Vertigo / Balance Issue Flashcards
Define Vertigo
Hallucination of movement •usually rotatory •Usually associated with vomiting •Nystagmus •+/-hearing loss
Not imbalance, wobbly, faint.
What three factors contribute to balance?
- 80% balance visual
- 10% balance proprioception
- 10% balance vestibular apparatus
Key history taking questions when patients present with vertigo
•1st episode or recurrence •Associations - Hearing loss - Tinnitus - Aural pressure - Vomiting - Diarrhoea
What examinations should be conducted in patients presenting with vertigo?
- TMs / ear
- CN
- Cerebellar System
- Dix-hallpike (R&L)
- Unterbergers
- Rombergs
- Hearing test
Differential for vertigo: central causes
- Neurological signs (facial weakness/cerebellar signs/CN palsy) - > Stroke
- Persistent vertigo without recovery >7 days -> Think neurological cause
Signs of PICA stroke
- ipsilateral limb ataxia
- vertigo and unable to mobilise
- saccadic eye movements with overshoot
Signs of AICA stroke
AICA-(lateral pontine medullary infarct)
•Reduced temp/pain sensation ipsilateral face
•Contralateral limbs
•SNHL severe
Differential Diagnosis in Vertigo
V Vascular E Epilepsy R Receiving Treatment T Tumours, Trauma, Thyroid I Infections G Glial (MS) O Ocular
Features of Benign paroxysmal positional vertigo
- Seconds of vertigo
- Rolling over in bed
- Comes in bouts
- Most settle spontaneously
Underlying cause of Benign paroxysmal positional vertigo
- Underlying physiology is loose otoconia
- PSCC most often affected
- Altered specific gravity of endolymph
BPPV Treatment Options
- Positional maneuver - Epley
* Surgical occlusion of SCC - in Refractory cases only, High chance SNHL
Clinical features of Labyrinthitis
- Classically sudden onset vertigo
- Vomiting
- +/- hearing loss
- Lasts days
- Then left with feeling general imbalance slowly improves after days- weeks
Treatment of of Labyrinthitis
- Treat with vestibular sedatives
- Supportive
- Balance physiotherapy to aid recovery
Most common cause of vertigo in children
Functional disturbance/anxiety followed by migraine related vertigo
Meniere’s disease triad
- Aural fullness/pressure
- Hearing loss
- Vertigo
