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 hours Associated tinnitus and hearing loss Need an audiogram MRI often required Medical 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