Vertigo Flashcards
What normally precedes labyrinthitis?
usually an URTI
However also:
middle ear infection
intrcranial sepsis
bactereamia
What are the main symptoms of labyrinthitis?
Disabling vertigo lasting days to weeks
Residual vertigo due to rapid movements for some months
What is the worst outcome in labyrinthitis?
Total destruction of the vestibule (the bit between the labyrinth and cochlea)
causing deafness
What is the treatment of labyrinthitis?
antibiotics
vestibular sedatives (Prochlorperazine)
rest
What is vestibular neuronitis?
Inflammation of the vestibular portion of the 8th nerve
What is thought to be the cause of vestibular neuronitis?
Viral infection
What is the treatment for vestibular neuronitis?
Same as for labyrinthitis:
antibiotics
vestibular sedatives (Prochlorperazine)
rest
In vestibular neuronitis how is hearing affected?
It is usually NOT
Describe the characteristics of benign paroxysmal positional vertigo (BPPV).
episodic vertigo
occurring when the head is moved in a certain position;
classically by turning in bed or
looking up at an object
How long to episodes in benign paroxysmal positional vertigo (BPPV) usually last?
usually a few minutes
can remain for hours
How often do episodes in benign paroxysmal positional vertigo (BPPV) usually occur?
Weeks or months
before settling
How common is benign paroxysmal positional vertigo (BPPV) and which age group is it most common in?
most common cause of vertigo
occurs at any age
How is benign paroxysmal positional vertigo (BPPV) diagnosed?
Clinically:
Hallpike manoeuvre
Nystagmus
Vertigo symptoms
How does one perform the Hallpike manoeuvre?
sitting up to lying down
and tilting head down 30 degrees quickly
Describe the nystagmus seen in benign paroxysmal positional vertigo (BPPV).
rotary towards affected ear
has a latent period before starting
It then: fatigues (slowly settles)
and shows adaptation (lessens with consecutive tests)
What is thought to be the cause of benign paroxysmal positional vertigo (BPPV)?
dislodged otoliths
settling in the posterior semicircular canal
and causing irritation with particular movements
How is benign paroxysmal positional vertigo (BPPV) treated?
Reassurance
Special head excercises (Epsley’s manoeuvre or cooksey-cawthorne exercises)
Rarely surgery on semi-circular canal
When should vestibular sedatives (e.g. prochlorperazine) be used in BPPV?
They SHOULDNT be as they slow the compensation process
What is presbystasis also known as?
disequilibrium
What is presbystasis?
a momentary feeling of unsteadiness
particularly in elderly people
What is thought to be the cause of presbystasis?
Small vessel disease in the brain
Which symptoms can rule out a potential diagnosis of presbystasis?
N+V
What is the prognosis of presbystasis and how is it treated?
Usually self-limiting
There are no good treatments
What is vestibular migraine?
Essentially a migrane
with vestibular symptoms (e.g. dizziness)
How long do symptoms of vestibular migraine usually last?
5 - 20 mins
How is vestibular migraine diagnosed?
It is a diagnosis of exclusion.
Must rule out things like BPPV
What is the relationship of vestibular migraine and auditory symptoms?
They do not normally occur in vestibular migraine
How is vestibular migraine normally treated?
Same as normal migraines (Pizotifen – this is an antihistamine and 5-HT antagonist)
What are the three types of dizziness?
Central
CV
Peripheral
Which bits of anatomy are included in central dizziness?
vestibular nuclei, brainstem and upwards
can be of a central nervous system
or cardiovascular origin (probably small vessel disease)
What does central dizziness essentially equate to and what is it due to?
presbystasis
ischemic small vessel disease of the brain
What are CV dizziness symptoms like?
General syncopal symptoms
What are some causes of CV dizziness?
postural hypotension
arrhythmias
vasovagal
What parts of anatomy are related to peripheral dizziness?
The labyrinth and
vestibular nerve
What are the symptoms of peripheral dizziness?
Sudden episodes of vertigo
almost always associated with N+V
Hearing loss
Tinnitus
Which symptoms of peripheral dizziness point towards a cochlear issue (with regards to peripheral dizziness)?
Hearing loss and
tinnitus
What are some examples of peripheral dizziness?
BPPV
Meniere’s disease (triad of vertigo, tinnitus and hearing loss)
vestibular neuronitis
What is nystagmus a clinical sign of?
vestibular abnormality (i.e. inner ear except the cochlear)
What type of nystagmus points towards a peripheral cause?
rotary
or horizontal nystagmus
What type of nystagmus ALWAYS points towards central causes?
vertical nystagmus or
nystagmus that changes direction
How can you tell that there is a DESTRUCTIVE lesion in the labyrinth (regarding nystagmus)?
the nystagmus is always AWAY FROM the damaged ear
How can you tell that there is a IRRITATIVE lesion in the labyrinth (regarding nystagmus)?
the nystagmus is always TOWARDS the damaged ear
How many degrees of nystagmus are there?
3
Describe the degress of nystagmus using examples and what do they indicate?
(they indicate the acuteness of the lesion, with 3rd being the most acute)
1st: when looking left (1 direction)
2nd: when looking left and straight ahead (2 direction)
3rd: nystagmus when looking left, right and straight ahead (3 direction)
What are the symptoms of Meniere’s disease?
triad of vertigo (15mins-24hrs)
tinnitus
flucutant hearing loss
What are the 3 inputs for balance?
Proprioceptors
Vision
Labyrinth
What is the nature of nystagmus due to a cerebellar lesion?
Nystagmus is only the ispilateral side
What happens to nystagmus over time?
It reduces as the body compensates
How can you tell is someones labyrinth has ever been damaged?
Use Frenzel’s glasses and this will elicit the first degree nystagmus that was caused when the labyrinth was originally damaged.
How long does it take for BPPV to get better?
Over 12-18 months
How common is Meniere’s disease?
Rare (ENT doctors see about 2-5 per year)
What is the typical age of onset of Meniere’s disease?
Middle age
What is the treatment of Meniere’s disease?
Reassurance, should spontaneously resolve (in 70%)
Bendroflumethiaze is first line treatment too
Can ablate the labyrinth surgically in extreme cases
What is an important differential to Meniere’s disease and how should it be investigated?
Acoustic neuroma, investigate using MRI.
What is benign vestibulopathy?
Like Meniere’s disease but:
without hearing loss or tinnitus
and benign vestibulopathy takes about 2 years to spontaneously resolve
What is the most common cause of acute labyrinthine faliure?
Fracture of temporal bone through labyrinth
What are the symptoms of vestibular neuronitis (and what symptoms does it not have)?
Sudden onset vertigo
N+V
nystagmus
(No hearing loss or tinnitus)
