15BPPV Signs and Symptoms Vertigo and nystagmus Nausea , vomiting Latency of onset , usually 2-6 sec.Short duration , usually less than 30 sec.ReversibilityFatigabilityNausea , vomitingDix-Hallpike maneuver
30Labyrinthitis Virus : mump, measles, Herpes Bacteria : syphilis , OM ,meningitisTB more often a complication of Tubercuolus meningitis than of Tuberculous otitis media.Syphilis : congenital , acquireFluctuating episodes of hearing loss and vertigo
31Acoustic neuroma Acoustic schwannoma Schwann cell tumor of vestibular part of CN VIII มักเกิดบริเวณ Internal acoustic canal แล้วยื่นเข้าไปบริเวณ CP angleInitially,slowly progressive hearing loss and tinnitus .Postural imbalance or disequilibrium.
32Acoustic neuromaOnce the lesion compress the brainstem and vestibulocerebellum ,central compensation becomes impaired : vertigo , ataxia.Audiogram : unilateral SNHLABRCaloric test : hypofunctionMRITreatment : surgery, radiation
33Central cause of vertigo 1.Vertebrobasilar insufficiencyElderlyAtherosclerosisVertigoNausea,vomitingAtaxiaVisual illusion ,visual field defect, diplopia, headache
34Central cause of vertigo 1.1Brainstem TIA1.2Wallenberg’s syndrome ( Lateral medullary infartion )1.3Acute posterior cerebellar infarction1.4Acute inferior cerebellar infarction
352.Cerebellar hemorrhage VertigoNausea, vomitingHeadacheStiffness of neck, incoordination50% loss of consciousness in 24 hr.
363.Vestibular migraine Episodes of vertigo Increased sensitivity to motion during the attack and increased susceptibility to motion sickness in between attacksIn 33% of pt episodic vertigo is not associated with headache.
373.Vestibular migraineIn 33% vertigo is associated with visual symptoms , dysarthria , tinnitus, decreased hearing , diplopia, ataxia, bilateral paraesthesia, bilateral paresis or decreased level of consciousness