Here, we have vestibular neuronitis.
An acute unilateral
No evidence of inflammation.
Sudden or spontaneous vertigo
associated with nausea and vomiting.
Symptoms will peak within 24 hours.
Resolves over days or weeks.
And unilateral nystagmus may be seen.
It can be suppressed
by visual fixation.
That’s the clinical pearl here.
It can be suppressed by
actual visual fixation.
This is known as your
What is labyrinthine concussion?
It’s a head injury in which maybe perhaps
there was or wasn’t a skull fracture.
Maybe associated with
hearing loss and tinnitus.
If there’s a problem with
the vertebrobasilar system
including your posterior
inferior cerebellar artery,
or maybe perhaps even your
spinal cerebral artery.
Associated with brainstem signs
including cranial nerve,
and we have weakness, ataxia.
The central-type nystagmus:
Pure vertical or pure
horizontal, may be bilateral.
Are not suppressed by visual fixation.
That’s important for you to pay
attention to here once again.
Not suppressed by visual fixation.
This is the central type of nystagmus.
What is Ménière's disease?
Episodic vertigo with
nausea and vomiting.
progressive hearing loss.
Tinnitus and sensation
of fullness in the ear,
your clinical pearl here
is fullness in the ear
and caused by increased endolymphatic
volume or perhaps pressure.
As the name implies, a fistula.
Abrupt onset of vertigo
which then persists episodically.
Often precedes by hearing a pop
in the affected ear with sneezing,
coughing, or blowing or straining.
A fistula, a perilymphatic, can be treated
with rest or a fat patch if refractory.
Pop, perilymphatic, if that helps you.
BPPV, benign positional
This is episodic vertigo, however,
triggered by head movement.
Episodes are brief, but severe.
Associated with latency,
finite duration and fatigue.
Often associated with
severe nausea and vomiting
caused by floating calcium carbonate
crystals in the endolymph.
Pathology here, calcium carbonate
actually floating in your endolymph.
Characteristic downbeating torsional
nystagmus on Dix-Hallpike testing.
Downbeating torsional nystagmus.
It can be rapidly treated with what’s known
as your Epley repositioning maneuver.
Here, what we have known as benign
positional paroxysmal vertigo.
So what is the Dix-Hallpike
or Epley maneuver?
Well, what you’re looking at here
is a patient that was sitting up.
And then you’re going to have
them lay down in supine position.
I’m having you move from left to right.
And as you do so,
you’ll notice here the degree of changes
that are taking place with each position.
The first picture on your left, the
patient is sitting straight up,
the patient next is then moving
back to a 45-degree angle.
The patient after that is moved
down to a 90-degree angle.
The patient now has then
turned over to the side,
maintaining that 90-degree angle
and the patient is able to
get back up or sit back up.
All this is referred to as being
your Dix-Hallpike or Epley maneuver.
And this is in reference to a
diagnosis that we just discussed
known as your benign positional
paroxysmal vertigo, BPPV.
What are pearls for vertigo?
Tinnitus and hearing loss
accompanied peripheral vertigo.
Diplopia, dysarthria, and other brainstem
signs point to a central cause.
Isolated vertigo is almost never
caused by brainstem ischemia.
And BPPV, your benign
positional paroxysmal vertigo,
is the most common cause
of new onset vertigo.
And I just walked you
through the Epley maneuver.