Monash Health Practice Fellowship SAQ

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Presentation transcript:

Monash Health Practice Fellowship SAQ Question 8

A 53 year old lady presents to your ED with sudden onset of vertigo A 53 year old lady presents to your ED with sudden onset of vertigo. She appears distressed with nausea and vomiting and is reluctant to open her eyes. She describes being unsteady on her feet and feels she is too unwell to sit up in bed. Q. What are the 2 main categories of vertigo and for each list 3 causes (6marks) Peripheral: BPPV, Vetibular neuritis, Menieres, trauma, perilymph fistula, acoustic neuroma Central- posterior circulation stroke, vertebral A dissection, posterior fossa tumor, MS, migraine, wallenberg syndrome, vertebrobasilar insufficiency Did well if you were broad in your list of differentials.

Her neurological examination is normal except for prominent nystagmus Her neurological examination is normal except for prominent nystagmus. You decide to proceed with HINTS test. List the 3 components of the HINTS test and for each state the findings consistent with a peripheral nerve lesion (6marks) Head Impulse- Eyes cannot fix on side of lesion when head turned rapidly to that side. Unilateral finding. Nystagmus- unidirectional fast phase, away from side of lesion. Test of Skew- negative in peripheral lesion. Eyes will remain fixed during cover test.