Vertigo Flashcards
Dizzy when rolling over in bed
BPPV
First attack severe, lasting hours and associated with N+V
Vestibular neuritis
Light sensitive during dizzy spells
Vestibular migraine
Feeling of fullness in one ear and difference in hearing around the time of the dizzy spell
Ménière’s disease
What is dizziness
Non-specific term used to describe a sensation of unsteadiness, lightheadedness, or a feeling of spinning or imbalance
What is vertigo
A sensation of motion
How might people describe vertigo
Spinning, falling, feeling of being pushed
Vertigo that lasts seconds
BPPV
Vertigo that lasts hours
Meniere’s
Vertigo that lasts days
Vestibular neuritis
Vertigo that lasts for variable amounts of time
Migraine associated vertigo
Name some associated symptoms of vertigo
Hearing loss, tinnitus, aural pressure
Migraines or sensory sensitivity
Sound or pressure induced symptoms
How might we investigate vertigo
Otoscopy
Blood pressure
Neurological exam
Test balance systems
Audiometry
What is BPPV
Benign positional paroxysmal vertigo
What causes BPPV
Otoconia from the utricle is displaced into the semi-circular canals
What are otoconia
Calcium carbonate crystals
Where is otoconia most commonly displaced to
Posterior semi-circular canals
Name 3 things that can cause BPPV
Head trauma
Ear surgery
Idiopathic
How does BPPV present
Vertigo when looking up, movement in bed, bending forward, moving head quickly
Other associated symptoms of BPPV
N+V
Diagnostic examination for BPPV
Dix-hallpike manoeuvre
Positive test for Dix-hallpike manoeuvre
Will invoke symptoms and cause geotropic, torsional nystagmus
What is nystagmus
Uncontrolled repetitive movements of the eyes
What is used to treat BPPV
Repositioning manoeuvres
Name 3 repositioning manoeuvres used to treat BPPV
Epley manoeuvre
Selmont manoeuvre
Brandt-daroff exercises
What is the epley manoeuvre
A series of head and body movements designed to reposition displaced otoliths in the inner ear
How often should a patient do Brandt-daroff exercises
10 reps 3x a day, usually for a week
What is vertebrobasilar insufficiency
Describes a temporary set of symptoms due to ischaemia in the posterior circulation of the brain
What is the most common cause of vertebrobasilar insufficiency
Atherosclerosis
Clinical presentation of VBI
Causes vertigo on looking up
What is VBI
vertebrobasilar insufficiency
What is needed for a diagnosis of VBI
Vertigo + symptoms of impaired circulation in the posterior brain
Give examples of symptoms that suggest impaired circulation in the posterior brain
Visual disturbance
Weakness
Numbness
What is labyrinthitis
Inflammation of the labyrinth of the inner ear
What is vestibular neuritis
Inflammation of the vestibular nerve
What is the probable cause of labyrinthitis and vestibular neuritis
Viral infection
What symptoms are associated with labyrinthitis
Tinnitus or hearing loss
Clinical presentation of vestibular neuritis and labyrinthitis
Prolonged vertigo
First attack severe, lasting hours with N+V
What is the management of vestibular neuritis and labyrinthitis
Supportive- vestibular sedatives
Rehabilitation exercises if prolonged
What is Ménière’s disease
An idiopathic disorder causing vertigo
What is Ménière’s disease thought to be caused by
Excess of endolymph within the membranous labyrinth caused by dysfunctioning sodium channels
Causes increase in pressure
Clinical presentation of Ménière’s disease
Triad of severe paroxysmal vertigo, sensorineural hearing loss and tinnitus on the affected side
Sensation of ear being full
Investigation for Ménière’s disease
Audiology
Positive testing for Ménière’s disease shows…
Low frequency sensorineural hearing loss
Management of Ménière’s disease
Supportive
Tinnitus therapy
Hearing aids
Lifestyle prevention of Ménière’s disease
Reduce salt, avoid chocolate and caffeine, avoid stress
What is a vestibular migraine
Episode of vertigo in someone who has a history of migraines
Clinical presentation of vestibular migraine
Light sensitive during dizzy spells
Fluctuating hearing loss
Phonophobia
Lifestyle management of vestibular migraines
Avoid: alcohol, caffeine, chocolate, citrus fruits, lack of sleep
Pharm management of vestibular migraines
Abortive agents e.g. triptans
Prophylaxis e.g. propranolol, amitriptyline
Which way does nystagmus occur
Away from the damaged side
