Etiology:
It is caused by endolymph (the fluid filling the cochlea & vestibule) accumulation in the vestibular apparatus. Possibly due to trauma, previous infection, or auto-immunity.

Signs and symptoms
It has a triad of symptoms:

• Spontaneous vertigo that lasts for hours (rarely for a day), and is not induced by head movement.
• Tinnitus
• Hearing loss that starts at low frequencies and progresses further.

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Just to be clear
Positional vertigo: occurs with change in position (head movement).

Spontaneous vertigo: occurs spontaneously without head movement

Diagnosis is based on:

• two or more spontaneous vertigo episodes that last 20 minutes to 24 hours.
• hearing loss in low to mid frequencies in the affected ear, as measured by audiometry.
• tinnitus or feeling of fullness in the ear.
• Symptoms not better accounted for by another vestibular diagnosis

The dx is clinical, and usually with the help of audiometry.
Imaging studies are required only to rule out other diseases.

3:42
Gentamicin to poison the ear and treat Meniere's disease

It's a special type of migraine, basically. You'll find it in patients with a history of migraine.

If a patient comes in with a vertigo that lasts for hours, and he has a hx of migraine, then you should think of this.

Criteria for diagnosis:

• Episodic, spontaneous vertigo that lasts for hours.
• 2 or more migraine symptoms ( migrainous headache, photophobia, phonophobia, visual aura or other type of aura), occuring during at least 2 episodes of vertigo.

Successful triptan treatment is generally diagnostic, since triptan is used for migraine.

Headache may occur during or following vertigo (in this case, the vertigo is considered a migrainous aura).

Spontaneous vertigo that lasts for days, regardless of the cause.

من يجيك المريض، يكلك أنّ الدوار مالته صارله أيام مستمر وما متوقف أصلًا (حركة الراس ممكن تزيده، بس مو هي السبب، يعني spontaneous vertigo).

أهم خطوة نسويها وية هيج مرضى، هي أنّ نتأكد هل السبب central أو peripheral، لأن السبب الأول خطير وممكن يكون بسبب جلطة بجذع الدماغ أو مرض عصبي أو غيره، بينما الثاني بسيط نسبيًا ومو بنفس خطورة الأول.

The HINTS exam has a sensitivity of almost 100% and specificity of 96% for stroke. Therefore it is superior to imaging studies like MRA which are more costly and time-consuming.