Vertigo

Question 1

Explain the brief symptoms of dysfunction in vestibular system

Answer 1

Symptoms rely on perceptual mechanism: vestibular - perception = sensation of motion of self or environment.

Seeing environmental motion = oscillopsia (indication of nystagmus ) - illusory self motion - low current, feeling of gentle rocking of self vis high current = violent feeling of self and room.

Question 2

What are the 4 types of vertigo diagnoses

Answer 2

1. BPPV (suddenly episodes of dizziness and spinning - vestibular perception)
2. Vestibular neuritis
3. Migranious vertigo
4. Stroke

Acute vertigo - postural hypotension and arterial saturation and ECG

Question 3

Explain the core examinations to determine vertigo

Answer 3

Eyes: cover, gaze, VOR, hallpike and fundoscopy
Ears: otoscopy
Legs: Gait

Nystagmus, if unidirectional - vestibular (gaze)
VOR, head - impulse test, if the test is not working - problem In periphery (inner ear)
Fundoscopy, retina (position of disc and macula) and spontaneous nystagmus and effect of visual fixation
Legs, tandem walking and Romberg (eyes closed affects hypotension)

Question 4

Explain the effects of BPPV

Answer 4

Lying back in bed (differentiates from postural hypotension) - brief and nystagmus

Question 5

Explain the effects of vestibular neuritis

Answer 5

Subacute onset (minutes to hours), continuous vertigo, obvious nystagmus, positive head impulse test, and normal gait. Red flags are headaches, gait ataxia, hyperacute onset, vertigo and hearing loss and prolonged symptoms.

Treatment: vestibular sedatives for 36-48 hours, mobilise at day 2 or 3 and treat any BPPV and migraine

Question 6

Describe the condition of acute vestibular migraine

Answer 6

Red flags: headache, gait, hyperacute onset, hearing loss, prolonged symptoms

Question 7

Describe the condition of cerebellar stroke

Answer 7

Thunderclap onset vertigo (embolic- valsalva, Afib)
Neck pain in stretching or trauma
Headache
Red flags: gait ………. [as all of the, ]