Vertigo Lecture Powerpoint

Question 1

Vertigo definition

Answer 1

Abnormal perception of movement typically described as spinning, floating, or ground rising or falling, associated with nausea and vomiting in severe cases

Question 2

Vertigo is a ___, not a ___

Answer 2

symptom, diagnosis

Question 3

Vertigo can be derived from a problem along these different areas (4)

Answer 3

• Vestibular system
• vestibulocochlear nerve (CN8)
• semicircular canals
• central vestibular structures in brainstem or cerebellum (TIA’s, tumors, MS)

Question 4

Vertigo epidemiology

Answer 4

Most commonly benign paroxysmal positional vertigo and vestibular neuritis (both benign), treated typically outpatient

Question 5

It is important to differentiate pure vertigo from these 2 conditions

Answer 5

• unsteadiness/imbalance (parkinson’s)

- lightheadedness/syncope

Question 6

Benign causes of vertigo arise in the ___, more urgent arise closer to the ___

Answer 6

periphery, CNS

Question 7

Common drugs that can result in drug induced vertigo (4)

Answer 7

• Lasix
• erythromycin
• NSAIDS long term
• tetracycline

Question 8

Nystagmus

Answer 8

Constant involuntary cyclic eye movements that can be caused by central or peripheral lesions either rotary, horizontal, or vertical

Question 9

Pure ___ or ___ nystagmus suggests a central lesion

Answer 9

vertical, torsional

Question 10

Nystagmus from peripheral cause tends to be…. (5)

Answer 10

• unidirectional
• horizontal with torsional component never purely torsional or vertical
• suppressed with fixation
• lack of ataxia, aphasia, hemiparesis
• walking preserved
• deafness or tinnitus may be present

Question 11

Nystagmus from central cause tends to be… (6)

Answer 11

• Tends to be torsional or vertical
• can change direction
• not suppressed by fixation
• often have ataxia, aphasia, hemiparesis
• walking not preserved
• no deafness or tinnitus

Question 12

Vestibular neuritis

Answer 12

Inflammation of the vestibulocochlear nerve presenting often subacute with nausea, vomiting, and gait instability (but hearing is intact) that resolves over days but can persist for months, usually viral and self limiting in healthy young people

Question 13

Labrynthitis

Answer 13

Vestibular neuritis combined with unilateral hearing loss

Question 14

Head thrust test and positive/negative interpretation

Answer 14

• Patient fixates on target on wall while examiner moves head rapidly to each side looking for any movement of the pupil that if it moves sign of decreased neural input from ispalateral ear to vestibulocochlear reflex
• Positive in vestibular neuritis, negative for CNS cause

Question 15

Vestibular neuritis treatment options (3)

Answer 15

• Antiemetics
• Steroids
• vestibular rehab

Question 16

Benign paroxysmal positional vertigo (BPPV)

Answer 16

Leading cause of vertigo caused by calcium debris in the posterior semicircular canal causing a brief reproducible spinning sensation when turning or tilting head backwards asking only a couple seconds

Question 17

Dix-Hallpike maneuver and interpretation

Answer 17

• Turn patients head to left and bring to supine position on table with head 20 degrees elevated above table for 30 seconds, then lifted and repeated on other side
• positive indicates ipsalateral BPPV

Question 18

Epley maneuver

Answer 18

Physical manipulation from the dix hallpike maneuver to rotate prone in order to dislodge calcium deposits causing BPPV

Question 19

Herpes zoster oticus/ramsay hunt syndrome

Answer 19

Herpes zoster infection of part of facial nerve causing acute vertigo, hearing loss, ipsalateral facial paralysis, ear pain, and vesicles in the auditory canal

Question 20

Herpes zoster oticus/ramsay hunt syndrome treatment options (2)

Answer 20

• Corticosteroids

- acyclovir

Question 21

Meniere’s disease

Answer 21

Excess endolymphatic fluid pressure brought on by unknown cause resulting in recurrent attacks of vertigo usually unilateral associated with auditory symptoms (hearing loss, tinnitus, fullness in the ear), with nystagmus during attacks and gait imbalance/nausea/vomiting

Question 22

Meniere’s disease treatment (4)

Answer 22

• Low salt diet
• diuretics
• avoid caffeine, chocolate, red wine
• intratympanic gentamycin injections (permanent hearing loss)

Question 23

Perilymphatic fistulas, diagnosis (1), treatment (1)

Answer 23

• Fistula at the oval or round window between inner ear and middle ear from head trauma, barotrauma, or heavy lifting causing episodic vertigo with hearing loss with coughing/sneezing
• CT scan
• Bed rest, avoid straining, resolves on own

Question 24

Labyrinthine concussion

Answer 24

Traumatic peripheral vestibular injury following direct concussive head trauma, more severe with temporal bone fracture can be permanent, while typically resolves in days to months

Question 25

Cogan syndrome and treatment (1)

Answer 25

• Rare autoimmune condition causing interstitial keratitis (dry red eyes) and vestibuloauditory dysfunction (vertigo, tinnitus, hearing loss) that comes and goes
• Systemic steroids

Question 26

Familial bilateral vestibulopathy

Answer 26

Brief attacks of vertigo (seconds in duration) followed by progressive loss of peripheral vestibular function leading to imbalance

Question 27

Vestibular schwannoma

Answer 27

Benign tumor of the 8th cranial nerve that can be seen on MRI that is a rare peripheral cause of vertigo

Question 28

Vestibular migraines

Answer 28

Migraines that present with vertigo and often mimic meniere’s disease but respond to medications for migraines

Question 29

Brainstem/cerebellar ischemia/infarction vertigo and 3 abnormal ocular motor findings

Answer 29

• Caused by embolic or atherosclerotic occlusion of vertebrobasilar arterial system
• spontaneous nystagmus purely vertical/horizontal/torsional, ataxia toward size of lesion, other neurological findings

Question 30

Wallenberg CVA

Answer 30

Specific type of brainstem infarct/dissection of the posterior inferior cerebellar artery causing infarction of the lateral medulla causing vertigo, nystagmus, and ataxia but also ipsalateral horner syndrome

Question 31

Horner syndome and its triad of presentation

Answer 31

Interruption of sympathetic nerve supply to eye characterized by

1) miosis
2) partial ptosis
3) anhidrosis (loss of hemifacial sweating

Question 32

___ type vertigo is made worse by head movement

Answer 32

All types

Question 33

Following a CVA, reflexes are ___ immediately but few days after become ____

Answer 33

hyporeflexive, hyperreflexive

Question 34

Treatment for vertigo options (3)

Answer 34

• Antivert (meclizine) 25-50mg TID
• Corticosteroids
• Phenothiazine antiemetics