Vertigo Flashcards
What is vertigo?
false sensation that the body or environment is moving
What are peripheral causes of vertigo?
BPPV Menieres disease Vestibular neuronitis Labyrinthitis Cholesteatoma Acoustic neuroma
What are central causes of vertigo?
Migraine
Stroke/TIA
Cerebellar tumour
MS
What features suggest a peripheral cause?
Can walk
May have hearing loss or tinnitus
NO neurological sx
Horizontal nystagmus, beats away from affected side, disappears w fixation of gaze
What features suggest a central cause?
- Hearing loss and tinnitus less common
- Nystagmus can be vertical
- Unable to stand up or walk with eyes open
- usually have neurological sx
- Less severe
Wat exams and tests would u do/
- Assess CNS and ears
- Test cerebellar function + reflexes
- Nystagmus? gait? rombergs?
- head thrust test
- Dix hallpike test
how long does vertigo last for in BPPV?
<30 seconds/1 min
What brings on vertigo in BPPV?
head turning
explain the pathology behind BPPV
displacement of otoliths in semicircular canals
what causes BPPV?
idiopathic
middle ear disease
otosclerosis
head injury
what are important negatives to rule out in BPPV?
- persistent vertigo
- speech, visual, motor or sensory problems
- tinnitus, headache, ataxia, facial numbness or dysphagia
- vertical nystagmus
What is the treatment of BPPV?
usually self limiting
Epley manœuvre
What is the underlying pathology in menieres?
dilatation of endolymphatic spaces of membranous labrynth
What are the features of menieres?
sudden attacks of vertigo for 2-4hrs
nystagmus ALWAYS present
increased feeling of fullness in ears +/- tinnitus followed by vertigo
fluctuating sensorineural hearing loss
how is menieres diagnosed?
electrocochleography
MRI of endolymphatic space
what is the treatment of menieres disease?
prochlorperazine
betahistine
chlortalidone
what causes of vertigo typically follow a viral infection?
viral labyrinthitis vestibular neuronitis (acute vestibular failure)
how does vestibular neuronitis present?
recurrent sudden vertigo attacks lasting hrs or days
N+V
horizontal nystagmus
no hearing loss or tinnitus
what is the treatment of vestibular neuronitis?
Vestibular rehabilitation exercises for chronic
Buccal/IM prochlorperazine - rapid relief when severe
Antihistamine - cyclizine
how does vertebrobasilar ischaemia typically present?
elderly
dizziness on extension of neck
What is the labyrinth made up of ?
cochlear and semicircular canals
what is the character of the nystagmus in vestibular neuronitis?
horizontal away from affected side
