Info
🌱 來自: Huppert’s Notes
Vertigo🚧 施工中
Vertigo
• Physical exam: Perform a cranial nerve exam and a HINTS exam (Head-Impulse, Nystagmus, Test of Skew); perform an otoscopic exam and assess for hearing loss; evaluate the patient’s gait; perform the Dix-Hallpike maneuver
• Differential diagnosis:
Peripheral causes
- Benign paroxysmal positional vertigo (BPPV)
• Symptoms: Dizziness triggered by changing head position, usually intermittent and brief episodes
• Physical exam: Positive Dix-Hallpike maneuver
• Diagnosis: Clinical diagnosis (no specific labs/imaging required)
• Treatment: Epley maneuver
- Meniere’s disease
• Symptoms: Ear fullness, tinnitus, unilateral hearing loss. Most patients cycle between periods with active symptoms followed by prolonged remissions.
• Pathogenesis: Excess fluid buildup in the endolymphatic spaces of the inner ear; the exact mechanism is not entirely clear
• Physical exam: Nystagmus during the acute attack
• Diagnosis: Clinical diagnosis (no specific labs/imaging required)
• Treatment:
- Avoid substances that cause increased endolymphatic retention (e.g., salt, alcohol, caffeine, nicotine)
- Consider a trial of a thiazide diuretic
- Provide symptomatic relief with meclizine or a scopolamine patch (avoid in the elderly given anticholinergic side effects)
• Complications: Refractory symptoms may require ENT referral to consider surgical interventions
- Acute vestibular neuritis
- Otosclerosis
Central causes
- Vestibular migraine
- Posterior circulation TIA/stroke (isolated vertigo from a TIA or stoke is very rare)
- Medication-induced