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vertigo due to peripheral lesions

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  • in peripheral vertigo (1)
    • hearing loss and tinnitus are commoner than in central vertigo
    • generally has a more sudden onset (exception-acute cerebrovascular events)
    • is highly associated with rotatory illusions (esp. nausea and vomiting)
    • nystagmus is combined horizontal and rotational, and lessens when the gaze is focussed
    • there is mild to moderate imbalance
    • nonauditory neurologic symptoms are rare
    • latency following provocative diagnostic maneuver is longer (up to 20 seconds)
  • the duration of vertiginous episodes and the presence or absence of auditory symptoms narrows the differential diagnosis (2)
    • causes of vertigo in which there are accompanying auditory symptoms:
      • Meniere's disease:
        • vertigo lasts for minutes or hours
        • episodic, associated with tinnitus and deafness
      • acute labyrinthitis - vertigo lasts for days
      • perilymphatic fistula - vertigo lasts for months/years
      • ototoxic drugs e.g. aminoglycosides
      • cholesteatoma
      • Ramsay-Hunt syndrome
    • causes of vertigo in which there is no hearing loss / tinnitus:
      • benign positional vertigo:
        • vertigo lasts for seconds
        • episodic, correlated with head position
      • vestibular neuronitis - vertigo lasts for days
      • cervical spondylosis and whiplash injury may cause vertigo by interfering with proprioception and movement of the neck

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