A Scientific and Clinical Approach to Acute Vertigo Flashcards
what is Vestibular-motion perception
sensation of motion- of self or environment
What is seeing environmental motion known as
Oscillopsia
Oscillopsia is…
Seeing environmental motion
Oscillopsia indicates…
nystagmus
Vertigo is…
Sensation of spinning of self and environment
2 types of Vertigo?
LOW current: Gentle rocking sensation
HIGH current: Violent spinning of self and room
What is dizziness defined as
see the world moving
Why do people feel like they’re still when in reality they’re on a moving chair
they begin to feel still because the fluid in the semi-circular canals moves with the chair
Acutely symptoms [may/may not] follow signs
may
Chronically symptoms [may/may not] follow signs
may not
Where is the area in the brain that relates to ability to suppress dizziness
Vestibular cerebellum
Phrases that could be used by patients to describe vertigo:
floating, spinning like a merry-go-round, rocking like a boat
Common causes of vertigo? (5)
BPPV - Benign paroxysmal positional vertigo Vestibular neuritis Stroke Menieres Anxiety Syncopy
Parts of the vestibular system? (6)
Cerebral cortex Thalamus Vestibular cerebellum The peripheral vestibular organ Ponto-medullary junction Spinal cord
First 3 things you do in A&E with a patient with vertigo?
you want to exclude presyncope, pulmonary embolism and cardiac arrhythmia so you would check postural BP, arterial saturation and do an ECG
what do we do when examining for acute vertigo? (3)
Gaze
VOR - vestibular ocular reflex
Hallpike
Opthalmoscopy
What is the result of a VOR test
Head impulse test assesses vestibular-ocular reflex- the deficient side will lose fixation on you and then undergo a re-fixation saccade
BPPV causes? (2)
Positional cause of vertigo- lying down
Torsional nystagmus (pulling on the skin around the eye causes nystagmus)
Describe a VOR test
Get patient to focus on you then twist head to right and left and see if they are still looking at you
Central problems cause what direction torsional nystagmus?
downbeat
Cure for BPPV
- Right hallpike and semont (basically pull the person’s torso over to the right very quickly while they sit, and check for nystagmus, and treat by then flipping the person over the other side very quickly- semont- this is curative)
VESTIBULAR NEURITIS onset?
Minutes to hours
VESTIBULAR NEURITIS symptoms?
Continuous vertigo
Obvious ‘vestibular’ nystagmus
Positive head impulse test
Normal gait
VESTIBULAR NEURITIS treatment?
Do not medicate- should resolve itself but medication can worsen its
Red flags of patients presenting with acute vertigo? (6)
Headache Gait Ataxia Hyperacute Onset: Vertigo + Hearing Loss Prolonged Symptoms (>4 days):
headache and vertigo could be due to…
posterior circulation stroke
Hyperacute Onset of vertigo could be due to…
suggests vascular origin
Vertigo + Hearing Loss could be due to…
AICA (anterior inferior cerebellar artery) or urgent ENT problem
Prolonged Symptoms of vertigo could be due to…
Floor of 4th ventricle problem
Gait Ataxia of vertigo could be due to…
non-vertigonous manifestation of cerebellar strokes
MIGRAINOUS VERTIGO signs and method of diagnosis? (3)
History of migraine
Acute vertigo without headache
Diagnosis of exclusion- main differential diagnosis is cerebellar stroke
CEREBELLAR STROKE signs and method of diagnosis? (3)
Thunderclap onset vertigo
Difficulty walking
Headache
positive HEAD IMPULSE TEST suggests damage where?
`peripherally
positive gait ataxia suggests damage where?
centrally
vertigo is a [symptom/diagnosis]
symptom
what is RAMSEY HUNT SYNDROME? central or peripheral?
peripheral
Facial weakness
Rash- re-activation of varicella zoster
Complete loss of hearing/vestibular function
