Vestibular Conditions Flashcards
What is BPPV?
Benign Paroxysmal Positional Vertigo is a vestibular disorder thats is primarily idiopathic but can also result from head trauma. Believed to be age related and associated with degeneration of the inner ear. It is the most common cause of dizziness.
What are typical symptoms of BPPV?
Vertigo (abnormal sensation of movement of the world or self) that is typically brief (<1min). Additional symptoms that may last hours include nausea, vomiting, imbalance, light headedness, falls/fear of falling, anxiety, blurred vision, headache, neck pain and decreased activity levels.
Note: do not get hearing loss or tinnitus.
What are common triggers of BPPV?
Getting in or out of bed Rolling over in bed Bending over Looking up Washing hair in the shower Looking down Climbing up and down ladders Standing up suddenly
What is the incidence of BPPV?
10% of the population will experience BPPV by 80 years of age. Incidence increase as we age. Within elderly population, undiagnosed BPPV was found in 9%.
What assessments can be used to determine if a pt has BPPV?
Dix-Hallpike test, roll test, cervical spine ROM, SF36 QOL questionnaire
How do you treat BPPV?
If posterior canal - epley’s manoeuvre.
If horizontal canal - BBQ roll.
Balance and Vestibular rehabilitation therapy.
What are the types of BPPV?
Canalithesis (most common) is when the otoconia (crystals) are in the canal. During manoeuvres, nystagmus is delayed in onset and goes away after 20-30 seconds.
The other type is Cupulolithesis. When the otoconia is inside the cupula - results in immediate nystagmus and will not ease until pt moves from their position.
What are some vestibular conditions that cause dizziness?
BPPV, Vestibular neuritis, labrynthitis, Meniere syndrome (disorder of inner ear).
What are some central conditions that cause dizziness?
Vertebro-basilar insufficiency, stroke, MS, vestibular migraine, degenerative cerebellar ataxia.
What are some non-vestibular conditions that cause dizziness?
Cervicogenic vertigo, cardiac arrythmia, orthostatic hypotension, panic attack
How can you differentiate between BPPV and VBI?
BPPV - positive dix-hallpike test/roll test, nystagmus onset by position and fatiguable. Vertigo explanation of dizziness. Nystagmus does not change direction. Impaired VOR upon head thrust test.
VBI - through passive rotation of neck - non-fatiguing nystagmus. Not positional with insidious dizziness.
What are some red flags for someone experiencing dizziness?
Nystagmus that changes direction Down beating nystagmus Oscillopsia (vision problem where still objects appear to jump, vibrate or jiggle) when the head is still (indicative of MS) Oily taste in throat (CSF leak) Constant severe headaches VBI - 5 D's and 3 N's
