.

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.

As many as 25% of patients older than 50 years presenting to the emergency department with this clinical picture have a cerebellar infarction rather than vestibular neuritis. As this alternative diagnosis represents a potentially immediately life-threatening condition, it is important to consider this possibility in every patient who presents with acute sustained vertigo.

Patients with a vascular event (stroke) are typically older and/or have atherosclerosis risk factors (hypertension, diabetes, smoking).
Despite these caveats, the distinction between vestibular neuritis and acute cerebellar lesions is not always apparent; patients with acute vertigo are often quite ill, and the examination may be limited. When the diagnosis is unclear, a neuroimaging study, typically MRI, may be necessary

Brainstem infarction — The most common stroke syndrome causing vertigo produces a constellation of symptoms and signs known as a Wallenberg syndrome:

• Ipsilateral Horner syndrome
• Dissociated sensory loss (loss of pain and temperature sensation on the ipsilateral face and contralateral limbs and trunk)
• Abnormal eye movements
• Ipsilateral loss of corneal reflex
• Hoarseness and dysphagia
• Ipsilateral limb ataxia

While these signs are usually apparent after a careful neurologic examination, these signs may be overlooked by patients and non-neurologists because the vertigo, nausea, and vomiting may overwhelm the clinical picture.