Vertigo

Question 1

What are the most common causes of vertigo?

Answer 1

Benign paroxysmal positional vertigo MC

Vestibular neuritis

Question 2

What are the two primary systems which can cause vertigo?

What are some potential causes within these systems?

Answer 2

CNS (vertebrobasilar insufficiency, migraine, brainstem infarct, MS, or tumors)

Vestibular system (Labyrinthitis, vestibular neuritis, BPPV, cholesteatoma, Herpes Zoster, Menieres)

Drugs can do it too (gentamycin, Macrolides (erythro) vanco, salicylates, high dose loop diuretics)

Question 3

How will a PT with suspected Vestibular Neuritis typically present?

Answer 3

Vestibular imbalance (veering towards affected side)

Horizontal nystagmus

Positive head thrust test

Question 4

What is vestibular neuritis commonly caused by?

What Tx would you Rx?

Answer 4

Virus; typically self-limiting

Symptomatic:
Antiemetics
Benzodiazepines (2 to 3 days b/c fall risk)
Steroids

Question 5

What is the pathology behind Benign Paroxysmal Positional Vertigo?

Answer 5

Calcium debris in the POSTERIOR SEMICIRCULAR CANAL

Question 6

Acute onset vertigo, hearing loss, and facial paralysis are your PT’s CC in the clinic; you have r/o stroke. What the next most likely Dx be?

What would Rx to Tx this PT?

Answer 6

Herpes Zoster Oticus (of geniculate ganglion)
Ramsay Hunt Syndrome

Facial paralysis is ipsilateral

Corticosteroids
Acyclovir