| OCR Text |
Show Acute Vestibular Syndrome (>24 hours) Episodic Spontaneous Vestibular Syndrome Vestibular Conditions to Consider 1) Peripheral (Vestibular neuritis [VN] and labyrinthitis) Symptoms & Historical Pearls 1) 2) Central (stroke> demyelinating disease and other) 2) 3) Wernicke (Korsakoff) 3) 1) TIA (minutes to hours) 1) 2) Vestibular migraine (seconds to days) 2) 3) Meniere's/ endolymphatic hydrops (20 minutes to 12 hours) Vestibular paroxysmia (seconds to minutes) Benign paroxysmal positional vertigo (<1-2 minutes) Superior canal dehiscence syndrome (seconds to minutes) Bilateral vestibular loss 3) 4) Episodic Triggered Vestibular Syndrome 1) Chronic Vestibular Syndrome 1) 2) Vertigo/dizziness, disequilibrium, nausea/vomiting, "sitting" oscillopsia at rest (not dependent on head motion, also referred to as "external vertigo") from nystagmus; aggravated by head movements; hearing is spared in VN and lost in labyrinthitis; consider labyrinthine ischemia when new hearing loss is present Symptoms can be indistinguishable from VN; may or may not have additional posterior fossa symptoms; hearing loss should be considered to represent labyrinthine ischemia (when otoscopy is normal) until proven otherwise History of alcoholism, malnutrition, hyperemesis gravidarum, gastric bypass or related surgeries; dizziness/vertigo, imbalance, confusion, diplopia are common Similar to AVS above, TIAs may present as isolated dizziness/vertigo or there may be additional posterior fossa symptoms; new headache with vestibular symptoms is concerning for dissection, or may simply be due to TIA Vertigo, dizziness, imbalance; history of motion sickness common; vestibular symptoms occur with or without headache; headache history may be remote and unrelated, but other migraine features will be present - e.g., photo- or phonophobia, visual aura; typical migraine triggers are common even in the absence of headaches - e.g., menstrual cycle, red wine, etc Vertigo, aural fullness, hearing loss, and tinnitus 4) Dizziness, vertigo, imbalance commonly associated with ipsilesional aural symptoms often spontaneous and many times each day; can be provoked by exercise or head movements 1) Vertigo or dizziness triggered by head movements - e.g., rolling over in bed, lying to sitting, sitting to lying, looking up or down 2) Autophony (hearing internal noises that are not normally perceived - e.g., heartbeat, eye movements); episodic vertigo/dizziness brought on by pressure changes (e.g., sneezing) or loud noises; may have chronic disequilibrium 1) Oscillopsia provoked by head movements ("walking" oscillopsia [dependent on head motion]); imbalance Following a vestibular, medical or psychiatric event/trigger that causes dizziness/vertigo or impaired balance, some patients (particularly those prone to anxiety or who had a particularly anxious response to the initial event) develop a maladaptive reaction including stiff/rigid posture which can lead to chronic dizziness (lasting >3 months) with a postural component (worse when upright) and visual sensitivity Rocking or swaying, feeling of being on a boat usually experienced after a cruise, long car ride or flight (note that some cases are spontaneous); symptoms are minimal with passive motion as in a car; significant overlap with migraine Oculopalatal tremor - oscillopsia due to vertical-torsional pendular nystagmus, worsening imbalance months after a posterior fossa injury (e.g., pontine hemorrhage); flocculus/paraflocculus syndrome - oscillopsia from downbeat nystagmus, progressive ataxia (e.g., spinocerebellar ataxia); uvula/nodulus syndrome - oscillopsia from periodic alternating nystagmus, central positional vertigo/nystagmus 2) Persistent postural perceptual dizziness 2) 3) Mal de debarquement syndrome 3) 4) Cerebellar/ Brainstem syndromes 4) Adapted from https://collections.lib.utah.edu/ark:/87278/s64x9bq1 |
