Transcript Vertigo - Bradford VTS

Vertigo
Lawrence Pike
James Street Family
Practice
Definition
An illusion or hallucination of movement
which is usually rotation, either of
oneself or the environment
Major Causes in General
Practice
3 Major Causes:
Vestibular Neuronitis
Benign Positional Vertigo
Meniere’s
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Vestibular Neuronitis
Vestibular Neuronitis Features
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Commonly occurs on first awakening
Nausea is marked and almost universal
57% evidence or recent viral infection
Fine horizontal or rotatory nystagmus
Vestibular Neuronitis Course
• Attacks become sequentially shorter
and if not then consider another
diagnosis
• Vertigo symptoms usually resolve over
a few days as vestibular compensation
occurs
Vestibular Neuronitis Management
• Symptomatic treatment for first few days
only
• Vestibular drugs delay compensation
Vestibular Neuronitis Prognosis
• Excellent
• 5% progress to Benign Positional
Vertigo
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Benign Positional Vertigo
Benign Positional Vertigo Features
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Recurrent
Brought on by changes in head position
Episodes last seconds, never >5 mins
Onset late middle age usually
Females : Males = 2 : 1
Typically turning over in bed, bending
over and straightening, extending neck
Benign Positional Vertigo Management
• Vestibular sedatives should be avoided
where the vertigo becomes chronic as
they supress vestibular feedback crucial
for compensation and symptomatic
recovery
Benign Positional Vertigo Brandt-Daroff Exercises
• Simple repositioning exercises and are
appropriate for less severe BPV
• Complete relief within 3 to 14 days
Benign Positional Vertigo Brandt-Daroff Exercises
• Sit patient on couch with eyes closed
• Tilt whole upper body laterally towards
lesion until lateral aspect of occiput lies
on the bed. Maintain until vertigo
subsides
• Sit patient upright for 30 seconds
• Repeat on then other side and rest
head for 30 seconds
• Repeat every 3 hours during day
Menieres
Menieres - Features
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Hearing Loss
Tinnitus
Vertigo
Sensation of fullness or pressure in ear
Fluctuates and episodic, lasts hours
Unilateral
20-50 years Familial predisposition
Menieres - Course
• Progressive
• Early on predominant Vertigo with
Deafness but normal hearing between
• Later on hearing loss stops fluctuating
and becomes progressively worse
Menieres - Management
• Referral to ENT Specialist has been
recommended for every case of vertigo
and hearing loss to exclude acoustic
neuroma
• Betahistine with or without diuretic is
favoured current treatment
Vertigo Final Notes
• Vertigo with Diplopia is likely to be a
vascular event
• Vestibular sedatives are not
recommended on a prolonged basis for
any type of vertigo