Vertigo Flashcards
What inputs do you have for balance sense position?
Vestibule
Vision
Proprioception/somatosensation
What is Benign Paroxysmal Positional Vertigo?
Otoconia detachment from macula - migrate into semicircular canals → unilateral overstimulation of cupula
Conflict with other sense → vertigo
What are the main features of BPPV?
Isolated vertigo
Occurs after specific movements, lasts seconds
How is BPPV diagnosed?
Dix-Hallpike Test:
Patient sat on bed → head rotate 45o then quickly laid down with head extended 20o → rotatory nystagmus (fast toward diseased ear)
How is BPPV cured?
Epley Manoeuvre:
- Patient sat with head at 45o towards affected side
- Patient laid down maintaining 45o rotation for 20 secs
- Patient rolled over to head 90o towards unaffected side for 20 secs
- Patient rolled a further 90o to face the floor
What is Meniere’s Disease? and what is the pathophysiology?
Rupture of the endolymphatic system - perilymph and endolymph mix
Happens due to pressure build up cause by stenosis of endolymphatic acqueduct
Rupture heals, but may repeat → progressive damage to neuroepithelia
What are the main features of Meniere’s disease?
Repeated attacks of vertigo with unilateral hearing loss and tinnitus
Attacks may last hours → days
May cause progressive hearing loss and vertigo over time
Common in 40+
What investigations are appropriate for Meniere’s disease?
Audiogram - low pitched hearing loss during attacks
MRI to exclude acoustic neuroma
What is the treatment for meniere’s?
Dietary - reduce salt
Prophylaxis - Betahistine - acts on histamine Rs → dilate blood vessels → increase drainage
Antiemetics for acute presentation
Surgical: Grommet, Saccus Decompression, Gentamycin → destroy vestibule (aim to destroy balance function of faulty ear so brain adapts to one)
What is vestibular neuritis?
Inflammation of the superior vestibular nerve (by infection or ischaemia) → acute vestibular failure, recover as brain compensates
What are the features of Vestibular neuritis?
Rapid onset isolated vertigo
N&V, pallor, sweating and diarrhoea
Shows slow recovery from 2 weeks
How should you treat vestibular neuritis?
Vestibular sedatives - Prochlorperazine (D2 agonist - antipscyh and antimigraine as well)
Early mobilisation and rehab
What is labyrinthitis?
Acute inflammation of membranous labyrinth - infection, ischaemia, autoimmune
What are features of labyrinthitis?
Rapid onset vertigo, hearing loss +/- tinnitus
Balance will recover after 2 weeks - brain compensates
Hearing loss +/- tinnitus permanent
What is the treatment for labyrinthitis?
Vestibular sedatives - Prochlorperazine
Early mobilisation and rehab
Hearing aids
