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GPEP ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

Does associated nausea and vomiting indicate a peripheral or central cause?

A

Peripheral

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2
Q

Features of peripheral vertigo - onset, duration, intensity

A

Sudden onset
Paroxysmal
Intense
Lasts minutes or hours

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3
Q

Features of central vertigo - onset, duration, intensity

A

Insidious or sudden onset
Continuous
Less intense
Lasts days or weeks

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4
Q

Direction of nystagmus in peripheral vs central vertigo (horizontal, vertical, torsional)

A

Peripheral - Horizontal or torsional nystagmus
Central - Vertical

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5
Q

Peripheral or central position related?

A

Peripheral - Aggravated with position change
Central - Not position‑related

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6
Q

Associated sx with peripheral vertigo

A

Tinnitus or deafness common or new onset
Associated with nausea and vomiting, blocked feeling in ear

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7
Q

Associated sx with central vertigo

A

Associated with ataxia, facial numbness or weakness, diplopia, dysphagia, hemiparesis, difficulty walking, skew deviation

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8
Q

Are tinnitus or deafness common with central vertigo?

A

No tinnitus or deafness

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9
Q

Examples of peripheral causes of vertigo

A

BPPV
Meniere disease
Vestibular neuronitis

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10
Q

Examples of central causes of vertigo

A

Stroke
Haemorrhage
Vertebrobasilar insufficiency (VBI)
TIA
MS
Neoplasm
Migraine

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11
Q

If central vertigo, look for __________ signs and consider a stroke, as the cause is likely to be neurological

A

Cerebellar and brainstem signs

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12
Q

Brainstem signs

A

Vertigo, nystagmus, diplopia, dysarthria, dysphagia, and ocular skew deviation.
Hemiparesis, facial weakness, or numbness.

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13
Q

Cerebellar signs

A

Ataxia
Difficulty standing or walking

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14
Q

When to use HINTS test

A

Continuous vertigo
To differentiate between a central and peripheral cause

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15
Q

Ménière’s disease is a triad of…

A

Vertigo, tinnitus, and hearing loss

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16
Q

Is BPPV associated with tinnitus or hearing loss

A

No

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17
Q

BPPV is triggered by…

A

Occurs with head turning or head movements

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18
Q

Do patients with BPPV have disequilibrium?

A

May have disequilibrium.

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19
Q

Associated sx with BPPV

A

Nausea and vomiting

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20
Q

Duration of vertigo with BPPV

A

Attacks last less than 1 minute and settle if head is kept still

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21
Q

BPPV usually resolves within…

A

Resolves in days

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22
Q

Do patients with Ménière’s have dysequilibrium?

A

Persistent dysequilibrium

23
Q

Associated sx with Ménière’s

A

“Pressure sensation” in the affected ear
Tinnitus which worsens with time.
Hearing loss which comes and goes and eventually is permanent

24
Q

Ménière’s typically lasts _____ hours

A

1 to 24 hours

25
Q

Characteristic presentation of vertigo with vestibular neuritis

A

A single, severe episode of vertigo, lasting at least 48 hours

26
Q

Associated symptoms with vestibular neuritis

A

Associated with nausea and vomiting, and may have preceding viral infection

27
Q

Duration of vertigo with vestibular neuritis

A

Lasts hours to days

28
Q

Vestibular neuritis typically resolves within ______

A

1 week

29
Q

Is vestibular neuritis associated with tinnitus or hearing loss?

A

No

30
Q

Vertigo with unilateral hearing loss and otitis media is suggestive of…

A

Acute bacterial labyrinthitis

31
Q

When to refer to ENT

A

Concern of acute bacterial labyrinthitis (acutely)
Peripheral vertigo not settling
Sudden unilateral hearing loss with peripheral vertigo –> manage as per asymmetrical sensorineural hearing loss

32
Q

How successful is the Epley mannouvre?

