Vertigo

Question 1

Vestibular neuritis

Answer 1

• Subacute onset (minutes – hours)
• Continuous vertigo
• Obvious ‘vestibular’ nystagmus
• Positive head impulse test
• Normal gait
• Treatment
• Vestibular sedatives for 24-36 hours
• Mobilise at day 3
• Treat any BPPV or migraine

Question 2

Red flags

Answer 2

Headache –
• 40% posterior circulation stroke.
• Gait ataxia –
• may be only non-vertiginous manifestation
of cerebellar stroke.
• Hyperacute onset –
• suggests vascular origin.
• Vertigo + hearing loss –
• AICA or urgent ENT problem.
• Prolonged symptoms (> 4 days) –
• Floor of 4th ventricle problem

Question 3

Acute vestibular migraine

Answer 3

History of migraine
• Acute vertigo with without headache
• Recurrent episodes
• Diagnosis of exclusion –
Main differential diagnosis is cerebellar stroke
• Red flags:
• Headache
• Gait problems
• Hyperacute onset
• Hearing loss
• Prolonged symptoms (>4 days)

Question 4

Cerebella stroke

Answer 4

• Thunderclap onset vertigo (?Valsalva)
• Difficulty walking
• Headache

Red flags:
• Headache
• Gait problems
• Hyperacute onset
• Hearing loss
• Prolonged symptoms (>4 days)