Dizziness

Question 1

Vertigo

Answer 1

sensation of motion when no motion is occurring

Question 2

Dizziness

Answer 2

sensation of disturbed spatial orientation

Question 3

Nystagmus

Answer 3

rapid involuntary movements of the eyes.
Vertical or Horizontal
fatigable or persistent

Question 4

Syncope

Answer 4

rapid onset of transient LOC usually due to cerebral hypoperfusion with spontaneous recovery after short duration

Question 5

Vertigo categories

Answer 5

Central and Peripheral

Question 6

Central vertigo pathophysiology

Answer 6

due to a disease originating from the CNS
includes lesions of CN8
experience hallucinations of motion

Question 7

Peripheral vertigo pathophysiology

Answer 7

due to a disease that affects the labyrinth of the inner ear or the vestibular branch of CN8

Question 8

Central vs Peripheral vertigo- onset

Answer 8

central- slow
peripheral- sudden

Question 9

Central vs Peripheral vertigo- frequency

Answer 9

central- constant, progressive
peripheral- episodic, recurrent

Question 10

Central vs Peripheral vertigo- duration

Answer 10

central- weeks to months
peripheral- seconds to minutes

Question 11

Central vs Peripheral vertigo-triggered by head position?

Answer 11

central- no, can be worsen but not triggered by
peripheral- yes, alleviated by motionless

Question 12

Central vs Peripheral vertigo- associated symptoms

Answer 12

central- neurological or visual
peripheral- tinnitus, nausea

Question 13

Central vs Peripheral vertigo- fatigable

Answer 13

central- no
peripheral- yes

Question 14

Central vs Peripheral vertigo- nystagmus

Answer 14

central- vertical
peripheral- horizontal

Question 15

Central- causes of vertigo

Answer 15

bad things

cerebellar strokes
tumors
infections
vascular disorders
vertebrobasilar migraine

Question 16

Peripheral- causes of vertigo

Answer 16

BPPV (benign paroxysmal positional vertigo
vestibular neuritis
migrainous vertigo

Question 17

Acute onset vertigo- dangerous causes

Answer 17

TIA
Cardiac dysrhythmia
CV disorder
Insulinoma, pheo

Question 18

Chronic onset vertigo- dangerous causes

Answer 18

posterior fossa stroke
bacterial/zoster labyrinthitis
brainstem encephalitis
miller fisher/Wernicke
meds/toxins

Question 19

Vertigo triggers

Answer 19

position- body vs head
exertion or valsava

distinguish triggers- not present at baseline vs
exacerbating factors- worsen preexisting symptoms

Question 20

Reproducible triggers- vertigo

Answer 20

have benign cause (ex BPPV)

Question 21

Episodic (nonreproducible) symptoms- vertigo

Answer 21

have dangerous causes
symptoms are spontaneous

Question 22

Focal neurological- vertigo

Answer 22

central (can be urgent or not)

Question 23

When should you worry about dizziness being a new onset?

Answer 23

Elderly (>60)

Question 24

Central vs Peripheral- physical exam findings- vertigo

Answer 24

Central
-constant- less severe
Peripheral
-intermittent, severe

Question 25

Central vs Peripheral- physical exam findings- nystagmus

Answer 25

Central- absent, directionality, vertical Peripheral- present, unidirectional, never vertical

Question 26

Central vs Peripheral- physical exam findings- hearing loss or tinnitus

Answer 26

Central- rarely present Peripheral- often present

Question 27

Central vs Peripheral- physical exam findings- intrinsic brainstem signs

Answer 27

Central- present Peripheral- absent

Question 28

DIX-hallpike maneuver

Answer 28

gold standard for dx of posterior canal BPPV 45 degrees- head (+) test= torsional fatigable nystagmus

Question 29

HINTs exam

Answer 29

HI- head impulse N- nystagmus Ts- test of skew if all 3= central

Question 30

Workups for vertigo

Answer 30

``` Caloric testing (cows) cold or warm water or air in ear canal stimulates acoustic nerve- causes nystagmus Cold= opposite, warm= same ```

Question 31

BPPV treatment

Answer 31

Eply's maneuver

Question 32

BPPV

Answer 32

dense calcium carbonate crystals from utricle dislodge and fall into semicircular canal -most common posterior canal

Question 33

BPPV- characteristics

Answer 33

vertigo= seconds- minutes n/v turning in bed, getting up from supine, tilting head

Question 34

Meniere's disease

Answer 34

episodic vertigo (minutes to hours) tinnitus imbalance caloric testing

Question 35

Meniere's disease tx

Answer 35

low salt diet diuretics- acetazolamide meclizine or valium steroid injections or surgery

Question 36

Labyrinthitis

Answer 36

acute onset, continuous, sever vertigo hearing loss, tinnitus

Question 37

Labyrinthitis tx

Answer 37

supportive care tx abx if fragile or bacterial vestibular suppressants- diazepam, meclizine

Question 38

Vertebrobasilar TIA

Answer 38

usually vascular risk factors minutes- 1-2 hours

Question 39

Vestibular paroxysmia

Answer 39

brief (1-several seconds), multiple a day nystagmus provoked by hyperventilation

Question 40

Vestibular migraine= migrainous vertigo criteria

Answer 40

1. meet IHS criteria for migraine 2. episodic of fluctuating symptoms suggestive of a balance disorder 3. no other neuro-otologic dx 4. migraine symptoms during vertigo or imbalance periods