Vertigo

Question 1

What is dizziness?

Answer 1

• Non-specific term which may cover vertigo, pre-syncope, disequilibrium, etc

Question 2

What is vertigo?

Answer 2

A sensation of movement, usually spinning

Question 3

What are the 4 inputs to the balance system?

Answer 3

• Visual
• Proprioceptive
• Cardiovascular
• Vestibular

Question 4

What are the 2 outputs of the balance system?

Answer 4

Vestibulospinal tract
Vestibular-ocular reflex

Question 5

What are some questions required for dizziness history?

Answer 5

Describe it in 1 word that isn’t dizzy
Duration of episode
Associated symptoms

Question 6

Give the cause:
Patient feels lightheaded, syncope, palpitations

Answer 6

Cardiac cause

Question 7

Give the cause:
Patient describes blackouts, visual disturbance, paraesthesia, weaknes, speech and swallow problems

Answer 7

Neurological cause

Question 8

Give the cause:
Patient describes vertigo

Answer 8

Vestibular cause

Question 9

Duration of vertigo episode: Seconds

Answer 9

Benign positional paroxysmal vertigo (BPPV)

Question 10

Duration of vertigo episode: Hours

Answer 10

Meniere’s disease

Question 11

Duration of vertigo episode: Days

Answer 11

Vestibular neuritis

Question 12

Duration of vertigo episode: Varying

Answer 12

Migraine associated vertigo

Question 13

Patient gets dizzy rolling over in bed (Give cause)

Answer 13

BPPV

Question 14

First attack was severe, lasting hours with nausea and vomiting (Give cause)

Answer 14

Vestibular neuritis

Question 15

Patient gets light-sensitive during the dizzy spells (Give cause)

Answer 15

Vestibular migraine

Question 16

One ear feels full and there is a change of hearing during dizzy spell (Give cause)

Answer 16

Meniere’s disease

Question 17

What is nystagmus?

Answer 17

Repetetive jerky eye movements

Question 18

In which direction does nystagmus occur in relation to the affected ear?

Answer 18

Nystagmus occurs away from the affected ear

Question 19

What test is used to track nystagmus?

Answer 19

Head impulse test

Question 20

What are the main causes of vertigo?

Answer 20

Benign positional paroxysmal vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Meniere’s disease
Migraine associated vertigo
Vertebrobasilar insufficiency

Question 21

Which causes of vertigo are associated with hearing loss or tinnitus?

Answer 21

Meniere’s disease
Labyrinthitis

Question 22

What is BPPV?

Answer 22

Vertigo caused by the presence of otoconia in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up

Question 23

What are some possible causes of BPPV?

Answer 23

• Head trauma
• Ear surgery
• Idiopathic

Question 24

How does BPPV occur?

Answer 24

Once in the canal, movement of the patient’s head will result movement of the otoliths, causing an abnormal movement of endolymph which results in vertigo

Question 25

What will be some possible triggers of vertigo in BPPV?

Answer 25

- Looking up - Turning in bed - often worse to one side - First lying down in bed at night - Getting out of bed in the morning - Bending forward - Rising from bending - Moving head quicky - often only in one direction - Attacks will last seconds

Question 26

What are some symptoms of BPPV?

Answer 26

- Vertigo - Nausea - Vomiting

Question 27

What is the main diagnostic test in BPPV?

Answer 27

Dix-Hallpike manoeuvre

Question 28

How is the Dix-Hallpike manoeuvre performed?

Answer 28

- Sit up - Lie down - Will be symptomatic or show eratic nystagmus for 10-60 seconds

Question 29

What are the management options used in BPPV?

Answer 29

- Epley manoeuvre (Shown) - Selmont manoeuvre - Brandt-Daroff exercises

Question 30

What is labyrinthitis?

Answer 30

Inflammation of the labyrinth

Question 31

What is vestibular neuritis?

Answer 31

Inflammation of the vestibular nerve

Question 32

What is the most common cause of labyrinthitis and vestibular neuritis?

Answer 32

Viral infection

Question 33

How will labyrinthitis and vestibular neuritis present?

Answer 33

- 1st attack lasting hours - Prolonged vertigo lasting days - Nausea and vomiting - Viral symptoms

Question 34

What is a symptom of labyrinthitis specifically?

Answer 34

Tinnitus or hearing loss

Question 35

What is the rule of 3 for vestibular neuritis and labyrinthitis?

Answer 35

- In bed 3 days - Off work 3 weeks - Off balance 3 months

Question 36

How is vestibular neuritis and labyrinthitis managed?

Answer 36

- Supportive management with vestibular sedatives - Generally self-limiting - May require further investigation if prolonged or atypical - May be helped by rehabilitation exercises if prolonged

Question 37

What is Meniere's disease?

Answer 37

Idiopathic disorder causing vertigo

Question 38

What is though to be the cause of Meniere's disease?

Answer 38

Excess of endolymph within the membranous labryth

Question 39

What is thought to cause symptoms in Meniere's disease?

Answer 39

Increase in endolymphatic pressure due to dysfunctioning sodium channels

Question 40

How does Meniere's disease present?

Answer 40

- Severe paroxysmal vertigo (At lease 2 episodes > 20 minutes) - Sensorineural hearing loss - Tinnitus - Aural fullness

Question 41

How will Meniere's disease present on audiometry?

Answer 41

Typically low frequency sensorineural hearing loss

Question 42

What condition is shown?

Answer 42

Meniere's disease

Question 43

How is Meniere's disease managed?

Answer 43

- Supportive treatment during episodes - Tinnitus therapy - Hearing aids - Lifestyle advice

Question 44

What lifestyle advice should be given in Meniere's disease?

Answer 44

Reduce salt intake Avoid chocolate Avoid caffeine Avoid stress

Question 45

What is meant by migraine associated vertigo?

Answer 45

Episode of vertigo in someone who has a history of migraines - about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia

Question 46

How will migraine associated vertigo present?

Answer 46

- Light-sensitive during dizzy spells of variable duration - Phonophobia - Fluctuating hearing loss, acute permanent hearing loss occur in a small percentage - Motion sensitivity with bouts of motion sickness

Question 47

How can migraine associated vertigo be managed?

Answer 47

- Lifestyle modification - Avoid triggers - Abortive agents (E.g. triptans) - Prophylaxis (E.g. Propranolol)

Question 48

What is vertebrobasilar insufficiency?

Answer 48

Describes a temporary set of symptoms due to ischaemia in the posterior circulation of the brain

Question 49

What causes vertebrobasilar insufficiency?

Answer 49

Narrowing of the posterior circulation arteries, most commonly due to arteriosclerosis

Question 50

How will vertebrobasilar insufficiency present?

Answer 50

- Vertigo on looking up - Visual disturbance - Weakness - Numbness