Otorhinolaryngology (ENT) for NEET-PG
Vertigo for NEET-PG
Vertigo is an illusion of movement, usually spinning, arising from disorders of the vestibular system, and a common ENT and neurology crossover topic in NEET-PG. The essential skill is separating peripheral causes in the inner ear from central causes in the brainstem or cerebellum, and recognising the classic syndromes. Peripheral vertigo tends to be sudden, severe, with prominent nausea, horizontal nystagmus that fatigues, and hearing symptoms, while central vertigo is often milder but persistent with vertical or direction-changing nystagmus, absent hearing loss, and other neurological signs. Benign paroxysmal positional vertigo is the commonest cause, producing brief spinning triggered by head position changes due to otolith debris in the semicircular canals, diagnosed by the Dix-Hallpike test and treated by the Epley repositioning manoeuvre. Meniere disease features the triad of episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus with aural fullness from endolymphatic hydrops. Vestibular neuritis causes acute prolonged vertigo without hearing loss following a viral infection, while labyrinthitis adds hearing loss. Central causes include vertebrobasilar ischaemia, cerebellar stroke, and acoustic neuroma. Examination uses the head impulse test, nystagmus characteristics, and the HINTS assessment to flag a central cause. Knowing BPPV and its manoeuvres, the Meniere triad, and the peripheral versus central distinction are recurrent exam anchors.
MedNext Academy | 3 min read
Vertigo for NEET-PG
Vertigo is an illusion of movement, usually spinning, arising from disorders of the vestibular system, and a common ENT and neurology crossover topic in NEET-PG. The essential skill is separating peripheral causes in the inner ear from central causes in the brainstem or cerebellum, and recognising the classic syndromes. Peripheral vertigo tends to be sudden, severe, with prominent nausea, horizontal nystagmus that fatigues, and hearing symptoms, while central vertigo is often milder but persistent with vertical or direction-changing nystagmus, absent hearing loss, and other neurological signs. Benign paroxysmal positional vertigo is the commonest cause, producing brief spinning triggered by head position changes due to otolith debris in the semicircular canals, diagnosed by the Dix-Hallpike test and treated by the Epley repositioning manoeuvre. Meniere disease features the triad of episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus with aural fullness from endolymphatic hydrops. Vestibular neuritis causes acute prolonged vertigo without hearing loss following a viral infection, while labyrinthitis adds hearing loss. Central causes include vertebrobasilar ischaemia, cerebellar stroke, and acoustic neuroma. Examination uses the head impulse test, nystagmus characteristics, and the HINTS assessment to flag a central cause. Knowing BPPV and its manoeuvres, the Meniere triad, and the peripheral versus central distinction are recurrent exam anchors.
Vertigo is an illusion of movement, usually spinning, arising from disorders of the vestibular system, and a common ENT and neurology crossover topic in NEET-PG. The essential skill is separating peripheral causes in the inner ear from central causes in the brainstem or cerebellum, and recognising the classic syndromes. Peripheral vertigo tends to be sudden, severe, with prominent nausea, horizontal nystagmus that fatigues, and hearing symptoms, while central vertigo is often milder but persistent with vertical or direction-changing nystagmus, absent hearing loss, and other neurological signs. Benign paroxysmal positional vertigo is the commonest cause, producing brief spinning triggered by head position changes due to otolith debris in the semicircular canals, diagnosed by the Dix-Hallpike test and treated by the Epley repositioning manoeuvre. Meniere disease features the triad of episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus with aural fullness from endolymphatic hydrops. Vestibular neuritis causes acute prolonged vertigo without hearing loss following a viral infection, while labyrinthitis adds hearing loss. Central causes include vertebrobasilar ischaemia, cerebellar stroke, and acoustic neuroma. Examination uses the head impulse test, nystagmus characteristics, and the HINTS assessment to flag a central cause. Knowing BPPV and its manoeuvres, the Meniere triad, and the peripheral versus central distinction are recurrent exam anchors.
Key points
- **Definition:** Vertigo is an illusion of movement, usually a spinning sensation, arising from vestibular system dysfunction.
- **Peripheral versus central:** Peripheral vertigo is sudden and severe with fatiguing horizontal nystagmus, while central vertigo has vertical nystagmus and neurological signs.
- **BPPV:** Commonest cause of vertigo. Brief spinning triggered by head position from otolith debris, usually in the posterior semicircular canal.
- **Dix-Hallpike and Epley:** The Dix-Hallpike test diagnoses posterior canal BPPV, and the Epley repositioning manoeuvre treats it by moving debris out of the canal.
- **Meniere triad:** Episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus with aural fullness, caused by endolymphatic hydrops.
- **Vestibular neuritis:** Acute prolonged vertigo without hearing loss following a viral illness, from inflammation of the vestibular nerve.
- **Labyrinthitis:** Resembles vestibular neuritis but adds hearing loss because inflammation involves the cochlea as well as the vestibule.
- **Central red flags:** Direction-changing or vertical nystagmus, absent hearing loss, and accompanying neurological deficits point to a central cause.
- **HINTS examination:** Head impulse, nystagmus, and test of skew help distinguish a dangerous central cause from benign peripheral vertigo.
- **Acoustic neuroma:** A vestibular schwannoma causes gradual unilateral hearing loss and imbalance rather than acute vertigo, and needs MRI.
- **Symptomatic drugs:** Vestibular sedatives such as prochlorperazine and betahistine relieve acute symptoms but should not be used long term.
Frequently Asked Questions
How do peripheral and central vertigo differ?
Peripheral vertigo is sudden and severe with fatiguing horizontal nystagmus and possible hearing symptoms, while central vertigo has vertical nystagmus and neurological signs.
What causes benign paroxysmal positional vertigo?
It results from displaced otolith debris in the semicircular canals, causing brief spinning triggered by head position changes.
How is BPPV diagnosed and treated?
The Dix-Hallpike test diagnoses posterior canal BPPV, and the Epley repositioning manoeuvre treats it by relocating the debris out of the canal.
What is the triad of Meniere disease?
Meniere disease features episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus with aural fullness, due to endolymphatic hydrops.
What findings suggest a central cause of vertigo?
Vertical or direction-changing nystagmus, absence of hearing loss, and accompanying neurological deficits suggest a central cause needing imaging.
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