Vertigo Flashcards
what are the two types of vertigo?
peripheral or central
what are the clinical features of peripheral vertigo?
Severe, accompanied by loss of balance, nausea, vomiting, reduced hearing, tinnitus, nystagmus (usually horizontal) and diaphoresis
what are the clinical features of central vertigo?
• Hearing loss and tinnitus are less common, less severe, nystagmus may be horizontal or vertical
what are the causes of peripheral vertigo?
Menieres disease, BPPV, vestibular failure, labyrinthitis, superior semi-circular canal dehiscence
what are the causes of central vertigo?
acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency
what is the duration of BPPV?
Mins
what is the duration of Meniere’s
Hours
what is the duration of Labyrinthitis?
Days-weeks
what is the duration of VN?
Days-weeks
is there associated HL or Tinnitus in BPPV?
No
is there associated HL or Tinnitus in Meniere’s?
Yes
is there associated HL or Tinnitus in Labyrinthitis?
Yes
is there associated HL or Tinnitus in VN?
No
is there aural fullness in BPPV?
No
is there aural fullness in Meniere’s?
Yes
is there aural fullness in labyrinthitis?
No
is there aural fullness in VN?
No
is there a clear positional trigger to BPPV?
Yes
is there a clear positional trigger to Meniere’s?
No
is there a clear positional trigger to Labyrinthitis?
No
is there a clear positional trigger to VN?
No
what are the causes of BPPV?
head trauma, ear surgery, idiopathic
What is the pathophysiology of BPPV?
otolith material from utricle displaced into the semi-circular canals (crystals float into fluid, displaced on movement)
what are the clinical features of BPPV?
o Induced by change in position
o Episodes – a few seconds to a few minutes
o No associated hearing loss, tinnitus, aural fullness
o nausea + vomiting
o May have visual disturbance – torsional nystagmus
how is BPPV diagnosed?
Hallpike Test
what is the management of BPPV?
Epley Manoeuvre
Brandt-Daroff
Drugs – antihistamines and anticholinergic
Surgery – vestibular nerve section
what is the cause of Menieres Disease?
unknown
what is the pathophysiology of Meniere’s disease
o Inner ear
o Inflammatory causes that contribute to the development of endolymphatic hydrops
= excess fluid in the inner ear leads to dilation of the endolymphatic spaces of the membranous labyrinth
what are the clinical features
o History of recurrent, spontaneous, rotational vertigo with at least 2 episodes > 20mins
o nausea and vomiting
o Recurrence +/- worsening of tinnitus on affected side
o aural fullness on affected side
o SNHL – lower frequencies, gets progressively worse
o Rare – drop attacks – falls without loss of consciousness
how is Meniere’s disease diagnosed?
through exclusion, electrocochleography, posterior fossa MRI
how is Meniere’s disease managed?
o Acute Attack: Prochlorperazine (vestibular sedative)
o Prophylaxis – betahistine
o Also: grommet insertion of gentamicin, labyrinthectomy
What is the cause of vestibular neuronitis?
viral – link to herpes, prior URTI
what is the difference between pathophysiology of VN and labyrinthitis?
VN - infection of vestibular nerve
Labyrinthitis - affects ear or 8th nerve as a whole
what are the clinical features of VN?
- Sudden onset, prolonged vertigo – days to weeks
- Associated Nausea/vomiting
- Causes horizontal nystagmus
- Vestibular Neuritis – no associated tinnitus/hearing loss
- Labyrinthitis – may have associated tinnitus/hearing loss
- Viral prodromal symptoms
what is the management of VN and labyrinthitis?
- Generally self limiting
- Vestibular sedatives – prochloperazine (dopamine rector antagonist)
- If prolonged – further investigations, rehab
