for example sitting up or rolling over. Vertigo usually resolves over 30-60 seconds when the head is kept still.
Nausea is common but vomiting is rare.
Symptoms may be worse in the morning and may be worse when the head is tilted to a particular side.

Question 19

reply manoeuvre

Answer 19

a
Sit the patient upright on a bed or stretcher and rotate their head to face one side, preferably toward the side that makes symptoms worse.
b
Assist the patient to lie back, keeping their head turned. Recline their head, using a pillow under their shoulders or with their head hanging off the end of the bed/stretcher, and their ear parallel with the floor.
c
Hold the patient’s head in this position for 60 seconds.
d
Quickly turn the patient’s head to face the opposite side and hold this position for 60 seconds.
e
Turn the head further, so that the patient is facing downward (this may require the patient to move their body to accommodate this). Hold this position for 60 seconds.
f
Assist the patient into a sitting position and rotate their head forward.

Question 20

green flags

Answer 20

Symptoms totally resolve within 60 seconds when the head is kept still.
Symptoms totally resolve following an Epley manoeuvre.

Question 21

what is nystagmus

Answer 21

Nystagmus is involuntary, rapid and repeated small movements of the eyes.

Question 22

how to look for nystagmus

Answer 22

To look for nystagmus, ask the patient to keep their head still and watch your finger while you move it from one side of their field of vision to the other. Pause your finger for ten seconds and observe the patient’s eyes.

Question 23

nystagmus durations and their indications

Answer 23

Nystagmus that stops within ten seconds of the patient focusing on your finger is usually due to a peripheral benign cause such as BPPV or vestibular neuritis.
Nystagmus that persists for longer than ten seconds when the patient is focusing on your finger is usually due to a central cause such as cerebellar stroke.