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Vertigo (Diagnosis (History (DH Current meds (ototoxics) Allergies, FH …
Vertigo
Diagnosis
Examination
ENT
Ear: signs of trauma/infection
Hallpike manouvre (provocation for BPPV)
Neurological
CNs: nystagmus, facial palsy, hearing loss
Upper/lower limb: weakness, parasthesia, gait, Romberg's
Cerebellar: function, reflexes
Fundoscopy
Investigations
Bloods
FBC, U+E, LFT (baseline)
Imaging
CT/MRI head (SOL)
Bedside
Obs (sats, RR, HR, BP, temp)
Special tests
Audiometry (hearing loss)
Electronystagmomograpgy
History
DH
Current meds (ototoxics)
Allergies
FH
ENT disease
PMH
Previous episodes
ENT problems, known conditions
Previous surgery
SH
Occupation, social support,
smoking, alcohol
PC/HPC
Vertigo (onset, character, timing, associated
symptoms, exacerbating/relieving factors)
Recent URTI or head trauma
Other symptoms e.g. ear pain, tinnitus, hearing loss,
N+V, headache, weakness, visual disturbance, swallowing, aura
Complications
Adverse QoL
Employment, driving
Falls
Increased
Psychological
Anxiety, depression
Definition
Vertigo
Sensation that self or world around
you is spinning/rotating in absence
of physical movement
Dizziness
Non-specific term encompassing
vertigo, pre-syncope,
disequilibrium, light-headedness
Pathophysiology
Peripheral (vestibular)
Caused by pathology in the ear
Often severe symptoms
Central
Less common cause
Pathology in the CNS
Less severe vertigo
Aetiology
Peripheral
Idiopathic
BPPV
Meniere's
Infection/inflammation
Vestibular neuronitis
Labyrinthitis
Syphilis
Trauma
BPPV
Meniere's
Labyrinthine concussion
Perilymph fistula
Drugs
Vestibular ototoxicity
Central
Vascular
Migraine (commonest)
Stroke/TIA
Vertebrobasilar insufficiency
Neoplastic
Acoustic neuroma
Cerebral tumour
Autoimmune
MS
Trauma
Head injury
Clinical
presentation
Sensation of
spinning/rotation