042215 dizziness Flashcards
true vertigo
has aspect of mvmt (spinning of self or room)
peripheral causes of vertigo
BPPV Meniere's vestibular neuronitis labyrinthitis direct trauma
peripheral vertigo vs central vertigo
peripheral has delay after stimulation (a sec or two) and exhibits fatigue. more episodic.
central has no delay and is usually more prfound and prolonged with little fatigue
central causes of vertigo
stroke-lateral medullary, cerebellum brainstem or cerebellar mass MEDICATIONS migraine MS anxiety
in your PE, what you should look for for vertigo pt?
nystagmus:
- if no nystagmus-NOT ear related
- verticular nystagmus-central
- direction changing-central
ataxia (particularly one sided-cerebellar)
dysphagia, diplopia, facial sensation loss, Horner’s syndrome, skew divation in eyes–brainstem stroke
weakness, numbness, other nuero findings-consider larger stroke, tumor, or mutlifocal process like MS
Dix Hallpike maneuver
drop pt backwards, turn head sideways and down to floor
in BPPV, you’ll see nystagmus
long duration dizziness (20 min, longer) and hearing loss
labyrinthitis
long duration dizziness (20 min, longer) and no hearing loss
vestbiular neuritis
short duration dizziness and hearing loss
Meniere’s disease
short duration dizziness and no hearing loss
BPPV (otoliths in utricle fall out to posterior canal)
true vertigo when standing for a period of time
consider vertebrobasilar insufficiency (bilateral vertebral or basilar artery. ischemia of vestibular nuclei in pons and medulla can present w vertigo)
locked in syndrome
vertebrobasilar insufficiency
feeling of being on boat
cerebellar -central vertigo
MS? stroke? hemorrhage? trauma? tumor?
tumors in the cerebellum and brainstem are more common in
children
medulloblastoma, PNET, pineal tumors, ependymoma, astrocytomas, gliomas
lateral medullary syndrome stroke - symptoms?
dysphagia, Horner’s syndrome, ataxia, sensory loss, nystagmus, vertigo
