Vertigo (see CKS for central vs periph etc)

Question 1

Central vs peripheral

Answer 1

-central-
Persis, LT. new headache. Focal neurology. LT sev imbal. Central nystagmus (any direc, not stop, can indic brain tum). NV usually LESS sev. Hearing us ok. Tinnitus uncomm.
-peripheral (vestibular)- often sev. Maybe naus, vom, hear loss, tinnitus, nystag.

Question 2

History Qs

Answer 2

Hear loss
Tinnitus
Triggers
NV
Other feats eg pianic, loss reality, loss mem.
How long lasts- secs then BPV, hours migraine. Days likely central eg CN VIII, brainstem vestib nuc, cerebellum, VS tract.

Question 3

Menieres

Dilatat of endolymphatic spaces of membranous labyrinth.

Answer 3

Triad- vertigo, tinnitus, prog sensorineural hear loss. Prostration, NV.
Also ear fullness.
RECURRENT vertigo lasting MORE THAN seconds eg up to 12hrs. Attacks in clusters.
Refer to ENT if new diag to rule out eg acoustic neuroma.
Anx worsens symps so ? SSRI
Tx- cyclizine, prochloperazine, betahistine, no driving dur attack, ?decomp inner ear eg grommet.
Surg decomp saccus endolymphaticus. Labyrinthectomy but causes deafness. Vestib neurectomy. Transtympanic instillat of ototox drugs.

Question 4

Sudden onset vertigo and continuous since.

Vestibular neuronitis or labyrinthitis

Answer 4

-vestibular neuronitis-
Balance affected. Sudd vertigo. Vom. Prostration worse with head movem. Fine horiz nystagmus, stops when focus.
Folows febrile illness.
Tx- self restore ventually. No driving and bed rest dur attack. Buccal prochlorperazine, oral if less sev. Cyclizine, methylprednisolone. No more then 1 wk tx as prolongs recovery. Follow up if not impr.
-labyrinthitis-
Vertigo plus tinnitus plus nystagmus plus vertigo.
Tx- admit In case acute isch of labyrinth or brainstem. Tx within 12hr can restore hearing.

Question 5

Freq vertigo for few secs- BPV

Answer 5

No NV. Symps when turn over in bed, sudd rotat vertido, under 30 sec. No hear loss, no tinnitus. Normal at rest.
-causes- otolith displ in endolymph of semi circ canals. Due to head inj, mid ear dis, idio, otosclerosis, labyrinth degen, post viral, stapes surg.
Ix- dix hallpike test (tip backw, head to 30 deg over bed, delayed/latent nystagmus which is unidirec and settles fast.
Tx- us self lim in mnths. Physio, reass. Betahistine, prochlorperazine, antiD. epleys manouvre to move otoliths away from post canals. V effec. Sleep upright for 48hr after. Not drive immed after.

Question 6

Causes

Answer 6

-periph-
Menieres, BPV, vestibular fail, labyrinthitis.
-central-
Acoustic neuroma, MS, head inj, inner ear syphillis, vertebrobasilar insuff.
-drugs-
Gentamicin, diuretics, co trimoxazole, metronidazole.
-other-
Cholesteatoma, trauma.

Question 7

ix

Answer 7

Otoscopy
CN exam
Nystag, gait, rhombergs. 
Cerebellar func and reflexes. 
Unterbergers. 
Hallpike manouvre head turned 30 deg side, then lower to 30 deg under bed. Ask dizziness and look for nystag- means likely periph (BPV). 
Audiometry. 
CT, MRI, EEG, LP.