Disorders I Flashcards
1
Q
what is the most common cause of vertigo in pts with vestibular disorders
A
BPPV specifically the most common type of BPPV is Posterior canal canalathiasis
2
Q
typical presentation of BPPV
A
- brief delay of symptoms followed by a sudden onset of vertigo that occurs after a provoking movement
- may continue for days or weeks on an intermittent basis
- pts often report imbalance issues in between the vertigo attacks
- occurs more frequently in the morning and in lesser degree as the day goes by because as the pts walk around and are upright, the canaliths settle down and are no longer free floating within the canal
3
Q
how severe is the head injury that causes BPPV
A
- may occur after head injury that is mild to severe
- –from a bump on a cabinet to a serious car accident
- really depends on the patient
- depends on the patients hisoty
4
Q
hearing loss with BPPV?
A
*pts do not typically report changes in hearing or have any other symptoms unless BPPV is secondary to another etiology
5
Q
disorders that might be secondary to BPPV
A
- migraine
- meniere’s
- vestibular neuritis (virus)
- ototoxicity
6
Q
other associations with BPPV
A
- surgery in the supine position (on back with face up)
- previous peripheral vestibular insults
- –ototoxicity, neuritis, history of migraine, etc
- chiropractic visits
- prolonged intense dental/oral surgeries
- prolonged periods of rest
- –bed rest during pregnancy
- –post-op surgical rest
7
Q
BPPV cause, pathological or idiopathic?
A
- can and often is idiopathic
- can be frustrating to the pt and cause them great fear and anxiety
- –pts want to know what caused their problem so they can avoid repeating that cause
8
Q
at what age and above is it common to have intermittent episodes of BPPV even after treatment
A
- over 50-60
* this is given their BPPV is idiopathic
9
Q
what can look like BPPV but is actually something else very dangerous
A
- vertebrobasilar ischemia
- to differentiate between the two:
- –BPPV is only vertigo while VBI has other symptoms:
- —-visual changes such as blurred vision
- —-lightheadedness, feeling of blacking out
- —-naseua
- —-dysarthria
10
Q
vertebral artery screening test (VAST) for VBI
A
- have pt look straight ahead
- have pt tilt head back as far as is comfortable for them
- have pt turn head to the side while it is tilted back and then repeat on other side
- –hold each position for 20-30 seconds
- in each position ask pts if they are dizzy, lightheaded, having blurry or double vision, nauseous, have them answer open ended questions to make sure no slurred speech and that they are making sense
11
Q
can you test a pt/ treat a pt for BPPV which a VBI
A
yes with modifications and being very careful
12
Q
BPPV testing
A
- no special equipment necessary unless wanting to record findings
- can be performed without Frenzels or infra-red videography because BPPV will not be suppressed with fixation
- but can use them if wanted to record to share with others or look for a true rotary component of the nystagmus
- when looking at a 2 dimensional tracing the nystagmus will look like there is horizontal nystagmus and vertical nystagmus rather than a rotary nystagmus
13
Q
cupulothiasis theory of BPPV
A
- otoconia is either embedded (stuck) or laying on the cupula which adds weight to the cupula and now stimulates the sensory haircells because the cupula is now gravity dependent like the otoliths
- with this theory the central system would adapt and essentially abort the nystagmus, however, this takes approximately 1 minute for it to take over
- it is controversial whether otoconia are adhered to the cupula or not or even if it actually exists
- brief delay in onset of nystagmus after provoking movement, usually less than 15 seconds
- persists while pt remains in provoking position> 1 minute
- do not see very often
14
Q
canalithiasis BPPV
A
- brief delay in onset of nystagmus after provoking movement, usually less than 15 seconds
- nystagmus typically lasts less than a minute but can only last a few seconds
- reversal of nystagmus is commonly noted upon sitting
- upon repeated provoking movements symptoms will decrease
- –but pts avoid the positions that will help them to feel better because they are trying to avoid an unpleasant situation
- –they will move like robots
15
Q
Dix-Hallpike testing
A
- start with pt in sitting position
- turn head to side and observe the eyes
- lay pt back into supine position at a swift but comfortable rate
- head should be extended slightly if possible
- observe eyes, they will want to close them if they are dizzy but need to keep them open
- wait for nystagmus to subside and then sit them up again slowing to avoid any issues with orthostatic hypotension
- look for nystagmus
- –often lesser but if observed it will reverse direction because the change of position will cause the endolymph to stimulate the cupula in the opposite direction
