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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