Vertigo Flashcards
What is dizziness?
- Non-specific term which may cover vertigo, pre-syncope, disequilibrium, etc
What is vertigo?
A sensation of movement, usually spinning
What are the 4 inputs to the balance system?
- Visual
- Proprioceptive
- Cardiovascular
- Vestibular
What are the 2 outputs of the balance system?
Vestibulospinal tract
Vestibular-ocular reflex
What are some questions required for dizziness history?
Describe it in 1 word that isn’t dizzy
Duration of episode
Associated symptoms
Give the cause:
Patient feels lightheaded, syncope, palpitations
Cardiac cause
Give the cause:
Patient describes blackouts, visual disturbance, paraesthesia, weaknes, speech and swallow problems
Neurological cause
Give the cause:
Patient describes vertigo
Vestibular cause
Duration of vertigo episode: Seconds
Benign positional paroxysmal vertigo (BPPV)
Duration of vertigo episode: Hours
Meniere’s disease
Duration of vertigo episode: Days
Vestibular neuritis
Duration of vertigo episode: Varying
Migraine associated vertigo
Patient gets dizzy rolling over in bed (Give cause)
BPPV
First attack was severe, lasting hours with nausea and vomiting (Give cause)
Vestibular neuritis
Patient gets light-sensitive during the dizzy spells (Give cause)
Vestibular migraine
One ear feels full and there is a change of hearing during dizzy spell (Give cause)
Meniere’s disease
What is nystagmus?
Repetetive jerky eye movements
In which direction does nystagmus occur in relation to the affected ear?
Nystagmus occurs away from the affected ear
What test is used to track nystagmus?
Head impulse test
What are the main causes of vertigo?
Benign positional paroxysmal vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Meniere’s disease
Migraine associated vertigo
Vertebrobasilar insufficiency
Which causes of vertigo are associated with hearing loss or tinnitus?
Meniere’s disease
Labyrinthitis
What is BPPV?
Vertigo caused by the presence of otoconia in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up
What are some possible causes of BPPV?
- Head trauma
- Ear surgery
- Idiopathic
How does BPPV occur?
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
What will be some possible triggers of vertigo in BPPV?
- 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
What are some symptoms of BPPV?
- Vertigo
- Nausea
- Vomiting
What is the main diagnostic test in BPPV?
Dix-Hallpike manoeuvre
How is the Dix-Hallpike manoeuvre performed?
- Sit up
- Lie down
- Will be symptomatic or show eratic nystagmus for 10-60 seconds
What are the management options used in BPPV?
- Epley manoeuvre (Shown)
- Selmont manoeuvre
- Brandt-Daroff exercises
What is labyrinthitis?
Inflammation of the labyrinth
What is vestibular neuritis?
Inflammation of the vestibular nerve
What is the most common cause of labyrinthitis and vestibular neuritis?
Viral infection
How will labyrinthitis and vestibular neuritis present?
- 1st attack lasting hours
- Prolonged vertigo lasting days
- Nausea and vomiting
- Viral symptoms
What is a symptom of labyrinthitis specifically?
Tinnitus or hearing loss
What is the rule of 3 for vestibular neuritis and labyrinthitis?
- In bed 3 days
- Off work 3 weeks
- Off balance 3 months
How is vestibular neuritis and labyrinthitis managed?
- Supportive management with vestibular sedatives
- Generally self-limiting
- May require further investigation if prolonged or atypical
- May be helped by rehabilitation exercises if prolonged
What is Meniere’s disease?
Idiopathic disorder causing vertigo
What is though to be the cause of Meniere’s disease?
Excess of endolymph within the membranous labryth
What is thought to cause symptoms in Meniere’s disease?
Increase in endolymphatic pressure due to dysfunctioning sodium channels
How does Meniere’s disease present?
- Severe paroxysmal vertigo (At lease 2 episodes > 20 minutes)
- Sensorineural hearing loss
- Tinnitus
- Aural fullness
How will Meniere’s disease present on audiometry?
Typically low frequency sensorineural hearing loss
What condition is shown?
Meniere’s disease
How is Meniere’s disease managed?
- Supportive treatment during episodes
- Tinnitus therapy
- Hearing aids
- Lifestyle advice
What lifestyle advice should be given in Meniere’s disease?
Reduce salt intake
Avoid chocolate
Avoid caffeine
Avoid stress
What is meant by migraine associated vertigo?
Episode of vertigo in someone who has a history of migraines - about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia
How will migraine associated vertigo present?
- 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
How can migraine associated vertigo be managed?
- Lifestyle modification
- Avoid triggers
- Abortive agents (E.g. triptans)
- Prophylaxis (E.g. Propranolol)
What is vertebrobasilar insufficiency?
Describes a temporary set of symptoms due to ischaemia in the posterior circulation of the brain
What causes vertebrobasilar insufficiency?
Narrowing of the posterior circulation arteries, most commonly due to arteriosclerosis
How will vertebrobasilar insufficiency present?
- Vertigo on looking up
- Visual disturbance
- Weakness
- Numbness
