Vertigo Flashcards
What is vertigo?
The hallucination of movement
What are the central causes of vertigo?
MS Posterior stroke Migraine SOL Ear surgery
What are the otological causes of vertigo?
BPPV
Meniere’s Disease
Vestibular neuronitis
What is the most common cause of true vertigo?
Benign positional paroxysmal vertigo (BPPV)
What causes BPPV and how does this bring on vertigo?
Presence of canaliths in the semi-circular canals instead of the utricle
Movement of the head causes movement of these crystals –> vertigo
What are the risk factors for BPPV?
Increased age
Recent head injury
History of labyrinthitis
What are the clinical features of BPPV?
Attacks of vertigo lasting seconds
Usually results from the same head movement every time
Associated nausea and vomiting
How is BPPV diagnosed?
Dix-Hallpike manoeuvre
–> evokes symptoms + nystagmus (<1 min)
How is BPPV managed?
Epley’s manoeuvre
If persistent, patient can try Brandt-Daroff exercises at home
What are the clinical features of Meniere’s disease?
Triad of:
- severe paroxysmal vertigo
- sensorineural hearing loss
- tinnitus
Classical aural fullness before attack
Usually unilateral, lasting minutes - hours, resolving with 24 hours
How does Meniere’s disease progress over time?
Remission between attacks but repeated attacked result in worsening hearing loss over time
What is the symptomatic treatment for Meniere’s during an acute attack?
Prochlorperazine (buccal or IM)
What are the management options for prophylaxis in Meniere’s disease?
Reduce salt in diet, avoid caffeine and chocolate
Regular betahistamines
Intratympanic gentamicin or steroid injections
What is vestibular neuritis?
Inflammation of the vestibular nerve
What are the clinical features of vestibular neuritis?
Usually viral, often preceded by URTI
Severely incapacitating –> vertigo with nausea and vomiting
Lasts for up to a week but unsteadiness may persist for several weeks
What is the management of vestibular neuritis?
Anti-emetics e.g. prochlorperazine
What can be done if there is persistent vestibular hypo function following vestibular neuritis?
Vestibular rehab with Cawthorne-Cooksey exercises
What are the clinical features of a vestibular migraine?
Vertigo lasting minutes to days
Classically associated with headache, photo/phonophobia but not always
What is the management for a vestibular migraine?
Avoid triggers
Migraine medications
Which investigations can be done in a patients with vertigo?
Full neuro exam
Pure tone audiometry
Dix-Hallpike test
MRI of internal acoustic meatus (if suspect acoustic neuroma)
Video head impulse testing (vHiT) - assess function of semicircular canals using vestibulo-ocular reflex
Lying-standing BP (differentiate from dizziness)
