Vertigo Flashcards
What is vertigo?
Sensation the everything is sinning
What are the features of vestibular (peripheral vertigo)
Often severe and may be accompanied by loss of balance, nausea and vomiting
Often coexisting hearing loss and tinnitus
Hearing loss and tinnitus do not feature as much in central vertigo
How can vertigo causes be divided?
Peripheral- damage of the vestibular apparatus or to the vestibular nerve
Central- damage to the vestibular structures in the brainstem or cerebellum
What are some peripheral causes of vertigo?
Meniere’s disease
BPPV
Vestibular failure
Labrynthitis
What are some central causes of vertigo?
Acoustic neuroma
Multiple sclerosis
Head injury
Migraine associated
What should you ask about when assessing for vertigo?
Ask did the world appear to spin (it is much more severe than just dizziness)
How can the duration of vertigo influence what might be causing it?
Seconds to minutes = BPPV
30 minutes to 30 hours= Meniere’s or migraine
Weeks= acute vestibular failure
If a patient presents with symptoms of vertigo, what should you examine?
Cranial Nerves Hearing tests Test cerebellar function and reflexes Check for nystagmus Do Romberg's Test- can be positive with vestibular dysfunction
What does BPPV stand for?
Benign paroxysmal positional vertigo
What is the most common cause of vertigo?
BPPV
Describe the features of BPPV?
Episodes of vertigo lasting for at least 30 seconds
Attacks provoked by suddenly turning the head
Other otological sx (e.g tinnitus/hearing loss) are rare
What must you do to diagnose BPPV?
Rule out other potential causes of vertigo
Is there any speech, visual, motor or sensory problems
Is there any tinnitus, headache, ataxia, facial numbness or dysphagia
What is the treatment for BPPV?
It is usually self limiting
Epley maneuver- also can teach patients how to do this at home
Rarely surgery vestibular nerve section (rarely done)
What in Meniere’s disease?
Meniere’s disease occurs when there is dilation of the endolymphatic spaces that causes sudden attacks of vertigo lasting for 2-4 hours
How long do attacks of Vertigo last in Meniere’s disease?
2-4 hours
What are the feautres of Meniere’s disease?
Vertigo lasting for 2-4 hours Nystagmus Feeling of fullness in the ears Tinnitus Sensorineural hearing loss is common
Meniere’s disease is due to dilation of the endolymphatic spaces
What investigations should be done for meniere’s disease?
Electrocochleography
Posterior fossa MRI
What treatment is available for Meniere’s disease?
Give answer for acute attack, prophylaxis and definitive
Acute attack:
Prochlorperazine (reduces nausea, it is a typical antipsychotic that reduces nausea) or an anti-histamine (cyclizine, promethazine)
Prophylaxis:
Betahistine (thought to reduce pressure in the endolymph)
Surgical:
Sac decompression, labyrinthectomy, vestibular neurectomy, gentamicin injections (as ototoxic)
Surgical options can cause permanent hearing loss in the affected ear.
What is acute vestibular failure also called?
Labyrinthitis
Acute Vestibular neuronitis
What are the symptoms of labyrinthitis?
Sudden attacks of unilateral vertigo
Nausea and vomiting
Previously well person
Often preceded by an URTI
How long does labrynthitis last?
Typically lasts 1-2 days and improves over a week
What signs may you seen with labrynthitis/acute vestibular failure?
Nystagmus- away from the affected side
Romberg’s positive
What typically precedes acute vestibular failure?
A upper respiratory tract infection
Typically lasts 1-2 days and improves within a week
What is the treatment for labrynthitis?
Buccastem- Prochlorperazine (Typical AP)
Cyclizine, Promethazine (Antihistamine)
