Balance - Vestibular disorders

9 important questions on Balance - Vestibular disorders

What are the suggested pathological mechanisms of vestibular neuronitis?

Viral infection
Vascular occlusion
Immunologic mechanisms
Degenerative

What are symptoms of vestibular neuronitis

Sudden onset vertigo with nausea and vomiting (no hearing loss), can stay for days
Normal hearing and normal neurological exam
Postural instability
Horizontal nystagmus at the contralateral side, suppressed by fixation

What is the treatment of vestibular neuronitis?

Mobilisation, antiemetics, and steroids
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What is the treatment of Meniére's disease?

Lifestyle changes
Antihistamines
Gentamycine ablation
Cranial nerve VIII neurectomy

What are the criteria for vestibular migraine?

  1. Past medical history of migraine
  1. >5 vertigo attacks with at least one of these symptoms:
    • Migraineous headache (50%of attacks)
    • Photophobia
    • Phonophobia
    • Visual aura

What is the treatment of vestibular migraine?

Topimirate (migraine drug)
Propanolol

What is the difference between vestibular neuronitis and labyrinthitis?

Labyrinthitis is also accompanied by  hearing loss

What is the management of labyrinthitis

Meclizine to relieve vertigo
Antiemetics
Antibiotics
Oral fluids
IV fluids for severe dehydration   

Surgical excision of cholesteatoma
Incision and drainage
Labyrinthectomy

What are the symptoms of bilateral vestibulopathy?

  • Oscillopsia
  • Imbalance
  • Spatial orientation problems

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