R42/H81.1
DESCRIPTION
An acute syndrome, consisting of vertigo, nystagmus, nausea, vomiting and postural instability. It is important to differentiate between peripheral and central causes of vestibular dysfunction.
Peripheral cause
Patients frequently present with vertigo, which is most often rotational, with nystagmus. The onset is usually sudden and often intermittent. Associated abnormalities of hearing may be present. Aetiology includes benign paroxysmal positional vertigo (confirm with a positive Dix-Hallpike test, https://www.youtube.com/watch?v=8RYB2QlO1N4), aminoglycoside vestibular toxicity, and vestibular neuritis.
Central cause
It is essential to conduct a thorough neurological examination in patients with vertigo, looking specifically for signs of brainstem or cerebellar dysfunction. Aetiology includes cerebellar stroke and space occupying lesions of the posterior cranial fossa.
GENERAL MEASURES
It is essential to find the cause and treat appropriately. Patients with suspected central causes should be referred for neuro-imaging and possible neurosurgical management.
Benign positional vertigo
H81.1
Good results may be achieved with particle relocation manoeuvres, such as the Epley manoeuvre. https://www.youtube.com/watch?v=jBzID5nVQjk
In a third of patients, symptoms recur after 1 year and repeat manoeuvres may be required.
MEDICINE TREATMENT
This is only for symptomatic relief and is determined by the aetiology.
Discontinue all medication as soon as symptoms subside as the medication itself may cause vertigo due to involvement of the unaffected side.
- Promethazine, oral, 10 mg 8 hourly.
- May be increased to 20 mg 8 hourly if necessary.
Note: This is sedating and patients should not drive or operate heavy machinery.
REFERRAL
- If there is no peripheral cause, suspect intracranial mass lesions or cerebellar stroke.
- Patients not responding to therapy for exclusion of alternative aetiology.