Vertigo

Question 1

Viral labyrinthitis features:

Answer 1

Recent viral infection
Sudden onset
N + V
Hearing may be affected

Question 2

Vestibular neuronitis features:

Answer 2

Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss

Question 3

Benign paroxysmal positional vertigo features:

Answer 3

Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds

Question 4

Meniere’s disease features:

Answer 4

Hearing loss
Tinnitus
Sensation of fullness/pressure in one/both ears

Question 5

Vertebrobasilar ischaemia features:

Answer 5

Elderly patient

Dizziness on extension of the neck

Question 6

Acoustic neuroma features:

Answer 6

Hearing loss, vertigo, tinnitus
Absent corneal reflex is an important sign
Associated with neurofibromatosis type 2

Question 7

Other causes of vertigo:

Answer 7

Posterior circulation stroke
Trauma
MS
Ototoxicity e.g. gentamicin

Question 8

What is end-point nystagmus?

Answer 8

Normal at the extremes of gaze

Question 9

Which nerves are inflamed in acute labyrinthitis?

Answer 9

Superior/inferior vestibular nerves

Cochlear nerve

Question 10

Features of vestibular nystagmus:

Answer 10

Horizontal
Maximal in direction of gaze
Suppressed with fixation (central nystagmus may not suppress)
Only goes in one direction (boy band sign)

Question 11

What are the three main peripheral vestibular diagnoses of vertigo?

Answer 11

Vestibular neuritis
BPPV
Meniere’s disease

Question 12

CNS causes of vertigo:

Answer 12

Migraine
Brainstem infarct
Cerebellar infarct
Tumours
MS

Question 13

Symptoms of vestibular neuritis:

Answer 13

Vertigo
N+V
Can’t get out of bed

Question 14

Signs of vestibular neuritis:

Answer 14

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

Question 15

Management of vestibular neuritis:

Answer 15

Hydration
Vestibular sedatives for acute/vomiting but stop ASAP as can lead to deficit
Rehab

Question 16

Signs that it is NOT vestibular neuritis:

Answer 16

Other CN signs
-ve head thrust test
Atypical forms of nystagmus e.g. downbeating
Hearing loss (anterior inferior cerebellar stroke)

Question 17

What can anterior inferior cerebellar stroke cause?

Answer 17

Hearing loss

Question 18

What causes BPPV?

Answer 18

CaCO3 crystals detached from otoconia

Question 19

What causes BPPV?

Answer 19

Classically, rolling over in bed to affected side and then room begins to spin

Question 20

How do you test for BPPV?

Answer 20

Hallpike manœuvre: once lying, nystagmus will appear after a few seconds

Question 21

How do you treat BPPV?

Answer 21

Epley manoeuvre

Modified Semont manoeuvre

Question 22

What can atypical positional nystagmus indicate?

Answer 22

CNS cause of vertigo

Question 23

How do you differentiate Meniere’s disease from vestibular neuritis?

Answer 23

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

Question 24

What is the pathology of Meniere’s disease?

Answer 24

Fluid build up from endolymphatic hydrops

Question 25

Features of Meniere’s disease:

Answer 25

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

Question 26

History of Meniere’s:

Answer 26

Fluctuating unilateral hearing loss that gradually gets worse
Disease burns out with poor but aid-able hearing
Drop attacks

Question 27

Preventative treatment in Meniere’s:

Answer 27

Low salt diet
Thiazide diuretics
Betahistine

Question 28

Treatment to abort attacks in Meniere’s:

Answer 28

Prochlorperazine (Buccastem)

Other vestibular suppressants

Question 29

Other treatments for Meniere’s:

Answer 29

Intratympanic gentamicin
Intratympanic steroids
Endolymphatic sac surgery
Vestibular neurectomy
Labyrinthectomy

Question 30

Features of vestibular migraine:

Answer 30

Normal hearing
Variable duration (minutes-days)
Provoked by migraine triggers such as food, stress, tiredness, hunger, menstrual cycle

Question 31

Treatment of vestibular migraine:

Answer 31

Standard migraine line of treatments

Vestibular suppressants and rehab may also be needed