Vertigo Lecture Powerpoint Flashcards
Vertigo definition
Abnormal perception of movement typically described as spinning, floating, or ground rising or falling, associated with nausea and vomiting in severe cases
Vertigo is a ___, not a ___
symptom, diagnosis
Vertigo can be derived from a problem along these different areas (4)
- Vestibular system
- vestibulocochlear nerve (CN8)
- semicircular canals
- central vestibular structures in brainstem or cerebellum (TIA’s, tumors, MS)
Vertigo epidemiology
Most commonly benign paroxysmal positional vertigo and vestibular neuritis (both benign), treated typically outpatient
It is important to differentiate pure vertigo from these 2 conditions
- unsteadiness/imbalance (parkinson’s)
- lightheadedness/syncope
Benign causes of vertigo arise in the ___, more urgent arise closer to the ___
periphery, CNS
Common drugs that can result in drug induced vertigo (4)
- Lasix
- erythromycin
- NSAIDS long term
- tetracycline
Nystagmus
Constant involuntary cyclic eye movements that can be caused by central or peripheral lesions either rotary, horizontal, or vertical
Pure ___ or ___ nystagmus suggests a central lesion
vertical, torsional
Nystagmus from peripheral cause tends to be…. (5)
- 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
Nystagmus from central cause tends to be… (6)
- 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
Vestibular neuritis
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
Labrynthitis
Vestibular neuritis combined with unilateral hearing loss
Head thrust test and positive/negative interpretation
- 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
Vestibular neuritis treatment options (3)
- Antiemetics
- Steroids
- vestibular rehab
Benign paroxysmal positional vertigo (BPPV)
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
Dix-Hallpike maneuver and interpretation
- 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
Epley maneuver
Physical manipulation from the dix hallpike maneuver to rotate prone in order to dislodge calcium deposits causing BPPV
Herpes zoster oticus/ramsay hunt syndrome
Herpes zoster infection of part of facial nerve causing acute vertigo, hearing loss, ipsalateral facial paralysis, ear pain, and vesicles in the auditory canal
Herpes zoster oticus/ramsay hunt syndrome treatment options (2)
- Corticosteroids
- acyclovir
Meniere’s disease
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
Meniere’s disease treatment (4)
- Low salt diet
- diuretics
- avoid caffeine, chocolate, red wine
- intratympanic gentamycin injections (permanent hearing loss)
Perilymphatic fistulas, diagnosis (1), treatment (1)
- 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
Labyrinthine concussion
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
Cogan syndrome and treatment (1)
- Rare autoimmune condition causing interstitial keratitis (dry red eyes) and vestibuloauditory dysfunction (vertigo, tinnitus, hearing loss) that comes and goes
- Systemic steroids
Familial bilateral vestibulopathy
Brief attacks of vertigo (seconds in duration) followed by progressive loss of peripheral vestibular function leading to imbalance
Vestibular schwannoma
Benign tumor of the 8th cranial nerve that can be seen on MRI that is a rare peripheral cause of vertigo
Vestibular migraines
Migraines that present with vertigo and often mimic meniere’s disease but respond to medications for migraines
Brainstem/cerebellar ischemia/infarction vertigo and 3 abnormal ocular motor findings
- Caused by embolic or atherosclerotic occlusion of vertebrobasilar arterial system
- spontaneous nystagmus purely vertical/horizontal/torsional, ataxia toward size of lesion, other neurological findings
Wallenberg CVA
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
Horner syndome and its triad of presentation
Interruption of sympathetic nerve supply to eye characterized by
1) miosis
2) partial ptosis
3) anhidrosis (loss of hemifacial sweating
___ type vertigo is made worse by head movement
All types
Following a CVA, reflexes are ___ immediately but few days after become ____
hyporeflexive, hyperreflexive
Treatment for vertigo options (3)
- Antivert (meclizine) 25-50mg TID
- Corticosteroids
- Phenothiazine antiemetics