A

Successful in about 50% of cases

33
Q

Management vestibular neuritis

A

Prochlorperazine TDS or scopolamine patches (not funded)

34
Q

If recurrent attacks of vestibular neuritis consider prescribing…

A

Self-administered antiemetics e.g., buccal prochlorperazine (not fully funded)

35
Q

When to follow up with vestibular neuritis

A

Most patients recover within a week.
Review the patient if vertigo persists after 2 weeks

36
Q

Management of Ménière disease if acute attack

A

Consider antiemetics e.g., prochlorperazine (buccal or intramuscular), cyclizine, promethazine.

Discuss:
- potential triggers, such as a high‑salt diet, caffeine, and alcohol
- hearing aids
- tinnitus management
- support groups

37
Q

Pharmacological treatments for prophylaxis in Ménière disease

A

Thiazide diuretics or betahistine can be used as prophylaxis. Betahistine may reduce the frequency or severity of attacks.

38
Q

Vestibular rehab/physio can be useful if

A

Recurrent vertigo e.g. BPPV

39
Q

Implications on driving if a patient has vertigo

A

No general prohibition on driving with vertigo
Except if attacks of are sudden, or unpredictable, and are sufficiently disabling that they may impair an individual’s ability to drive safely, eg unable to concentrate on driving

40
Q

If the vertigo is due to a peripheral cause, there should be no abnormal neurological signs other than __________

A

Nystagmus and possibly hearing loss.

41
Q

When to do a Dix Hallpike test

A

A Dix-Hallpike positional test is essential for all patients presenting with, or with a history of, vertigo who do not have spontaneous nystagmus while upright

42
Q

How do you tell which side is affected in peripheral vertigo? (by looking at nystagmus)

A

Nystagmus from a peripheral cause is usually horizontal with a slow component to the symptomatic side (affected ear) and a fast component (VOR) to the opposite side.

43
Q

The direction of the nystagmus is defined by __________

A

The fast component, i.e. left, right, up or down-beating

44
Q

Features of nystagmus that would suggest a peripheral cause

A

Fatigues with time
Goes away with fixation (e.g. asking the patient to stare at your finger)
Starts after a short delay
Does not change direction with gaze

45
Q

Vertical nystagmus is usually a sign of…

A

An underlying central lesion.

The upward torsional nystagmus of BPPV is the only exception.

46
Q

Recurring episodes of vertigo, usually lasting for several hours, associated with fluctuating hearing, tinnitus and aural fullness is suggestive of…

A

Ménière’s disease

47
Q

Meniere’s disease is caused by…

A

Excess of cochlear endolymph (endolymphatic hydrops) which eventually “refluxes” into the semicircular canals to cause vertigo. As the vertigo episodes continue, hearing may decline to a “flat” sensorineural loss at 60 dB

48
Q

What age group does Meniere’s occur in?

A

Usually > 40yo, but in one-third of people it starts > 60yo

49
Q

Diagnosis of Meniere’s

A

Classical symptoms + pure tone audiogram
A MRI scan to exclude retrocochlear pathology is usually required

50
Q

Goal of treatment in Meniere’s

A

Currently there is no treatment which can reverse the hydrops and the hearing loss.
The goal of management is symptom control.

51
Q

ENT possible management of Meniere’s

A

Intratympanic gentamicin - placed in the middle ear through a myringotomy then absorbed into the inner ear.
Does not treat the underlying pathology, but disables the semicircular canal receptors causing the vertigo episodes. A single treatment usually results in cessation of vertigo for several years.

52
Q

A single, severe episode of vertigo, lasting at least 48 hours is suggestive of ____________

A

Vestibular neuritis

53
Q

Recurrent, fluctuating vertigo that occurs with a throbbing headache, photophobia or transient visual symptoms is likely to be…

A

Vestibular migraine

54
Q

Treatment of vestibular migraine

A

Treat as for migraine, if vertigo persists, reconsider the initial diagnosis (it is easily confused with Ménière’s disease) and consider referral to an otolaryngologist.

GPEP ENT (3 decks)

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