Vertigo Flashcards
What is the definition of vertigo?
an illusion of movement, often toatory, of the patient or their surroundings. Pt can veer sideways as if pulled by a magnet - not always ‘room spinning’. Always worse on movement.
What are the associated symptoms with vertigo?
difficulty walking or standing, relief on lying or sitting still, nausea, vomiting, pallor or sweating. Associated hearing loss or tinnitus implies labyrinth or VIII nerve involvement
What symptoms would go against the diagnosis of vertigo in someone who is dizzy?
faintness may be due to anxiety with associated palpitations, tremor and sweating. Lightheadedness may be due to anaemia, orthostatic hypotension or effort in an emphysematous patient.
What are the causes of vertigo and how should they be split up?
Labyrinth & VIII nerve: Meniere’s disease, vestibular neuronitis, benign positional vertigo, motion sickness, trauma, ototoxic drugs, Zoster (Ramsay Hunt Syndrome), Tullio phenomenon. Brainstem, cerebellum and cerebello-pontine angle: MS, acoustic neuroma, Stroke/TIA, haemorrhage, Migraine. Cerebellar cortex: vertiginous epilepsy. Central and peripheral causes (peripheral can further be split in outer, middle and inner ear)
What is benign (paroxysmal) positional vertigo?
due to canalolithiasis debris in the semicircular canal, disturbed by head movement, resettles causing vertigo lasting a few seconds after the movement. Nystagmus on performing the Hallpike manoeuvre is doagnostic. Eply manoeuvres clear the debris from the semicircular canals
What is acute labyrinthitis (vestibular neuronitis)? What are the causes?
abrupt onset of severe vertigo, nausea, vomiting +/- prostration. No deafness or tinnitus. Severe vertigo subsides in days, complete recovery takes 3-4 weeks. Causes: viral, vascular lesion.
What is Meniere’s disease? What is the treatment both acute and prophylactic?
endolymphatic hydrops causes recurrent attacks of vertigo lasting >20 min (+/- N+V), fluctuating (sometimes permanent) sensorineural hearing and tinnitus (with sense of aural fullness +/- drop attacks - no LOC or vertigo but falling to one side). Acute: bed rest and reassurance, antihistamine if prolonged or buccal prochlorperazine if severe, consider endolymphatic sac surgery or ablation of vestibular organ with gentamicin in very severe disease. Prophylaxis: low Na diet or betahistine (no evidence though)
What drugs are commonly ototoxic and what can they cause?
Aminoglycosides, loop diuretics or cisplatin can cause deafness +/- vertigo
What is an acoustic neuroma? What is the proper name? How does it present? Who/what is it commoner in?
vestibular schwannoma - a growth originating from the vestibular nerve. Presents with unilateral hearing loss, vertigo occurs later, with progression, ipsilateral V, VI, IX and X palsies may be affected (ipsilateral cerebllar signs) - VII rarely involved preop. Signs of incr ICP occur later - sign of large tumour. Commoner in women and neurofibromatosis (NF2). Account for 80% of cerebello-pontine angle tumours. Differential = meningioma
What is the syndrome called in which Herpes Zoster affcts external auditory meatus causing facial palsy +/- deafness, tinnitus and vertigo?
Ramsay Hunt Syndrome
What two bedside tests can be done to test for hearing loss and describe each one?
Rinnes: vibrating tuning fork held in front on auditory canal, testing air conduction, negative test = BC>AC and suggests conductive deafness, positive test suggests normality or sensorineaural hearing loss. Weber’s test: vibrating tuning fork on the centre of the forehead, sound localises to the ear with conductive loss, contralateral to sensorineaural hearing loss and to neither is normal
What are the causes of conductive deafness?
wax, otosclerosis, otitis media or glue ear
What are the causes of chronic sensorineural deafness?
accumulated environmental noise toxicity, presbyacusis or inheirted disorders. Presbyacusis - loss of acuity for high frequency sounds start before 30 years old , hearing most affected by background noise
What are the causes of sudden sensorineural deafness?
noise exposure, gentamicin/other toxin, mumps, acoustic neuroma, MS, stroke, vasculitis, TB
What are the causes of tinnitus?
unilateral: acoustic neuroma. Focal hyper-excitability in the auditory cortex, hearing loss, wax, viral, presbyacusis, excess noise, head injury, septic otitis media, post-stapedectomy, Meniere’s, anaemia, incr BP, drugs - aspirin, loop diuretics, aminoglycosides, psychological associations - redundancy, divorce, retirement. Pulsatile tinnitus - carotid artery stenosis or dissection, AV fistulae and glomus jugular tumours
