10-29 Dizziness and Vertigo Flashcards
When a patient says they feel “dizzy”?
vertigo - room is spinning/on an amusement ride
pre-syncope - lightheaded or fait “might pass out”
disequilibrium - unsteady on your feet
“Other” issues like visual disturbances, anxiety, head pressure
peripheral vertigo
due to damage to inner ear/CN VIII; usually severe, unidirectional (horizontal or rotary) nystagmus, no other signs of central damage, may have hearing problem and motion sickness A) PROVOCATION BY MOV'T —benign positional —cervicogenic —vertebrobasilar B) PROVOCATION BY NOISE —Meniere Syndrome —Perilymph fistula C) HEAD/NECK TRAUMA D) HEARING LOSS/TINNITUS E) DRUG/TOXIN
central vertigo
typically milder than peripheral. —nystagmus is usually >> patient’s illusion of movement and may be in multiple directions or possibly in a vertical direction —not associated with hearing loss —often other CNS abnormalities on exam A) cerebrovascular dz B) MS C) Chiari malformation D) Other conditions directly damaging the caudal brain stem or the vestibulocerebellum.
benign paroxysmal positional vertigo
—most common vertigo provoked by mov’t
—condition in which some otoliths are free to move around the inner ear. They provoke sudden attacks of vertigo beginning after several seconds of delay and lasting Hall pike (Nylan-Barany) maneuver often reproduces sx and provokes rotatory nystagmus that also lasts ts; may dissolve over time
Ménière Syndrome
condition in which there is increased pressure in the endolymph of the inner ear (prob b/c of diminished resorption)
—may result in “blowouts” of the membranes of the inner ear (endo-/peri-lymph mix), with sudden attacks of vertigo lasting hours.
—usually also results in gradually progressive, low-pitch hearing loss, often w/ humming or buzzing tinnitus; this is due to damage to vestib and cochlear hair cells
—test w/ insufflation
canilith repositioning (Epley) maneuver
used to treat benign paroxysmal postional vertigo by moving the patient through a series of postions that move otoliths from the semicircular ducts into the utriculus.
perilymph fistula
—small tear in the wall separating the perilymph of the inner ear from the middle ear (often near round window)
—P ∆s in middle ear or in the fluids of the inner ear can provoke mov’t of fluid and vertigo sx
—also some chronic hair cell damage
—test w/ insufflation or h/o vertigo w/ air travel, mountains, Valsalva
Hennebert sign
provocation of vertigo by pressure introduced to the external ear canal via insufflation. This can be seen in perilymph fistula or Meniere syndrome. This is similar to a “fistula test.”
fistula test
reproduction of vertigo by changing pressure (either increasing or decreasing) in the external ear canal through an otoscope. This can provoke symptoms in perilymph fistula, but also in Meniere syndrome. This is similar to Hennebert sign.
Chiari malformation
congenital herniation of the cerebellum through the foramen magnum. There are several types based on associated abnormalities, but it often results in vertigo and occipital headaches. There may be vertical nystagmus and, when severe, dysfunction of long tracts of the spinal cord.
—downbeat nystagmus
acoustic neuroma
relatively common, benign Schwannoma around the vestibular nerve
—characterized by progressive hearing loss and some (usually mild) vertigo.
Tinnitus
perception of sound in the absence of stimuli. It can be high pitched (ringing) or low pitched (humming or buzzing).
cervicogenic vertigo
—a PERIPHeral vertigo, provoked by MOVT
—provoked by movt or sustained neck position usu w/ pain and restriced motion
—sx begins quickly when the neck is moved and remains during the period of sustained head position.
—vertigo (and nystagmus) is typically much less than with BPV.
—not common; can be seen after H&N injuries.
vertebobasilar insufficiency
vertebrobasilar a. may be compromised by neck rotation
—If causing positional vertigo, sx gradually build after a lag of 5-15s necessary to produce ischemia.
—uncommon, but requires investigation of the posterior circulation when it does occur
H&N Trauma
—perilymph fistula
—loosen otoliths
—Whiplash—>cervicogenic
—direct concussion of the inner ear hair cells w/ “labyrinthine concussion” expect gradual recovery
—Vertebral a. dissection: rare but serious 2° to neck injury; may occlude branches to vestibular area of brain stem or cerebellum and produce vertigo due to stroke.
—studies suggesting instability intracranial blood flow after head and neck injuries; can produce vertigo or, more commonly, presyncope as part of “postconcussion syndrome”.
