vestibular disorders

The answer first

Vestibular disorders produce vertigo (the illusion of movement — rotational or linear), dizziness, imbalance, and sometimes oscillopsia, and are classified as peripheral (inner ear or eighth nerve) or central (brainstem or cerebellum). The FRACP candidate must defend the HINTS examination (Head Impulse, Nystagmus, Test of Skew) as the bedside discriminator between central (e.g., posterior circulation stroke — HINTS "central": normal head impulse, direction-changing gaze-evoked nystagmus, skew deviation present) and peripheral (e.g., vestibular neuritis — HINTS "peripheral": abnormal head impulse, unidirectional horizontal nystagmus, no skew) causes of acute vestibular syndrome, the Dix-Hallpike manoeuvre for BPPV with the Epley manoeuvre as the curative treatment for posterior canal BPPV, and the AAO-HNS diagnostic criteria for Meniere disease. The answer-first synthesis is: distinguish vertigo from other forms of dizziness (presyncope, disequilibrium, light-headedness) by history; localise peripheral vs central by the eye examination (HINTS, nystagmus characteristics, skew); image (MRI brain) if central signs, neurological features, or risk factors for stroke; treat BPPV with canalith repositioning (Epley), vestibular neuritis with corticosteroid, Meniere disease with low-salt diet and diuretic, and vestibular migraine with migraine therapy. ^{[3] [11]}

References11ShowHide

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