Vestibular Neuritis Flashcards
Vestibular neuritis is a condition that affects the vestibular nerve, which connects the inner ear to the brain. What is the Incidence of this?
1 - 400 cases per 100,000
2 - 40 cases per 100,000
3 - 4 cases per 100,000
4 - 0.4 cases per 100,000
3 - 4 cases per 100,000
Affects men an women equally
Vestibular neuritis is a condition that affects the vestibular nerve, which connects the inner ear to the brain. What age does incidence typically peak?
1 - 60-70
2 - 40-50
3 - 20-30
4 - 10-20
2 - 40-50
Which of the following is NOT a component of the vestibular system?
1 - cochlea nerve
2 - vestibular nerve
3 - semi-circular canals
4 - otolith organs (utricle and saccule)
1 - cochlea nerve
Semi-circular canals = head rotation
Sacule = linear motion (gravity)
Utricle = horizontal motion
What is the most common cause of Vestibular neuritis?
1 - bacterial infection
2 - trauma
3 - viral infection
4 - idiopathic
3 - viral infection
Herpesviruses, such as herpes simplex virus (HSV) and varicella-zoster virus (VZV) are common
Upper respiratory tract infections
Causes inflammation of the vestibular nerve
Patients with vestibular neuritis typically present with all of the following, EXCEPT which one?
1 - diplopia
2 - sudden onset vertigo
3 - imbalance
4 - nystagmus
5 - nausea and vomiting
1 - diplopia
Patients often report a sense of unsteadiness or imbalance, which may lead to difficulties walking or performing daily activities.
Patients with vestibular neuritis typically present with:
- sudden onset vertigo
- imbalance
- nystagmus
- nausea and vomiting
Hearing loss is not normal, but if hearing loss does occur, what is this called?
1 - menieres disease
2 - labyrinthitis
3 - otitis media with effusion
4 - cholestaemia
2 - labyrinthitis
This is because the whole labyrinths system is likely to be involved
Patients with vestibular neuritis typically present with sudden onset of vertigo. How long does this typically last for?
1 - minutes to hours
2 - hours to days
3 - days to weeks
4 - years
3 - days to weeks
Can vary, but typically can last days to weeks.
Symptoms are more severe in first few days
Once a patient has developed vestibular neuritis they will have sudden onset of vertigo that is most severe in the first few days. Does this remain constant after the first few days?
- No
Typically triggered, or worsened by head movement
Patients with vestibular neuritis can present with nystagmus. Is this unidirectional, bidirectional or vertical?
- unilateral
Everything else would suggest a central issue instead of a vestibular nerve issue
Do patients with vestibular neuritis typically experience tinnitus or hearing loss?
- no
Cochlea is unaffected so they dont experience these symptoms
The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):
1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right
If they are able to maintain a fixed gaze, this is called a corrective saccade. If the patient is able to maintain their gaze on your nose is this a central or peripheral problem?
- central
- indicates that the vestibulocochlear nerve is NOT damaged
The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):
1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right
If they are unable to maintain a fixed gaze, this is called a corrective saccade. Is this a central or peripheral problem?
- peripheral
Suggests that there is an issue with vestibulocochlear
Both vestibular neuritis and labyrinthitis will cause a corrective saccade.
The 1st part of head impulse, nystagmus and test of skew (HINTS) is the head impulse test (HIT). If the patient is unable to maintain a fixed gaze, this is called a corrective saccade. suggesting a peripheral problem. Does this occur in both directions or just one?
- unilateral only
The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). Which of the following are true about the nystagmus aspect of the HINTS examination?
1 - unidirectional nystagmus is more likely to be of peripheral origin
2 - change in nystagmus direction is likely to be associated with central pathologies
3 - bidirectional nystagmus, is highly specific for stroke
4 - all of the above
4 - all of the above
The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a unidirectional nystagmus, and its always in the same direction, is this due to a peripheral or central cause?
- peripheral
Indicates vestibulocochlear issue
The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a bidirectional or vertical nystagmus, and its always in the same direction, is this due to a peripheral or central cause?
- central cause
bidirectional nystagmus, is highly specific for stroke
If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:
1st part = corrective saccade
2nd part = unidirectional nystagmus
3rd part = normal test of skew
Is this a central or peripheral issue?
- peripheral
Most likely vestibular neuritis and patient can be discharged
If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:
1st part = normal reflex
2nd part = vertical/bidirectional nystagmus
3rd part = abnormal test of skew
Is this a central or peripheral issue?
- central
More serious issue and needs more investigations
Which 2 of the following present in a similar way to vestibular neuritis, but also have tinnitus and hearing loss associated with them?
1 - labyrinthitis
2 - migraine
3 - optic neuritis
4 - menieres disease
1 - labyrinthitis
4 - menieres disease
Which of the following patients may need admission with vestibular neuritis?
1 - severe vertigo and imbalance
2 - severe nausea and vomiting
3 - diplopia associated with vertigo
4 - all of the above
2 - severe nausea and vomiting
May cause AKI and need fluids
Patients with vestibular neuritis can be treated with all of the following, EXCEPT which one?
1 - metoclopramide
2 - cyclizine
3 - cinnarizine
4 - promethazine
1 - metoclopramide
All others are H1 receptor blocker antihistamines
Use for 3 days, as longer may worse the recovery
Patients with vestibular neuritis can be treated with which of the following?
1 - Haloperidol
2 - Chlorpromazine,
3 - Prochlorperazine
4 - Olanzapine,
3 - Prochlorperazine
Typical anti-psychotic
Use for 3 days, as longer may worse the recovery
When should patients with vestibular neuritis be referred to an ENT/neurology specialist?
1 - severe vertigo and imbalance
2 - severe nausea and vomiting
3 - diplopia associated with vertigo
4 - no improvement in symptoms after 1 week
4 - no improvement in symptoms after 1 week
Which of the following is most likely to develop following vestibular neuritis?
1 - labyrinthitis
2 - migraine
3 - benign paroxysmal positional vertigo
4 - menieres disease
3 - benign paroxysmal positional vertigo
A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms. How long do the vertigo symptoms typically last?
1 - seconds to minutes
2 - minutes to hours
3 - hours to days
4 - days to weeks
2 - minutes to hours
A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. Patients that experience vestibular migraine are also likely to experience which of the following?
1 - Headaches/history of migraines
2 - Visual aura
3 - Photophobia/phonophobia
4 - all of the above
4 - all of the above
Triggers include visual overload like travelling in a car, traffic lights etc..
A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. What is the key way to differentiate this from menieres disease?
1 - lack of dizziness beyond 5 minutes
2 - female gender
3 - lack of otological symptoms
4 - history of ear infections
3 - lack of otological symptoms
A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. Which of the following can be used to treat this?
1 - avoid excess caffeine
2 - avoid excess chocolate
3 - drink plenty of fluids
4 - reduce stress
5 - good sleep hygiene
6 - all of the above
6 - all of the above
Can also be treated in a similar manner to migraines
