Vertigo Flashcards
What is the commonest cause of peripheral vertigo?
BPPV
What happens in BPPV?
Displacement of otoconia in semicircular canals
What are the symptoms of BPPV?
- Attacks of acute rotational vertigo > 30s
- Provoked by head movement (link to occupation)
- N&V
- Reducing hearing and tinnitus
- Horizontal nystagmus
How do you diagnose BPPV?
Positive Dix-Hallpike test (presence of fatiguable nystagmus)
Is Romberg’s test positive or negative in BPPV?
Negative
How do you treat BPPV?
Epley manoeuvre
What is acute labyrinthitis?
Vestibular neuritis - peripheral vertigo post-URTI (can also be caused by vascular lesion)
What are the symptoms of acute labyrinthitis?
- Single attack of severe vertigo that lasts few days (unilateral) and improves within couple weeks
- N&V
- Horizontal nystagmus (away from affected side)
- Prostration (can’t get out of bed)
- No deafness or tinnitus
How do you diagnose acute labyrinthitis?
Positive head thrust/impulse test
How do you treat acute labyrinthitis?
Prochlorperazine (Buccastem) = vestibular suppressant (need to stop these asap bc affects both sides and need other side to compensate)
- Supportive
- Rehabilitation
What is Meniere’s disease?
Peripheral vertigo caused by dilation of endolymphatic spaces of membranous labyrinth and increased pressure
What are the symptoms of Meniere’s disease?
- Recurrent attacks of vertigo lasting > 20 min (2-4h)
- Fluctuating (or permanent) unilateral sensorineural hearing loss esp. in low frequencies
- Unilateral tinnitus - with sense of aural fullness ± falling to one side
- Horizontal nystagmus
How do you diagnose Meniere’s disease?
- Audiometry
- Electrocochleography
- MRI
How do you treat attacks of vertigo in Meniere’s disease acutely?
- Prochlorperazine (Buccastem)
How do you prevent attacks of vertigo in Meniere’s disease?
- Betahistine
- Thiazide diuretics e.g. bendroflumethiazide
- Low salt diet
