Chapter 18. Dizziness and Vertigo Flashcards
Question 18-1:
Which of the following statements is true regarding post-traumatic vertigo?
1. Prognosis is usually good
2. Onset is always at the time of the injury
3. Most patients respond to exercise therapy
4. Long-term post-traumatic vertigo does not occur
Select: A = 1,2, 3. B = 1,3. C = 2,4. D = 4 only. E = All
Answer 18-1: B.
Post-traumatic vertigo usuailly has a good
prognosis, however, long-term disabling
vertigo can Occasionally occur. Onset is
commonly at the time of the injury, but call be
delayed for days or weeks; this delay may be
due to hemorrhage into the labyrinth. Most
patients do improve with exercise therapy.
Question 18-2:
Drug toxicity is an important cause of vestibulopathy. Which of the following statements are true about drug-induced vestibulopathy?
1. Streptomycin and gentamycin have greater vestibulotoxic effects than other drugs of the class
2. Risk of aminoglycoside vestibulopathy is increased with renal failure
3. Patients have clinical findings of bilateral dysfunction
4. Patients have examination findings of vestibulopathy but seldom have neurologic deficit
Select: A = I. 2. 3. B = 1. 3. C = 2. 4. D = 4 only. E = All
Answer 18-2: A.
Streptomycin and gentamycin have greater
effects on the vestibular end organ whereas
kanamycin and tobramycin have greater
effects on the auditory end organ. Testing
shows bilateral vestibular dysfunction.
Patients commonly have ataxia with
progressive unsteadiness which is exacerbated
by loss of visual input, as in the dark
Question 18-3:
Brainstem ischemia is an occasional cause of vertigo. Which of the following statements are true regarding cerebrovascular disease and vertigo?
1. Isolated vertigo is never due to ischemic disease
2. Patients with brainstem ischemia usually have other signs of brainstem dysfunction
3.Unidirectional nystagmus suggests brainstem ischemia whereas with peripheral vestibulopathy fast phase of the nystagmus is in the direction of gaze
4. Sudden hearing loss with dizziness suggests infarction in the distribution of internal auditory artery
Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer 18-3: c.
Patients with brainstem ischemia usually have
other signs of brainstem dysfunction.
However, incipient brainstem ischemia may
occasionally have vertigo as a first finding.
Characterization of the nystagmus can help to
differentiate between peripheral
vestibulopathy and brainstem ischemia - the
former causing unidirectional nystagmus with
a fast phase away from the affected ear.
Incipient cerebellar infarction causes
nystagmus which is gaze-dependent, the fast
phase is in the direction of gaze, though it is
usually greater with gaze ipsilateral to the
lesion. Infarction of the internal auditory
artery produces dizziness with bearing loss
with an abrupt onset.
Question 18-4: A 40-year-old man presents with episodes of severe vertigo and vomiting, associated with tinnitus, fluctuating hearing loss, and a pressure sensation in the ear. Which is the most likely diagnosis? A. Acoustic neuroma B. Meniere's disease C. Brainstem infarction D. Toxic vestibulopathy
Answer 18-4: B.
Meniere’s disease is characterized by attacks
of severe vertigo with vomiting, tinnitus, and
fluctuating hearing loss. Patients often report a
fullness or pressure sensation in their ears.
The cause is usually idiopathic, although
rarely, infections can produce the same
symptoms.
Question 18-5:
Which of the following statements regarding seizures and vertigo is true ?
A. Vertigo with epilepsy is usually of temporal lobe origin
B. Most patients have other associated findings of seizures
C. Seizures are a rare cause of vertigo
D. Dizziness can be an aura of a seizure
E. All of the above
Answer 18-5: E.
All of these features are true of seizures and
epilepsy. Epilepsy is a rare cause of vertigo.
Vertigo can be part of the ictus with other
signs of seizure activity, or dizziness of a
variety of types can be part of the aura of a
psychomotor seizure
Question 18-6:
Migraine-type headache with vertigo indicates brainstem ischemia and is a warning sign of impending basilar thrombosis.
T. True
F. False
Answer 18-6: F
Vertigo is often associated with migraine, and
does not have any particularly bad prognostic
significance
Question 18-7:
Hypotension with vertigo indicates bilateral vertebral or basilar artery occlusive disease.
T. True
F. False
Answer 18-7: F.
Postural hypotension from any cause can
produce not only a non-specific report of
dizziness, but also can produce vertigo
without implicating arterial occlusive disease,
though this has to be at least considered.
Postural hypotension is a common effect of
many medications, especially antihypertensive
and dopaminergic agents
Question 18-8:
Benign paroxysmal positional vertigo is suggested by episodic vertigo induced by certain head positions, with a history of either labyrinthitis with a URI or head injury.
T. True
F. False
Answer 18-8: T.
Benign paroxysmal positional vertigo is
characterized by episodes of vertigo due to
certain head positions such as lying down or
turning over in bed. There are typically few
symptoms when the patient is not moving.
Many patients have a history of severe vertigo
with a URI suggestive of labyrinthitis or a
history of head injury as antecedent events.
Question 18-9:
In differentiation of peripheral positional vertigo from central causes of positional vertigo, which of the following statements are true?
1. Peripheral vertigo exhibits fatigability whereas central vertigo does not
2. Peripheral vertigo has a shorter latency
3. Peripheral vertigo has a shorter duration
4. Peripheral vertigo is usually less severe than central vertigo
Select A = 1.2.3. B = 1,3. C = 2. 4. D = 4 only. E = All
Answer 18-9: B.
Peripheral vertigo can be differentiated from
central vertigo in a number of ways.
Peripheral vertigo tends to be of longer
latency, shorter duration, is more severe, and
is subject to fatigability. In addition,
peripheral vertigo is more inconsistent on
repeated testing than central vertigo
