Vertigo Flashcards
What are causes?
Central
- brainstem pathology
- posterior stroke
- vestibular migraine
- intracranial tumours
- MS
Peripheral
- BBPV
- Menieres
- Vestibular neuronitis
- Labrynthitis
What are red flags of vertigo?
Isolated event lasting >24 hours with sudden onset
Associated headache
Acute deafness
Not provoked/altered by change in position
Abnormal gait/ataxia
Neurological signs identified
What is BPPV?
Caused by movement of debris/crystals within the semi-circular canals of the inner ear
Movement of head causes movement of calcium carbonate crystals leading to endolymph movement and dizziness
What are clinical features of BPPV?
Most common in women aged 50-70
Recurrent transient episodes of vertigo
Triggered by head movements/changes in position- when person rolls over or bends
Dix Hallpike- provokes vertigo and nystagmus
What is the management of BPPV?
1) Epley manoeuvre
2) Brandt- Daroff rehab exercises
betahistine is often prescribed but of little use
What is Meniere’s disease?
Inner ear disorder of uncertain aetiology
What are the symptoms of Menieres disease?
Episodic vertigo
- lasting at least 20 mins
- can have N&V with this
Fluctuating SNHL
Roaring tinnitus
Sensation of aural fullness- feeling of pressure within affected ear- often precedes an attack
Unilateral symptoms
Positive Romberg Test
What is the management of Meniere disease?
Refer to ENT to confirm diagnosis
Patients to inform DVLA
Relief of vertigo/ N&V
- prochlorperazine for up to 7 days
If rapid relief required
- Buccal/IM prochlorperazine or IM cyclizine
Prophylaxis
- consider trial of betahistine to reduce frequency or severity of episodes
What is Vestibular neuronitis?
Inflammation of the vestibular nerve post viral infection
What are clinical features of Vestibular neuronitis?
Vertigo
- severe and sudden onset
- lasting hours to days
- there constantly
Imbalance
Falls
No hearing loss
No tinnitus
History of viral illness
Will have fine horizontal nystagmus
What is the management of vestibular neuronitis?
Rapid relief
- Buccal/IM prochlorperazine or cyclizine
Less severe symptoms
- 3 day course of PO prochlorperazine or cyclizine
What is viral labrynthitis ?
Inflammation of the labyrinth
Can be viral/bacterial or assocaited with systemic disease
Viral is most common
What are the symptoms of labyrinthitis?
Vertigo
Hearing loss- SNHL
Tinnitus
No aural fullness
History or URTI
Gait disturbance
Unidirectional horizontal nystagmus towards unaffected side
What is the management of labyrinthitis?
Self limiting
Prochlorperazine or antihistamine can help
