Dizziness

Acoustic Neuroma

• Presentation:
  • – More commonly causes continuous dysequilibrium rather than episodic vertigo
    
  • – Central lesions are unlikely in patients with vertigo, hearing loss and an otherwise normal neurological exam
    
  • – Must r/o intracranial mass lesion in any patient with unilateral hearing loss

Benign Paroxysmal Positional Vertigo (BPPV) 

• Presentation:
  • Transient vertigo following changes in head position but is not associated with hearing loss
• Work-up:
  • – MRI—brain
  • – Audiogram
  • – Dix-Hallpike Test

Labyrinthitis

• Presentation:
  • – Frequently follows viral infection (usually URI) and is accompanied by hearing loss and tinnitus, but vertigo is usually continuous and lasts several days to a week
    
  • – HEARING LOSS
• Work-up:
  • – Audiogram
    
  • – Electronystagmography
    
  • – MRI/MRA—brain

Menieres Disease

• Presentation:
  • – Classically presents with episodic vertigo (usually lasting 1-8 hours) and low-frequency hearing loss
    
  • – Tinnitus and a sensation of aural fullness
    
  • – Symptoms result from distension of the endolymphatic compartment of the inner ear
    
  • – Syphilis and heard trauma are two known causes
• Work-up:
  • – CBC with diff
    
  • – VDRL/RPR (syphilis is a cause of Ménière’s disease)
    
  • – MRI—brain

Orthostatic HypOtension

• Presentation:
  • Due to dehydration (diuretics and diarrhea)
  • Drug-induced 
• Work-up
  • – Orthostatic vital signs
    
  • – CBC with diff, Electrolytes, BUN/Cr
    
  • – MRI—brain
  • – Stool exam (occult blood, fecal leukocytes)

Perilymphatic Fistula

• Presentation:
  • – Rare cause of vertigo and sensorineural hearing loss
    
  • – Usually resulting from head trauma or extensive barotrauma
    
  • – Episodes of vertigo are fleeting, generally lasting seconds

Vestibular Neuronitis

• Presentation:
  • – Can be a paroxysmal, single attack of vertigo, a series of attacks, or a persistent condition which diminishes over two weeks.
  • – Associated with nausea, vomiting, and previous upper respiratory tract infections
  • – NO Hearing Loss – Generally has no auditory symptoms, unlike labyrinthitis.
  • – May also be associated with eye nystagmus.
  • – Due to inflammation of the vestibular nerve, the nerve that connects the inner ear to the brain.
• Work-up:
  • – CBC with diff, Electrolytes
    
  • – Electronystagmography
    
  • – MRI/MRA—brain