vertigo Flashcards
what is vertigo
Sensation of movement, typically horizontal spinning in nature
Associated with nausea, vomiting, sweating and general unwellness
vertigo is Caused by a mismatch between….
the sensory input that is responsible for maintaining your posture and your vision, proprioception and vestibular system
vestibular apparatus function and location
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
Vertigo can be caused by a…..
PERIPHERAL problem (the inner ear) or a CENTRAL problem in the brain
The three main vestibular causes are
benign paroxysmal positional vertigo, meniere’s disease and vestibular neuronitis
BPPV is caused by
crystals of calcium carbonate that become displaced in the canals of the inner ear.
symptoms of BENIGN PAROXYSMAL POSITIONAL VERTIGO are…
usually positioned as movement is required to confuse the system
No symptoms when still
what is MENIERS DISEASE
Caused by an excessive buildup of fluid in the inner ear, causing too high pressure, thus disrupting the normal flow of fluid
presentation of meniers disease
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
what is ACUTE VESTIBULAR NEURONITIS
Inflammation of the vestibular nerve
Usually due to viral infection, due to mismatch of signals to the brain
presentation of acute vestibular neuritis
Usually presents with an acute onset of vertigo, lasts fro several weeks prior to resolving
most common central causes
The most common causes are posterior infarct, tumours, MS and vestibular migraine
Central causes will all cause a
sustained, non- positional vertigo because they are not caused by a disruption of the movement of fluid in the inner ear
presentation of posterior stroke
Sudden onset of vertigo, can be associated with ataxia, double vision, cranial nerve issues or FAST pos
presentation of vestibular migrane
Symptoms last minutes to hours
Associated with visual aura and headache
vertigo red flags
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.
The symptoms of cerebellar stroke usually come on suddenly (over a few minutes) and are associated with:
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.
The symptoms of BPPV usually come on slowly over 12-24 hours and are associated with
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.
green flags
Symptoms totally resolve within 60 seconds when the head is kept still.
Symptoms totally resolve following an Epley manoeuvre.
what is nystagmus
Nystagmus is involuntary, rapid and repeated small movements of the eyes.
how to look for nystagmus
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
nystagmus durations and their indications
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.
