Vertigo Flashcards
What is vertigo?
feeling of motion when not moving or exaggerated response to movement
What are the peripheral causes of vestibular dysfunction?
labryinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Meniere’s), vestibular neuritis, head injury
What are the causes of central vertigo?
brainstem vascular disease, arteriovenous malformations, tumors, MS, vertebrobasilar migrane
What is the presentation of peripheral vertigo?
ACUTE, tinnitus, hearing loss, horizontal nystagmus
What is the presentation of central vertigo?
gradual, no auditory symptoms, vertical nystagmus
What are some drugs that can cause vertigo?
ABX - doxy, metro, aminogly Anticonvulsants - phenytoin Hypnotics - diazepam Analgesics - ASA Traquilizing drugs & ETOH
What is benign paroxysmal positional vertigo?
triggered by head change position, clusters for several days, last few seconds, can treat via habiutation
When vertigo last seconds, think?
benign paroxysmal positional vertigo
When vertigo last minutes to hours, think?
meniere disease, migrane associated, otic symphilis, cogan syndrome
When vertigo last days to weeks, think?
vestibular neuritis
When vertigo constant, think?
central cause
What is the most common cause of peripheral vertigo?
BPPV
What age is the onset of BPPV and who?
40-50 yo, women
What manuver is used to dx BPPV?
Dix-Hallpike - pt lies back on exam table and head turned 45 degree one way, if normal do the same thing but turning to the opposite side, if still normal eye response, then repeat but extend the head off the exam table
What is the treatment for BPPV?
epley maneuver
What causes BPPV?
canalithiasis of posterior semicircular cancal
What do you need to observe nystagmus?
Frenzel goggles
What presents with sudden severe vertigo + vegetative symptoms?
vestibular neuritis
Does vestibular neuritis include hearing loss?
no
What are the symptoms of meniere’s disease?
episodic vertigo, SNHL, tinnitus, unilat aural fullness
When does meniere’s disease have its onset?
40-50 yo, whites
What is the hallmark of meniere’s disease?
endolymphatic hydrops
What is the triad of meniere’s disease?
vertigo, hearing loss, tinnitus
What is the treatment for meniere disease?
low salt diet and diuretics
Contiguous vertigo + hearing loss =
labrinthitis
Contiguous vertigo + no hearing loss =
vestibular neuritis
What is the treatment for vestibular neuritis and labrynthitis?
steroids first line
What is a false sensation of mvmt associated with difficulty in balance or gait?
vertigo
What is the perceived motion in vertigo?
rotary
What is the first step in dx vertigo?
get info on what it actually feels like - dizziness or vertigo
dizziness - light headed
vertigo - room is spinning
What causes peripheral vertigo?
secondary to disorders of inner ear or 8th CN
What causes central vertigo?
CNS disorder, vestibular nuclei and pathway
What is the presentation of peripheral vertigo?
sudden, intermittent with severe symptoms, affected by head position and mvmt. N/V, motor function intact
What is the presentation of central vertigo?
gradual, constant, milder, unaffected by head position, N/V less likely, motor function issues
What do you see in cerebellar stroke?
bilat or vertical nystagmus, limb ataxia, gait disturbance, CAN NOT stand w/o support
What are some urgent considerations?
cerebellar stroke, CV disease, Vestibular neuritis and labrynthitis
What do you get if you suspect urgent causes?
CT or MRI w/ internal auditory canals
What are the possible causes of central vertigo?
cerebellar bleeds, infarcts and tumors, lesion of brainstem, MS. cerebellopontain angle tumors
When do you admit a vertigo pt?
neuro deficits or cardiac issues, if unable to walk despite max tx, protracted vomiting, significant co morbid, concern of central vertigo
What is the motion of nystagmus in central?
vertical
What is the motion of nystagmus in peripheral?
horizontal, rotary or absent
Can you fatigue a central nystagmus?
NOPE
When is an abnormal time you can observe horizontal nystagmus?
cerebellar infarction
What are the steps to hallpike maneuver?
lie back and neck extended, sit back up and lay down again, turn head to one side, repeat and have them turn head to other side
What is a nystagmus with hallpike that is unidirection, latent and fatigues?
peripheral origin
What do you use to alleviate symptoms of vertigo?
Antihistamines
Meclizine 12.5-25mg every 8 hours PRN vertigo
Benadryl 25-50mg every 4-6 hours PRN
Anticholinergics
scopolamine – transdermal patch, apply q72 hours
What antiemetic/anti nausea do you use?
ondansetron (Zofran) 4 mg q 4-6 hr PRN
Phenothiazines - prochlorperazine, promethazine
What are the common causes of peripheral vertigo?
benign paroxysmal persitional vertigo, Meds, Head injury, vestibular neuronitis, labryrinthitis, meniere’s disease, pressure on vestibular nerve
What are the crystals in BPPV?
otoconia
Where do otoconia sit?
basement but can get moved during activities
What is the most common cause of peripheral vertigo?
BPPV
When are symptoms worse in BPPV?
in the morning
How do you dx BPPV?
hallpike
How do you tx BPPV?
epley, meds for symptoms, rarely surgery
What do you have to do after eply?
sleep sitting up 2 nights, dont bend head a lot for 1 wk
When does BPPV pt come back?
2 wks later
What is the treatment for labryrinthitis?
diazepam or benzodiazepines - vestiblular suppressant
Short course of steroids
Antiviral therapy - acyclovir, famciclovir, valacyclovir
Is hearing affected in vestibular neuronitis?
no
What is vestibular neuronitis due to?
HSV type 1 in vestibular ganglia
How do you treat vestibular neuronitis?
steroids, antivirals
How do you distinguish labrynrinthisi from vestibular neuronitis?
labrynthrinthis - hearing loss
Steroid and antiviral
What happens in meniere’s diseae?
increase in fluid of endolymphatic system
What happens in menieres when endolymph swells?
microruptures - mixing of perilymph and endolymph
What is the quadrad of meniere’s disease?
vertigo - 2 episodes 20 min w/ nystagmus
tinnitus,
sensation of aural fullness,
hearing loss - lower 20-25 than unaffected side
