Peripheral vertigo

Summary

This video script delves into peripheral vertigo, a condition stemming from inner ear vestibular system issues. It distinguishes peripheral vertigo from central vertigo, caused by central nervous system problems. The script explains various causes of peripheral vertigo, including Benign Paroxysmal Positional Vertigo (BPPV), Meniere's disease, labyrinthitis, and other less common conditions. It outlines symptoms, diagnosis methods, and treatments for each, emphasizing the importance of identifying the specific cause to provide effective care.

Takeaways

• 🌀 Peripheral vertigo is caused by issues with the vestibular system in the inner ear, specifically the semicircular canals.
• 🔍 Central vertigo, in contrast, is caused by problems within the central nervous system and is not the focus of this script.
• 💡 The vestibulocochlear nerve (cranial nerve eight) connects the semicircular canals to the central nervous system and can be a source of vertigo.
• 👂 Dizziness can have various meanings for patients, with 'vertigo' referring to a spinning sensation or false sense of motion.
• 🏥 Benign Paroxysmal Positional Vertigo (BPPV) is often caused by displaced otoconia in the semicircular canals, leading to brief, head movement-triggered episodes of vertigo.
• 🌪 Meniere's disease involves increased volume or pressure of endolymph in the semicircular canals, causing episodes of vertigo lasting up to 24 hours, along with hearing loss and tinnitus.
• 🔥 Labyrinthitis is an inflammation of the vestibular nerve, often resulting from a viral infection, and presents with acute vertigo, nausea, and hearing loss.
• 🦠 Ramsay Hunt syndrome, or Herpes Zoster Oticus, is caused by the reactivation of the latent herpes zoster virus, affecting the facial nerve and causing facial pain, paralysis, and a rash.
• 🛡 Perilymphatic fistula and semicircular canal dehiscence syndrome are caused by trauma to the inner ear, leading to leakage of perilymph and symptoms triggered by pressure changes.
• 👁 Kogen syndrome is thought to be an autoimmune condition affecting the eye and causing episodes of hearing loss, vertigo, and vision changes.
• 💊 Aminoglycoside toxicity can cause bilateral vestibular damage, potentially leading to disequilibrium or oscillopsia but not necessarily vertigo due to the lack of conflicting inputs.

Q & A

What is peripheral vertigo?

Peripheral vertigo refers to a sensation of dizziness or spinning caused by a problem with the vestibular system in the inner ear, specifically the semicircular canals, which are crucial for maintaining balance.

What is the difference between peripheral vertigo and central vertigo?

Peripheral vertigo is caused by issues within the inner ear's vestibular system, while central vertigo is caused by problems in the central nervous system, often related to the brain or brainstem.

What is the vestibulocochlear nerve, and what is its role in vertigo?

The vestibulocochlear nerve, also known as cranial nerve eight, connects the inner ear's semicircular canals and cochlea to the central nervous system. Problems with this nerve can lead to vertigo due to disruptions in balance and hearing signals.

What is the definition of vertigo according to the script?

Vertigo is defined as a spinning sensation or a false sense of motion, which patients may describe when experiencing this condition. It is one of several meanings that patients might attribute to the term 'dizziness.'

What are the typical symptoms of Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV symptoms include brief, reproducible episodes of vertigo, rotary nystagmus, and nausea, triggered by head movements and typically lasting seconds to about a minute.

How is BPPV diagnosed and treated?

BPPV is diagnosed clinically, often with the Dix-Hallpike maneuver to trigger nystagmus. Treatment involves the Epley maneuver, a canalith repositioning procedure, and sometimes antihistamines to manage symptoms.

What is Meniere's disease and how is it diagnosed?

Meniere's disease is characterized by increased volume or pressure of endolymph in the semicircular canals, leading to episodes of vertigo, hearing loss, and tinnitus. Diagnosis involves clinical assessment and may include Weber and Rinne tests, as well as regular audiometry.

What are the symptoms of Labyrinthitis?

Labyrinthitis symptoms include acute episodes of vertigo, nausea, vomiting, hearing loss, gait instability, and can last up to several days. It is often associated with a viral or post-viral process.

How is the diagnosis of Labyrinthitis confirmed?

Labyrinthitis is diagnosed through an abnormal head thrust test and by ruling out other causes of vertigo with brain imaging, such as pontine stroke, tumors, cerebellar hemorrhage, or infarction.

What is the treatment for Labyrinthitis?

Treatment for Labyrinthitis involves the use of steroids, ideally given within 72 hours of symptom onset, and antihistamines like meclizine for acute relief of vertigo.

What is the difference between peripheral and central causes of vertigo in terms of diagnosis and treatment?

Peripheral vertigo is diagnosed based on symptoms related to the inner ear and treated with maneuvers like the Epley for BPPV or lifestyle changes and medication for Meniere's disease. Central vertigo requires brain imaging to diagnose issues like stroke or tumors and is treated based on the underlying cause.

What is the role of the Epley maneuver in treating BPPV?

The Epley maneuver is a series of head movements designed to reposition the displaced crystalline deposits, or otoconia, in the semicircular canals, thereby alleviating the vertigo symptoms associated with BPPV.

What are the typical symptoms of Herpes Zoster Oticus (Ramsay Hunt Syndrome)?

Herpes Zoster Oticus presents with ipsilateral facial pain, facial paralysis, a dermatomal vesicular rash in the external auditory canal, and may also include auditory or vestibular problems such as tinnitus, hyperacusis, vertigo, and nausea.

How is a Perilymphatic Fistula diagnosed?

A Perilymphatic Fistula can be diagnosed clinically with symptoms of progressive sensorineural hearing loss and episodic vertigo triggered by pressure changes. A CT scan may also reveal fluid around the round window, indicating a fistula.

What is the treatment for a Perilymphatic Fistula?

Treatment for a Perilymphatic Fistula starts conservatively with bed rest, head elevation, and limiting activities that increase inner ear pressure. If persistent, surgical patching of the broken otic capsule may be required.

What is the significance of the Tulio phenomenon in the context of a Perilymphatic Fistula?

The Tulio phenomenon is significant as it can induce nystagmus by clapping or playing a loud noise in the ear, which is a result of a high-pressure sound wave transmitted into the vestibular system, indicating a possible fistula.

What is Aminoglycoside toxicity and how does it affect the vestibular system?

Aminoglycoside toxicity refers to damage caused by gentamicin and other aminoglycosides to the vestibular system. It can cause bilateral vestibular damage, potentially leading to disequilibrium or oscillopsia, but not necessarily vertigo due to the lack of conflicting inputs from both sides.