Vertigo Flashcards
What is vertigo?
An illusion of movement which includes a sensation of rotation of self or environment. As well as sensations of being pulled down/sideways.
What is dizziness?
Generic term referring to light-headedness, faintness, unsteadiness.
How can you identify ‘true’ vertigo in a history?
Patient will known exactly which way they were spinning/direction they were being pulled to.
What are the central causes of vertigo (brain)?
- Acoustic neuroma
- MS
- Head injury
- Migraine associated dizziness
What are the peripheral causes of vertigo (ear)?
- Meniere’s disease
- BPPV
- Vestibular failure
What is this a presentation of (vertigo)?
Usually vertical nystagmus, fast beat towards side of lesion, cerebellar signs, not relieved by gaze fixation.
Central cause of vertigo
What is this a presentation of (vertigo)?
Usually horizontal nystagmus, fast beat away from side of lesion, no cerebellar signs, relieved by gaze fixation.
Peripheral cause of vertigo
How is vertigo investigated?
- Otoscope
- Assess cranial nerves
- Test cerebellar function and reflexes - nystagmus, gait
- Consider audiometry and MRI
What is this a presentation of?
Attacks of sudden rotational vertigo lasting seconds to minutes, provoked by head turning.
Benign paroxysmal positional vertigo (BPPV)
What is the pathophysiology of vertigo?
Displacement of otoconia which stimulate the semi-circular canals, usually idiopathic.
What are the symptoms that need to be ruled out before diagnosing BPPV?
- No persistent vertigo
- No speech, visual, motor, or sensory problems
- No tinnitus, headache, ataxia, facial numbness
- No vertical nystagmus
What is the diagnostic test for BPPV?
Hallpike test
What is the curative treatment for BPPV?
Epley manoeuvre
What is this a presentation of?
Sudden attacks of vertigo lasting 2-4 hours, nystagmus present, aural fullness, tinnitus, sensorineural hearing loss, unilateral becoming bilateral.
Meniere’s disease
What is the pathophysiology of Meniere’s disease?
Excessive pressure and dilation of the endolymphatic system.
What is the management of Meniere’s disease?
- Acute - buccal prochlorperazine
- Prevention - PO betahistine
- Inform DVLA, stop driving until symptoms controlled
What is this a presentation of?
Recurrent vertigo lasting hours or days, nausea and vomiting, horizontal nystagmus, no hearing loss or tinnitus.
Acute vestibular failure/vestibular neuronitis
What is the cause of vertigo in acute vestibular failure/vestibular neuronitis?
Viral infection attacks vestibular ganglion
What is the management of acute vestibular failure/vestibular neuronitis?
Short course of PO prochlorperazine
What is this a presentation of?
Acute onset vertigo, nausea and vomiting, hearing loss (varying severity), and tinnitus.
Labyrinthitis
What is labyrinthitis and what is it associated with?
- Inflammatory disorder of the membranous labyrinth
2. Preceding or concurrent URTI (usually viral)
What is the management of labyrinthitis?
Short course of PO prochlorperazine
What are the causes of a post-traumatic vertigo?
- BPPV or vestibular migraine
2. Temporal bone fracture
What is this a presentation of?
Acute head injury, unilateral deafness, CN VII palsy, vertigo.
Temporal bone fracture
What is the most common finding in the acute phase of post-traumatic vertigo?
Central vestibular gait apraxia
What is multisensory dizziness syndrome?
Reduced inputs from more than one sensory system.
What is this a presentation of?
Reduced visual acuity (cataract/glaucoma), peripheral neuropathy (reduced proprioception), impaired hearing, elderly/diabetes mellitus patient.
Multisensory dizziness syndrome
