00:00
Here, we have vestibular neuronitis.
00:03
An acute unilateral
peripheral vestibulopathy.
00:07
No evidence of inflammation.
00:09
Sudden or spontaneous vertigo
associated with nausea and vomiting.
00:13
Symptoms will peak within 24 hours.
00:16
Resolves over days or weeks.
00:18
And unilateral nystagmus may be seen.
00:20
It can be suppressed
by visual fixation.
00:24
That’s the clinical pearl here.
00:26
It can be suppressed by
actual visual fixation.
00:29
This is known as your
vestibular neuronitis.
00:32
What is labyrinthine concussion?
It’s a head injury in which maybe perhaps
there was or wasn’t a skull fracture.
00:41
Maybe associated with
hearing loss and tinnitus.
00:45
Infarction:
If there’s a problem with
the vertebrobasilar system
including your posterior
inferior cerebellar artery,
anterior inferior
cerebellar artery,
or maybe perhaps even your
superior cerebellar artery.
00:58
Associated with brainstem signs
including cranial nerve,
and we have weakness, ataxia.
01:04
The central-type nystagmus:
Pure vertical or pure
horizontal, may be bilateral.
01:11
Are not suppressed by visual fixation.
01:14
That’s important for you to pay
attention to here once again.
01:16
Not suppressed by visual fixation.
01:19
This is the central type of nystagmus.
01:22
What is Ménière's disease?
Episodic vertigo with
nausea and vomiting.
01:28
Fluctuating, but
progressive hearing loss.
01:32
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.
01:43
Ménière's disease.
01:46
Perilymphatic fistula:
As the name implies, a fistula.
01:51
Where?
Abrupt onset of vertigo
then persists episodically.
01:58
Often precedes by hearing a pop
in the affected ear with sneezing,
coughing, or blowing or straining.
02:06
A fistula, a perilymphatic, can be treated
with rest or a fat patch if refractory.
02:13
Pop, perilymphatic, if that helps you.
02:18
BPPV, benign positional
paroxysmal vertigo.
02:23
This is episodic vertigo, however,
triggered by head movement.
02:27
Episodes are brief, but severe.
02:29
Associated with latency,
finite duration and fatigue.
02:35
Often associated with
severe nausea and vomiting
caused by floating calcium carbonate
crystals in the endolymph.
02:42
Pathology here, calcium carbonate
actually floating in your endolymph.
02:47
Characteristic downbeating torsional
nystagmus on Dix-Hallpike testing.
02:55
Downbeating torsional nystagmus.
03:00
It can be rapidly treated with what’s known
as your Epley repositioning maneuver.
03:06
Here, what we have known as benign
positional paroxysmal vertigo.
03:11
So what is the Dix-Hallpike
or Epley maneuver?
The Dix-Hallpike maneuver can be done while examining a patient who doesn't have vertigo symptoms at rest.
03:20
It tests for canalithiasis (or calcium crystals) of the posterior semicircular canal,
which is the most common cause of BPPV (or positional vertigo).
03:29
It is performed by having the patient sit on the exam table, with their neck extended and turned 45 degrees to one side.
03:35
Instruct the patient to keep their eyes open, then help them to rapidly lie supine with their neck still extended
so that the head hangs over the edge of the table.
03:42
Observe for signs of nystagumus or symptoms of vertigo for 30 seconds.
03:46
Then have the sit up quickly again, observe for another 30 seconds for nystagmus.
03:51
If the test is not already positive, then repeat with the head turned into the opposite direction.
03:55
The eply mameuver can be taught to patients who are experiencing vertigo at home. They lie on their backs and tirn their head side to side as shown in this depiction.
04:01
They lie on their backs as shown in this picture, and turn their heads from side to side.
04:05
This helps to dislodge the crystals and move them out of the posterior canal.
04:08
What are pearls for vertigo?
Tinnitus and hearing loss
accompanied peripheral vertigo.
04:15
Diplopia, dysarthria, and other brainstem
signs point to a central cause.
04:22
Isolated vertigo is almost never
caused by brainstem ischemia.
04:27
And BPPV, benign
paroxysmal positional vertigo,
is the most common cause
of new onset vertigo.
04:36
And I just walked you
through the Epley maneuver.