Master the board step 3

Neurology
room is spinning, the eyes should naturally dart back and forth to give the
feeling of looking at a single point.
Generally all patients with vertigo should have an MRI of the internal auditory
canal.
The following table summarizes the presentation of a number of conditions
that cause vertigo.
Disease Characteristics Hearing Loss/Tinnitus
Benign positional vertigo Changes with position No
Vestibular neuritis
Vertigo occurs without position
changes
Labyrinthitis Acute Yes
Meniere’s disease Chronic Yes
Acoustic neuroma Ataxia Yes
Perilymph fistula History of trauma Yes
No
Benign Positional Vertigo (BPV)
This presents as vertigo alone with no hearing loss, no tinnitus, and no ataxia.
The question may describe a positive Dix-Hallpike maneuver. History may
describe onset of symptoms when quickly changing positions.
There is no specific diagnostic test. BPV responds modestly to meclizine
(Antivert).
Vestibular Neuritis
This is an idiopathic inflammation of the vestibular portion of the 8th cranial
nerve. Because only the vestibular portion is involved, there is no hearing loss
and no tinnitus. Presumably, this condition is viral. It is entirely characterized
by vertigo and dizziness and is not related to changes in position.
There is no specific diagnostic test. Treat with meclizine.
Labyrinthitis
Labyrinthitis is inflammation of the cochlear portion of the inner ear. There
is hearing loss as well as tinnitus. This condition is acute and self-limited and
may be treated with meclizine and steroids. Acute hearing loss may respond
to steroids.
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