Vertigo Flashcards
Labyrinth-based causes of true vertigo, and when they are likely to occur/in whom
Labyrinthitis - occurs with measles, mumps, influenza
Wax accumulation in ear canal - quite common in elderly
CHRONIC otitis media, especially if cholesteatoma formation
Benign paroxysmal positional vertigo - esp in older patients
Drugs
Meniere syndrome (vertigo+tinnatus+sensorineural deafness)
Trauma affecting labyrinth
CN-based causes of true vertigo
CNVIII neuronitis - consider if recent URTI in young person
Accoustic neuroma (often associated hearing loss, tinnitis, headaches, facial pain, balance issues)
Drugs
Central, Brainstem, cerebellar causes of true vertigo
Brainstem -
TIA/stroke
Verterobasilar insufficiency (insufficiency of posterior blood supply to brain)
Cerebellar - Tumour MS Degeneration Alcohol
Other - Migraine
Describe hallpike test. What does it diagnose?
Benign Paroxysmal Positional Vertigo
Pt seated on bed, feet up on bed, so that if they were to lye back, their neck, head would hang over end.
Support pt head/neck, with head turned 45-degrees to left/right depending on side being examined
(inform the patient of what you’re going to do so they aren’t shocked, inform them it is important for them to keep their eyes open as it is part of the test)
Take patient rapidly from upright position, to lying backwards, with their head at ~20-degree angle over the back of the bed. If positive test, with observe nystagmus within 30 seconds. Rarely at 1 minute. Repeat on other side.
More likely to see horizontal than vertical nystagmus** vertical very subtle…
What two manouvres can be used to treat BPPV?
Epley
Semont manouevrers
Describe Epley
Sitting up, legs out striaght, on bed. Pillows positioned behind patient so when they fall back will create ~20-degree angle from neck.
Turn head 45-degrees away from affected side
Fall straight back. Wait 30seconds.
Turn head to 45-degree position to other side
Keep head in this position, and slowly move onto left side.
Stay for 30 seconds.
Then move legs off side of bed, and rise to seated position.
Semont manouvre describe
Sit on edge of bed facing forward. Move head to 45-degrees facing opposite to the side with the issue. (e.g. if left BPPV, face to the right, then first fall to the left).
Fall quickly down onto one side, on side that is affected. Keep head in position. Stay for 1 minute.
Then quickly go from lying on that side to the other side - Without changing direction of head positioning. Stay there for 1 minute.
Then rise to seated position again. Keep head straight. Wait in position for 10 minutes.
What are some key appropriate investigations in patients presenting with dizziness / vertigo>
FBC, haemoglobin - anaemia
BGL - hypoglycemia, diabetes
ECG - arrhythmias
Hearing tests
Cervical spine x-ray - if considering vertebrobulbar insufficiency and ischemic TIA type thing
Brain MRI - can identify tumours, acoustic neuromas, potentially can identify MS or vascular infarction
Likely diagnosis of dizzy turns in female teens?
Heavy periods? Anaemia?
Sometimes due to BP fluctuations - advise on reducing stress, not exercising excessively, getting good sleep. This type usually resolves by mid-20s
Dizziness or vertigo in elderly - likel diagnoses?
Postural hypotension - drugs (e.g. antihypertensives), other cardiological issues (e.g. aortic stenosis?)
Wax accumulation in ear canal
Cardiac arrhythmias - syncopal episodes?
Malignancy
Middle ear disorders - auditory nerve, inner ear
Cerebellar / brainstem issues
Triad of:
Acute vertigo + Nausea + Vomiting
What is a group of patients associated with this?
Vestibular neuronitis
Consider in Younger patients with recent URTI and new vertigo symptoms
Collection of: Acute vertigo, nausea, vomiting + Hearing loss +/- Tinnitus?
What other conditions might be associated with this>
Acute labyrinthitis
Hx of Influenza, Mumps, Measles
Acute severe attack of vertigo lasting several days?
What does this condition involve?
What is this analogous to?
And what similar vestibular condition can this be mistaken for, but what is the key difference that separates them diagnostically?
Acute Vestibular failure
Involves both vestibular neuronitis and acute labyrinthitis
(vira infection of labyrinth and vestibular nerve)
Comparable to the viral infection of CNVII (facial nerve) causing Bell’s Facial Palsy
Similar to meniere syndrome, but there is NO HEARING DISTURBANCE
Triad of: Vertigo (quite severe) + Tinnitus + Sensorineural hearing loss + usually vomiting
Menierres syndrome
Note this is overdiagnosed, and involves a severe vertigo*
Brief attacks of vertigo, not associated with nausea/vomiting, tinnitus or hearing loss, related to changes in head position
BPPV
