Vertigo

Peripheral Causes

100

Caused by canalithiasis -- calcium debris within the posterior semicircular canal

What is benign paroxysmal positional vertigo?

200

This pathology is due to excess endolymphatic fluid pressure that causes episodic inner ear dysfunction

What is Ménière's disease?

300

This peripheral cause of vertigo is believed to be a viral or postviral inflammatory disorder. It affects the vestibular portion of the eighth cranial nerve.

What is vestibular neuritis?

400

A neoplastic cause of vertigo

What is a vestibular schwannoma?

500

This syndrome is believed to represent activation of latent herpes zoster infection of the geniculate ganglion. It is also known as Ramsay Hunt syndrome.

What is herpes zoster oticus?

Central Causes

100

This central cause is due to an occlusion of the ipsilateral vertebral artery

What is Wallenberg's syndrome?

200

This cause typically occurs in older patients (>60 years) and in those who have risk factors such as hypertension and diabetes

What is a cerebellar hemorrhage or infarction?

300

This demyelinating disease causes vertigo in 20% of patients.

What is multiple sclerosis?

400

In this congenital anomaly, the cerebellar tonsils extend below the foramen magnum.

What is a Chiari I malformation?

500

This condition is triggered by passive motion, including water travel, air travel, land travel, flight simulators, water beds, or video games.

What is disembarkment (mal de debarquement) syndrome?

Clinical Presentation of Peripheral Causes

100

Presents with - Rapid onset of severe, persistent vertigo - Rapid onset of nausea and vomiting - Spontaneous vestibular nystagmus - Gait instability, but able to ambulate - Severe sxs last for 1-2 days; followed by gradual resolution

What is vestibular neuritis?

200

Presents with - Brief spinning sensation brought on when turning in bed or tilting the head backward - Dizziness is brief (usually seconds; rarely minutes) - Nausea; rarely vomiting - No ear pain, hearing loss, or tinnitus

What is benign paroxysmal positional vertigo?

300

Presents as - CNS has compensated for subtle imbalances in vestibular input - Imbalance - Vague feeling of swaying or tilting - Unilateral hearing loss or tinnitus

What is a vestibular schwannoma?

400

Presents with - Spontaneous, episodic, severe vertigo - Vertigo lasts minutes to hours; disequilibrium may last for several days - Often associated with unilateral tinnitus, hearing loss, and ear fullness - Nausea, vomiting, and disabling imbalance. - Horizontal-torsional nystagmus - Sensorineural hearing loss - Exacerbations may last for months - years with episodes every few days - Can go into remission spontaneously or with treatment - Can recur

What is Ménière's disease?

500

Presents with - No hearing loss - No vertigo (both vestibular end organs are equally affected) - May experience oscillopsia, a to-and-fro illusion of environmental motion

What is aminoglycoside toxicity?

Clinical Presentation of Central Causes

100

Present as - Usually asymptomatic - May have a constellation of neurologic deficits (headache, neck pain, weakness, dysphagia, and other lower cranial nerve impairments) - Positionally-induced Vertigo and gait imbalance - Downbeating nystagmus or other patterns of central nystagmus

What is a Chiari I malformation?

200

Presents with - Vertigo - Abnormal eye movements - Ipsilateral Horner's syndrome - Ipsilateral limb ataxia - Dissociated sensory loss (loss of pain and temperature sensation on the ipsilateral face and contralateral trunk) - Hoarseness and dysphagia are often present.

What is Wallenberg's syndrome?

300

Presents with - Sudden, intense vertigo accompanied by nausea and vomiting - Limb ataxia may be present, but is often absent - Pt falls toward the side of the lesion - Nystagmus is more pronounced to the side of the lesion - Gait impaired

What is a cerebellar hemorrhage or infarction?

400

Presentation of vertigo may be associated with symptoms reflecting dysfunction of adjacent cranial nerves (facial numbness, diplopia, etc.)

What is multiple sclerosis?

500

Presentation - Pts describe a sense of swaying or rocking, or walking on uneven ground. - No nausea - Normal physical exam - Typically lasts several minutes or a few hours. May last 1-2 days - Persisent/disabling sxs may uncommonly last for weeks to years

What is disembarkment (mal de debarquement) syndrome?