vertigo history

Question 1

What are the central causes of vertigo?

Answer 1

vertebrobasilar insufficiency

posterior inferior cerebellar syndrome (wallenburg syndrome)

multiple sclerosis

cerebellar disease

basilar migraine

infratentorial tumours-astrocytoma, ependyoma, medullablastoma, glioma

trauma to cervical neck

epilepsy in temporal lobe

Question 2

what are the peripheral causes of vertigo?

Answer 2

Anything that damages the vestibulocochlear nerve:

BPPV

meniere’s disease

vestibular neuronitis

labyrinthitis

medication

head trauma/ acoustic trauma that can cause damage to VIIIth nerve or labyrinth

acoustic neuroma

ramsay hunt affecting vestibulocochlear nerve

Question 3

What are the important questions to ask about vertigo?

• before
• during
• after

Answer 3

• timeframe
• onset-acute or chronic
• how many episodes; when was your last
• anything that made it worse?was it triggered by moving your head? anything that made it better
• did you feel nauseous

Asking other Q to rule out differentials:

• any ringing or fullness in your earrs (meniere’s)
• any fever and any previous infection in your ears? any hearing loss (vestibular neuronitis and labyrinthitis)
• any drooping of your face
• any pins and needles/weakness in your limbs (rule out central causes of vertigo like posterior stroke
• any fever, night sweats as well as weight loss

Question 4

what are the questions to ask for PMH/SH

DH

FH

SH:

Answer 4

PMH/SH

• previous ear surgeries or trauma
• previous ear infections

DH

• antibiotics

FH

• family history of hearing problems (otosclerosis may be congenital)

SH:

• how are they coping
• is their work environment noisy
• how is it affecting work/lifestyle
• driving
• smoking/ETOH/RD

Question 5

What investigations would you do?

Answer 5

• vestibular assessment
• pure tone audiogram
• vestibular function tests
• MRI of temporal head
• cranial nerve and cerebellar assessment to rule out central causes of this