Vertigo

Question 1

What is vertigo

Answer 1

abnormal sensation of movement - spinning rather than lightheadedness

Question 2

what is the classification of vertigo

Answer 2

peripheral - ear and labyrinth

central - involves brain and cranial nerves

Question 3

what are causes of peripheral vertigo

Answer 3

labyrinthitis 
BPPV
menieres
endolymphatic hydrops
middle ear disease
post-ear surgery
post-trauma
vascular insufficiency 
dead labyrinth 
drugs

Question 4

what are causes of central vertigo

Answer 4

vestibular neuritis
tumours - acoustic neuroma
Ms
head injury
vascular occlusion  
drugs

Question 5

what is the differential for balance disturbance

Answer 5

cardiac insufficiency 
cervical spine disease
metabolic disorders
anaemia
epilepsy
migraines

Question 6

what is vestibular neuritis

Answer 6

inflammation of the vestibular portion of cranial nerve 8

Question 7

what tends to cause vestibular neuritis

Answer 7

viral infections - most commonly herpes simplex

Question 8

what are the symptoms of vestibular neuritis

Answer 8

Vertigo, tinnitus, hearing may be affected but not commonly

Question 9

how do you treat vestibular neuritis

Answer 9

vestibular sedatives (prochlorperazine)
rest
if within 3 days of start of attack steroids may help reduce course of disease

Question 10

what is the prognosis for vestibular neuritis

Answer 10

resolutions occurs gradually over a period of weeks

Question 11

what is labyrinthitis

Answer 11

acute inflammation of the inner ear following URTIs

Question 12

what are the main symptoms of labyrinthitis

Answer 12

disabling vertigo and disequilibrium +/- sensorineural hearing loss, tinnitus + N+V

Question 13

what’s the treatment for acute labyrinthitis

Answer 13

vestibular sedatives (prochlorperazine) 
anti-emetics if required

Question 14

what organisms tend to cause viral labyrinthitis

Answer 14

CMV
Varicella
mumps
measles
rubella
HIV

Question 15

what is the treatment for bacterial labyrinthitis associated with otitis media

Answer 15

antibiotics - ofloxacin
anti-emetics
vestibular suppressant - prochlorperazine

Question 16

what are some more uncommon causes for labyrinthitis

Answer 16

syphilis
HIV
autoimmune
secondary to meningitis

Question 17

what autoimmune conditions are associated with labyrinthitis

Answer 17

cogans syndrome

behcet’s disease

Question 18

what physiotherapy may be recommended for labyrinthitis

Answer 18

Cooksey-Cawthorne exercises

Question 19

what are Cooksey-Cawthorne exercises

Answer 19

throwing balls back and forth
eyes open and closed
throwing/catching ball whilst working

Question 20

what is the prognosis for labyrinthitis

Answer 20

there may be some residual imbalance with rapid movements for some months after initial episode

full recovery not guaranteed + in these patients acute decompensation after an acute event may happen

Question 21

what are the consequences of severe labyrinthitis

Answer 21

hearing loss with total labyrinth destruction or a ‘dead labyrinth’

Question 22

what is benign paroxysmal positional vertigo

Answer 22

episodic vertigo occurring after head position change occuring for minutes-hours (usually quite short though)

Question 23

what is the best diagnostic test for BPPV

Answer 23

dix-hallpike manouver

Question 24

what is the dix-hallpike manouver

Answer 24

diagnostic test for BPPV

patient site facing dr and lies backwards quickly, dr turns their head through 30 degrees and extends down

+ve = nyastagmus + symptoms

repeat on other side

Question 25

what kind of nyastagmus is characteristic for BPPV

Answer 25

rotatory towards underlying unaffected ear
latent period before starting
shows fatigue

Question 26

whats the theory for why BPPV causes

Answer 26

dislodged otoliths settling in the posterior semilunar canal with certian movements causing irritation

Question 27

whats the treatment for BPPV

Answer 27

reassurance of spontaneous resolvance

Epleys manouvre may dislodge otolith (70-90% effectiveness) - but high recurrence (36%)

Cooksey-Cawthorne maneuvers may speed up compensation

Question 28

what should you avoid in BPPV

Answer 28

vestibular sedatives

Question 29

what is presbyastasis

Answer 29

momentary feeling of unsteadiness (particularly in elderly)

Question 30

what is thought to cause presbyastasis

Answer 30

small vessel disease in brain

Question 31

how do you manage presbyastasis

Answer 31

self limiting - may improve
no treatment
no N+V

Question 32

what is a vestibular migraine

Answer 32

migraine with vestibular symptoms - mainly vertigo/dysequilibrium

Question 33

how long do vestibular migraines typically last for

Answer 33

5-20 mins

Question 34

whats the diagnostic criteria for vestibular migraines

Answer 34

episodic vestibular symptoms
current/previous migraines
exclusion of all other causes
migraine symptoms during an attack of vertigo on 2 separate occasions

Question 35

what is the treatment for vestibular migraine

Answer 35

migraine treatment:

analgesia
triptan (1st choice = sumitriptan)
anti-emetics if reuqired

Question 36

what is the difference between CNS vertigo and peripheral vertigo symptomatically

Answer 36

CNS = momentary disequilibrium with ataxia, unsteadiness, gradual feeling off balance

peripheral - sudden episodes of vertigo + N+V, H/L + tinnitus more common

Question 37

what kind of nystagmus indicates a central pathology

Answer 37

Vertical
Torsional
horizontal + direction changing

Question 38

when does nystagmus move towards the affected ear

Answer 38

when there is an irritative pathology

Question 39

where would the nystagmus move with cerebellar lesions

Answer 39

ipsilateral side

Question 40

in what pathologies is rotational vertigo present

Answer 40

labyrinthitis
BPPV
menieres