Vertigo Flashcards
Viral labyrinthitis features:
Recent viral infection
Sudden onset
N + V
Hearing may be affected
Vestibular neuronitis features:
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss
Benign paroxysmal positional vertigo features:
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
Meniere’s disease features:
Hearing loss
Tinnitus
Sensation of fullness/pressure in one/both ears
Vertebrobasilar ischaemia features:
Elderly patient
Dizziness on extension of the neck
Acoustic neuroma features:
Hearing loss, vertigo, tinnitus
Absent corneal reflex is an important sign
Associated with neurofibromatosis type 2
Other causes of vertigo:
Posterior circulation stroke
Trauma
MS
Ototoxicity e.g. gentamicin
What is end-point nystagmus?
Normal at the extremes of gaze
Which nerves are inflamed in acute labyrinthitis?
Superior/inferior vestibular nerves
Cochlear nerve
Features of vestibular nystagmus:
Horizontal
Maximal in direction of gaze
Suppressed with fixation (central nystagmus may not suppress)
Only goes in one direction (boy band sign)
What are the three main peripheral vestibular diagnoses of vertigo?
Vestibular neuritis
BPPV
Meniere’s disease
CNS causes of vertigo:
Migraine Brainstem infarct Cerebellar infarct Tumours MS
Symptoms of vestibular neuritis:
Vertigo
N+V
Can’t get out of bed
Signs of vestibular neuritis:
Single episode that lasts days
Following URTI - viral inflammatory of vestibular nerve?
Slow compensation
Peripheral nystagmus (beating away from side with lesion)
+ve head thrust test
Management of vestibular neuritis:
Hydration
Vestibular sedatives for acute/vomiting but stop ASAP as can lead to deficit
Rehab
Signs that it is NOT vestibular neuritis:
Other CN signs
-ve head thrust test
Atypical forms of nystagmus e.g. downbeating
Hearing loss (anterior inferior cerebellar stroke)
What can anterior inferior cerebellar stroke cause?
Hearing loss
What causes BPPV?
CaCO3 crystals detached from otoconia
What causes BPPV?
Classically, rolling over in bed to affected side and then room begins to spin
How do you test for BPPV?
Hallpike manœuvre: once lying, nystagmus will appear after a few seconds
How do you treat BPPV?
Epley manoeuvre
Modified Semont manoeuvre
What can atypical positional nystagmus indicate?
CNS cause of vertigo
How do you differentiate Meniere’s disease from vestibular neuritis?
Meniere’s has a longer vertigo that is incapacitating
Unilateral tinnitus (sea-shell)
Unilateral hearing loss (only also in vestibular neuritis if there has been an AICA infarct)
Preceded by aural fullness/pressure
What is the pathology of Meniere’s disease?
Fluid build up from endolymphatic hydrops
Features of Meniere’s disease:
Multiple episodes in clusters Each episode is 30 minutes-hours Vomiting and diarrhoea Exhausted and washed out for day+ 40% will develop the disease in the other ear
History of Meniere’s:
Fluctuating unilateral hearing loss that gradually gets worse
Disease burns out with poor but aid-able hearing
Drop attacks
Preventative treatment in Meniere’s:
Low salt diet
Thiazide diuretics
Betahistine
Treatment to abort attacks in Meniere’s:
Prochlorperazine (Buccastem)
Other vestibular suppressants
Other treatments for Meniere’s:
Intratympanic gentamicin Intratympanic steroids Endolymphatic sac surgery Vestibular neurectomy Labyrinthectomy
Features of vestibular migraine:
Normal hearing
Variable duration (minutes-days)
Provoked by migraine triggers such as food, stress, tiredness, hunger, menstrual cycle
Treatment of vestibular migraine:
Standard migraine line of treatments
Vestibular suppressants and rehab may also be needed
