VERTIGO

Question 0

What is BPPV? What triggers it? Tests?

Answer 0

MC cause of vertigo
Attributed to calcium debris (otoliths) entering the semicircular canals. Occurs after changes in position e.g tilting head back or turning in bed.

Question 1

What are the causes of vertigo?

Answer 1

Physiological 
Benign paroxysmal positional vertigo 
Ménière's disease 
Vestibular neuronitis
Labyrnthitis 
Acoustic neuroma

Question 2

What is Hallpikes test? What is Epleys manoeuvre?

Answer 2

BPPV

Sit patient, rotate head 45’
Lie down backwards quickly with head in extension
Observe eyes for nystagmus (rotational nystagmus = positive test)

Used to dislodge the otoliths

Question 3

What is vertigo?

Answer 3

When room is spinning

Question 4

Features of vestibular neuritis?

Answer 4

Infection of the inner ear

Acute onset vertigo, N + V
NO AUDITORY OR NEURO SYMPTOMS

OFTEN URTI 1-2 weeks before vertigo

Question 5

Ménière’s disease?

Answer 5

Episodic severe attacks with hearing loss, tinnitus and aural fullness.

Due to over-accumulation of endo lymph distorting membranous labyrinth.

No Rx

Question 6

Labrynthitis?

Answer 6

Infection of the inner ear.

Rapid onset vertigo with nystagmus
Usually resolves in 24 hours

Question 7

Bilateral acoustic neuromas?

Answer 7

Cochlear nerve

• hearing loss
• tinnitus

Vestibular nerve

• unsteady gait
• vertigo is uncommon due to central compensation

Trigeminal nerve

• facial numbness
• pain

Question 8

Management of vertigo in one word for short term symptomatic? Rx BPPV, menieres? Vestibular neuritis?

Answer 8

Diazepam or Stematil (prochlorprerazine) short term

BPPV: particle repositioning maneuvers

Menieres: low salt diet/hydrochlorithaizide

Question 9

Differentials for unconscious collapse? Differentials for conscious collapse?

Answer 9

Unconscious collapse 
SAH
PE
ANAPHYLAXIS
SHOCK/HYPOTENSION 
CARDIAC ARREST 
SEIZURES 
ARRHYTHMIAS 

Conscious collapse
Stroke
Vertigo - BPPV, Labrynthitis, Ménière’s disease, hypoglycaemia

Question 10

What are the 6p’s to ask for vertigo?

Answer 10

Previous episodes
Precipitates
Pre-syncope
Position
Palpitations
Post-event phenomena