Vertigo

FM

• Vertigo is the hallucination of movement of the environment around the patient, or of the patient with respect to the environment. It is not a fear of heights.
• Vertigo is not necessarily the same as dizziness.

Classification

• Vertigo may be classified as:
  • Central Vertigo - due to a brainstem or cerebellar disorder
  • Peripheral Vertigo - due to disorders of the inner ear or the vestibulocochlear (VIII^th) cranial nerve

Causes of Vertigo

Vertigo with Deafness

• Ménière’s disease
• Labyrinthitis
• Labyrinthine trauma
• Acoustic neuroma
• Acute cochleo-vestibular dysfunction
• Syphilis (rare)

Vertigo without Deafness

• Vestibular neuritis
• Benign positional vertigo (BPV)
• Acute vestibular dysfunction
• Medication e.g. aminoglycosides
• Cervical spondylosis
• Following flexion-extension injury

With Intracranial Signs

• Cerebellopontine angle tumour
• CVD: TIA / CVA
• Vertebro-basilar insufficiency and thromboembolism
• Brain tumor
• Migraine
• Multiple sclerosis

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ENT

Peripheral Vertigo

Attacks : sudden , severe, usually seconds or minutes Nystagmus: horizontorotatory, worsened by head position No neurologic findings

• BVP: Short livid, positional caused by stray otoconial particles Positive Hallpike test

• Meniere’s disease

  • Tennitus
  • Hearing loss
  • Attacks in clusters
  • Long symptom free intervals

• Vestibular neuronitis

  • Severe vertigo for days
  • Mild persistent positional vertigo
  • No auditory symptoms
  • Head thrust test +

Acoustic neuroma

• Peripheral cause that can become central vertigo hearing loss Tennitus

Central Vertigo

Attacks: gradual, mild usually continuous for weeks and months but can be sudden, severe  and seconds or minutes with vascular causes

1. Nystagmus: usually vertical and downbeat
2. Little change with head position
3. Neurologic findings usually present

• Cerebellar hemorrhage
• Hypoglycemia
• Head Truama
• Multiple Sclerosis
• Vertebrobasilar migraine
• Vertebrobasilar insufficiency; Associated with neurological abnormalities

Labyrinthitis

Acute suppurative - Toxic patient - Severe vertigo

Serous: - Inflammatory response to nearby infections

Toxic - Hearing loss - Tennitus

Chronic - Symptoms secondary to fistula