Vertigo

Question 1

Definition of vertigo

Answer 1

Illusion of movement

Question 2

Peripheral/vestibular causes of vertigo

Answer 2

Meniere’s disease
BPPV
Labrynthitis

Question 3

Central causes of vertigo

Answer 3

Acoustic neuroma
MS
Stroke
Inner ear syphilis

Question 4

Ototoxic drugs which can cause vertigo

Answer 4

Gentamicin
Loop diuretics
Metronidazole
Co-trimoxazole

Question 5

Ix for vertigo

Answer 5

Hearing
CNs
Romberg's +ve = vestibular or proprioception
Hallpike manouvre - BPPV
Audiometry

Question 6

Pathology of Meniere’s disease

Answer 6

Dilatation of endolymph spaces of membranous labyrinth

Question 7

Presentation of Meniere’s disease

Answer 7

Attacks in clusters - last up to 12 hrs
Progressive sensorineural hearing loss
Vertigo
Tinnitus
Aural fullness

Question 8

Ix of Meniere’s disease

Answer 8

Audiometry - low frequency SNHL which fluctuates

Question 9

Mx of Meniere’s disease

Answer 9

Vertigo - cyclizine, betahistine
Gentamicin instillation via grommets
Saccus decompression

Question 10

Presentation of viral labyrinthitis

Answer 10

Follows febrile illness eg. URTI
Sudden vomiting
Severe vertigo - exacerbated by head movement

Question 11

Mx of viral labyrinthitis

Answer 11

Cyclizine

Improvement in days

Question 12

Pathology of BPPV

Answer 12

Benign Paroxysmal Positional Vertigo
Displacement of otoliths in semicircular canals
Common after head injury

Question 13

Presentation of BPPV

Answer 13

Sudden rotational vertigo < 30s
Provoked by head turning
Nystagmus

Question 14

Causes of BPPV

Answer 14

Idiopathic
Head injury
Otosclerosis
Post viral

Question 15

Dx of BPPV

Answer 15

Hallpike manoeuvre –> Upbeat torsional nystagmus

Question 16

Mx of BPPV

Answer 16

Self limiting
Epley manoeuvre
Betahistine