Vertigo

Question 1

-some causes of vertigo (8)

Answer 1

-causes of vertigo

>vestibular neuronitis

>labrynthitis

>Menieres

>benign paroxysmal positional vertigo

>presbystasis

>vestibular migrane

>nb also cardiovascular disease - vertigo may occur pre-syncope

syncope is a transient loss of consiousness

Question 2

labrynthitis = acute inflammation of inner ear. inner ear =the labryth

• aetiology (3)
• pc (1) hpc - how long does this last.
• comp
• mx - acute (2)

Answer 2

• aetiology - usually follows simple upper resp tract infection, may also follow middle ear infection or intracranial sepsis
• pc - vertigo. may last for days - weeks before settling.
• in some pts there may be inbalance for a bumber of months followng episode. some pts may never recover fully and have episodes of labrynthine decompensation/failure in balance challening enviromnents eg boat.*
• -*comp - if severe inflammation hearing loss may occur following labrynth destruction
• mx - vestibular sedatives eg prochorperazine and rest. after this there is gradual labrynthine recovery or compensation. may be accelerated with special exercises.

Question 3

benign paroxysnal positional vertigo

aka bppv

-pc (1) hpc - timing - how long does episode last (1) how often are episodes (1) age onset (1) classic exaccerbator (1)

Answer 3

• pc- vertigo when head is moved in certain positions .
• hpc - each episode lasts for mins-hours. episodes may occur regularly for weeks- months before settling. onset any age. classically exacerbated by looking up.

Question 4

• diagnosed based on what test (1) and how is it done (4)
• positive result for bppv(2)

Answer 4

-diagnosed using Dix-Hallpike maneouvre

>pt starts sitting on end of bed

>pt quickly lies flat

>examiner then supporting pts head turns it 45 degree to the side and inclines it downwards of edge of bed

>waits a short while the repeat this on the other side

-maneuvre elicits vergito. nystagmus is observed pupil drifts towards affected ear then snaps back multiple times, this has a latent period befre starting and slowly settles.

nb nystagmus is common in acute vertigo

Question 5

vestibular neuronitis

anatomy pathophysiology

• nerve viii leaves inner ear (semicircular canals and cochlea) through the internal auditory meatus to enter the brainstem at the cerebellopontine angle
• in the brainstem connections are made with the auditory and vestibular nuclei. disease processes may affect nerve viii during its pathway from the inner ear. what is this type of pathology called. (1) what sx can it cause (3)

Answer 5

-viii pathology from inner ear to brain is called retrocochlear pathology. can cause vertigo, hearing loss, tinnitus

Question 6

• what is the main sx of inflammation of vestibular portion of viii.(1) similar presentation to what disease (1)
• what is thought to be the main cause of this inflammation (1) what sx is usually spared (1)
• course(1) mx (2)

Answer 6

• inflammation of vestibular portion of cochlear nn - main sx vertigo. similar presentation to labrynthitis
• viral infection thought to be the main cause of this inflammation. hearing loss usually spared
• resolves gradually over period wks. may be slow compensation of vertigo.
• mx (same as labrynthitis ) - rest, vestibular sedatives

Question 7

vestibular migraine. define (1)

• in what diseases may this occur (2)
• mx (5)

Answer 7

• vestibular migraine is vertigo associated with a migraine. pathophysiology unclear
• can occur in bppv and menieres. also motion sickness and anxiety and depression

-mx same as for migraine treat migraine and vertigo seperately.

>analgesia, avoidance triggers, anti-emetics, migraine medication eg tripans, preventative medications

Question 8

Romberg’s test. can be used to investigate vertigo

• how to carry out test (2)
• what is positive result (1)
• what does positive result tell us (3)

Answer 8

• pt stands upright comfortabley . then ask to shut eyes and tries to maintain balance
• if unable to maintain balance test is positive. nb be ready to catch pt
• if they are unable to maintain their balance with their eyes closed suggests a problem with proprioception or vestibular function (semi circular canals within inner ear). pt usually fall to the side of the lesion
• can also be +ve in neuromuscular disorders and may not be reliable in v elderly*