Vertigo/ dizziness Flashcards
Define vertigo
Vertigo is the sensation that the environment is spinning around relative to oneself (objective vertigo) or vice versa (subjective vertigo).
Pathophysiology of BPPV?
presence of debris in the semicircular canals of ears cause vertigo upon head movement
Diagnostic test of BPPV?
Dix-hallpike manœuvre- rotatory nystagmus brings on symptoms
What resolves BPPV?
Epley manœuvre
How does BPPV present?
Vertigo on turning head
Gradual onset
Episodes last 10-20 secs
What is acute labyrinthitis?
Inflammation of the vestibular nerve causes acute severe vertigo, may be associated with vomiting/
How does acute labyrinthitis present?
Recent viral infection
Vertigo
N&V
hearing may be affected/tinnitus
Vestibular neuritis presentation?
Recent viral infection
recurrent vertigo attacks lasting hours or days
Nausea and vomiting
Horizontal nystagmus
No hearing loss
How do you differentiate between vestibular neuritis and acute labyrinthitis?
Vestibular neuritis will not have any hearing loss but acute labyrinthitis might
Treatment for acute labyrinthitis?
Self-resolving in about a month, conservative treatment.
prochlorperazine or antihistamines may help reduce the sensation of dizziness
Meniere’s disease features?
Recurrent episodes of vertigo, sensorineural hearing loss, tinnitus and feeling of aural fullness
Can be unilateral or bilateral
Treatment of Menieres disease?
Antihistamines and bedrest
Presentation of vestibular schwannoma?
The classical history of vestibular schwannoma includes a combination of:
* vertigo
* hearing loss
* tinnitus
* absent corneal reflex.
Features can be predicted by the affected cranial nerves:
* cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
* cranial nerve V: absent corneal reflex
* cranial nerve VII: facial palsy
What condition is vestibular schwanoma associated with?
Neurofibromatosis type 2
What is Ramsay Hunt syndrome?
Herpetic infection of the facial N–> causes facial nerve palsy
With or without vertigo, tinnitus and hearing loss
How do you treat Ramsay Hunt?
Aciclovir and prednisolone
What causes ototoxicity?
Aminoglycoside abs
Loop diuretics
Features of carbon monoxide poisoning?
Headache
Nausea and vomiting
Vertigo
Confusion
Subjective weakness
In severe toxicity: ‘pink’ skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death
Investigations in carbon monoxide poisoning?
Pulse ox may be FALSELY high
VBG/ABG
ECG- for cardiac ischaemia
What are typical carboxyhemoglobin levels?
< 3% non-smokers
< 10% smokers
10 - 30% symptomatic: headache, vomiting
> 30% severe toxicity
Management of carbon monoxide poisoning?
100% high-flow oxygen via a non-breath mask, target sats are 100%
Treatment until all symptoms have resolved
Indications of hyperbaric oxygen use in carbon monoxide poisoning?
Discussion with specialist should be considered in more severe cases: >25%
LOC
Neuro signs other than headache
Myocardial ischaemia or arythmie
Pregnancy
What is a TIA?
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
Features of TIA?
Usually resolve within one hour
Unilateral weakness or sensory loss
aphasia/dysarthria
Ataxia, vertigo, loss of balance
Visual problems (amaurosis fugax), diplopia, homonymous hemianopia
Management of Vestibular neuronitis?
buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
What is essential to determine about the cause of vertigo when assessing a pt? WHy?
Whether the vertigo is due to a central or peripheral cause.
why? cerebellar infarction / haemorrhage (central) is life threatening as opposed to non life threatening e.g. BPPV or mernieres (peripheral)
What are DDx for a patient presenting with acute vertigo i.e. causes of vertigo
Mechanical
- BPPV (otoliths moving in semicirucalr canals)
- Menieres
Infectious (viral)
- Acute vestibular neuritis (semicircular canal function)
Vascular :
- Infarction in anterior vestibular artery territory (presents like v. neuritis - think pts with RF for stroke e.g. DM, HTN, AF)
- Brainstem stroke (accompanied by other signs, horners, dysarthuria, incoordination, diplopia, facial numbness)
- Inferior cerebellar artery infarction (present only with vertigo, nystagmus and postural instability)
MS
- plaque around VIII cranial nerve
Migraine
- diagnosis of exclusion
Migrainous vertigo
what are clinical features of acute vertigo ?
vertgio
nausea
vomitting
Compare clincial features of BPPV vs Menieres vs migraine
BPPV vertigo lasts for seconds
Meniere’s vertigo lasts for mins/hours
Migraine vertigo last for hours
compare central vs peripheral vertigo charachteristics
What examination can you do to determine if peripheral or central origin of vertigo?
HINNTs exam
involves:
Head impulse test
evaluation of nystagmus
test of skew
https://www.youtube.com/watch?v=1q-VTKPweuk
