vertigo

Question 1

what are the types of vertigo?

Answer 1

BPPV
meniere’s
vestibular neuritis
migraine associated vertigo

Question 2

what is key to identifying which type of vertigo?

Answer 2

duration of episodes

Question 3

how long does does BPPV last?

Answer 3

seconds

Question 4

how long does meniere’s last?

Answer 4

hours

Question 5

how long does vestibular neuritis last?

Answer 5

days-weeks

Question 6

how long does migraine associated vertigo last?

Answer 6

days-weeks

Question 7

dizziness rolling over in bed indicates..?

Answer 7

BPPV

Question 8

first attack severe, lasting hours with nausea & vomiting indicates…?

Answer 8

vestibular neuritis

Question 9

light-sensitivity during dizzy spells indicates…?

Answer 9

vestibular migraine

Question 10

if one ear feels fully or you notice a change to your hearing (or tinnitus) around the time of the dizzy spell indicates…?

Answer 10

meniere’s disease

Question 11

what is benign positional paroxysmal vertigo?

Answer 11

vertigo caused by the presence of otoliths (calcium carbonate crystals) in the semi-circular canal instead of the utricle

• most common cause of vertigo on looking up

Question 12

what can cause benign positional paroxysmal vertigo (BPPV) ?

Answer 12

head trauma
ear surgery
idiopathic

Question 13

once in the canal movement of a patients head (with BPPV) will result in what?

Answer 13

movement of the otoliths causing an abnormal movement of endolymph which results in vertigo

Question 14

when does vertigo occur in patients with BPPV?

Answer 14

looking up

turning in bed - often worse to one side

first lying down in bed at night

GETTING OUT OF BED IN THE MORNING

bending forward

rising from bending

moving head quickly - often only in one direction

attacks will last seconds

Question 15

what are the other symptoms of BPPV (other than dizziness) ?

Answer 15

nausea and vomiting
nystagmus (rapid uncontrolled eye movements)

Question 16

what is the diagnostic examination for BPPV?

Answer 16

the Dix-hallpike manoeuvre

patient turns head 45 degrees
is rapidly laid back with the head extending 20-30 degrees below horizontal, hanging slightly over the edge

checks for nystagmus (involuntary eye movement) and vertigo, which indicates the affected ear.

Question 17

what in a BPPV positive patient will the dix-hall pike manoeuvre show?

Answer 17

rotatory geotropic nystagmus

Question 18

what reposition manoeuvres are used to treat BPPV?

Answer 18

EPLEY manouvre

Selmont manoeuvre

brandt-daroff exercises

Question 19

what is labyrinthitis?

Answer 19

inflammation of the labyrinth

Question 20

what is vestibular neuritis?

Answer 20

inflammation of the vestibular nerve (CN VIII)

Question 21

what causes vestibular neuritis and labyrinthitis?

Answer 21

probably viral

• history of (acute) illness + vertigo in question

Question 22

how does vestibular neuritis and vestibular neuritis present?

Answer 22

first attack is severe - lasting Horus with N+V

prolonged vertigo (days)

may be viral symptoms e.g. malaise, headache, N+V

Question 23

what symptoms are labyrinthitis associated with (but not seen in vestibular neuritis) ?

Answer 23

tinnitus or hearing loss

Question 24

how to manage vestibular neuritis and labyrinthitis?

Answer 24

supportive management with vestibular sedatives - prochlorperazine

generally self-limiting

may require further investigation if prolonged or atypical, may be helped by rehab exercises

Question 25

what is vestibular migraine?

Answer 25

episode of vertigo in someone who has a history of migrates about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia

Question 26

how does vestibular migraines present?

Answer 26

light sensitivity during dizzy spells of variable duration phonophobia fluctuating hearing loss, acute permanent hearing loss occur in small no.s motion sensitivity with bouts of motion sickness

Question 27

what is phonophobia?

Answer 27

sensitivity to sound

Question 28

what is the management options for vestibular migraines?

Answer 28

- lifestyle modifications and finding then avoiding triggers - Pharmacology - abortive agents e.g. triptans, prophylaxis e.g. propanalol, amitriptyline

Question 29

what is Ménière's disease?

Answer 29

idiopathic disorder causing vertigo

Question 30

what is thought to be the cause of Ménière's disease?

Answer 30

excess of endolymph within the membranous labrynth - symptoms result from an increase in endolymphatic pressure due to dysfunctioning sodium channels

Question 31

what triad of symptoms is associated with a meneier's disease attack?

Answer 31

recurrent episodic vertigo (severe paroxysmal) sensorineural hearing loss tinnitus (changing in hearing during dizzy spell)

Question 32

what is the vertigo like in meniere's disease?

Answer 32

recurrent, spontaneous, rotational vertigo with at least 2 episodes > 20 (often lasting hours)

Question 33

in Ménière's disease there is a sensation of ear being what?

Answer 33

full!

Question 34

what are the supportive treatments for during Ménière's disease episodes?

Answer 34

Prochlorperazine for acute attacks, betahistine for prevention

Question 35

what are the other managements for Ménière's disease ?

Answer 35

- Tinnitus therapy - Hearing aids - Lifestyle advice - reducing salt, avoiding chocolate and caffeine, avoiding stress - There are some medical, injected and surgical options but not much evidence to support effectiveness

Question 36

what is vertebrobasilar insufficiency?

Answer 36

a temporary set of symptoms due to ischaemia in the posterior circulation of the brain

Question 37

what causes vertebrobasilar insufficiency ?

Answer 37

narrowing of the posterior circulation arteries, most commonly due to arteriosclerosis

Question 38

how does vertebrobasilar insufficiency present?

Answer 38

- Causes vertigo on looking up - For diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo - Visual disturbance - Weakness - Numbness