To know the common causes of vertigo

To know how of perform a Dix-Hallpike manoeuvre

To know how to perform an Epley manoeuvre

The Hallucination of movement

The cardinal symptom of disease of the vestibular system

3 major inputs Visual input. (70% balance) Proprioception (15% balance) Vestibular System (15% balance) Coordinated in the brainstem and with

additional cerebellar input maintains balance.

Peripheral causes Benign Paroxysmal Positional Vertigo Menieres Disease Acute Vestibular Failure

Central causes MS CVA Migraine Tumour

Very short episodes of vertigo – 10 seconds

Precipitated by head movement Often turning over in bed

Complete recovery between episodes Most cases resolve in 3 months Dix-Hallpike Epley

80% successful with first attempt Excellent Patient UK PILS

Vertigo – 5 minutes to 24 hoursAssociated tinnitus and hearing lossNeed an audiogramMRI often requiredMedical management successful in

80% Betahistine 16mg tds Thiazide diuretics

Vertigo for > 24 hours Nausea +/- vomiting No associated symptoms Vestibular sedatives effective in the

short term - avoid for longer than a week

Rehabilitation Encourage movements that provoke

vertigo Stop long term vestibular sedatives