Dizziness Flashcards
define dizziness
a feeling of spinning or light headedness, without loss of consciousness, and may or may not be associated with falls
what is the term describing a sensation of the environment
exteroception
what is proprioception
internal sense of body/ limb position
the utricle senses
horizontal acceleration
the saccule senses
vertical linear acceleration
canals and otolith organs are innervated by the
vestibular nerve
describe some PNS changes with age
degeneration of ampullae of the semicircular canals and otolith organs
describe CNS changes with age
decreased vestibular hair and nerve cells, loss of cerebellar purkinje cells
what are some disease related factors that cause somatosensory changes
arthritis
joint replacements
peripheral neuropathy
Sensation of motion when there is none (false sense of motion) or an exaggerated moving sensation to normal daily activities
vertigo
Feeling of unsteadiness, imbalance, or insecurity without rotation
disequilibrium
feeling of losing consciousness, impending fainting, blacking out
presyncope
Swimming, floating, giddy, or swaying sensation in the head or room
Vague sx- possibly feeling disconnected with the environment
lightheadedness
list some points of pt assessment to hit when assessing dizziness
clarify terms
what is the specific sensation
timing- onset/ pattern
triggers and progression
med and trauma hx
blood work
diagnostic imaging- CT, MRI head
physical exam to reproduce dizziness
med hx- ototoxic drugs? hypotensives?
what is the goal of the physical exam in dizziness? what is the specific maneuver to assess called?
to reproduce the dizziness
Dix-Hallpike Maneuver
3 approaches to treating dizziness
disease spec tx
symptomatic tx
rehab
match the following sx to central or peripheral vertigo
1. mild-mod
2. abrupt onset
3. chronic and continuous
4. more prominent movement illusions
5. gets worse with movement
6. has neurologic signs
7. hearing loss present
8. no N/V
9. severe imbalance
- mild-mod = central
- abrupt onset = peripheral
- chronic and continuous = central
- more prominent movement illusions = peripheral
- gets worse with movement = peripheral
- has neurologic signs = central
- hearing loss present = peripheral
- no N/V = central
- severe imbalance = central
list 3 central causes of dizziness
brainstem ischemia
cerebellar hemorrhage
normal pressure hydrocephalus
MS
space occupying lesions
3 approaches for treating central vertigo
manage/ reverse underlying condition
vestibular rehab
rehab with physio F3mths
describe presyncope clinical presentation
fainting or near fainting, seconds to minutes, can be accompanied by diaphoresis, nausea, blurred vision, pallor
presyncope is
1. red flag that requires assessment ASAP
2. may be accompanied by movement difficulties and hearing loss
3. may be managed by canalith repositioning
4. is most often caused by volume overload in the ear
5. often slower onset and lead up to syncope
1
causes/ origin of presyncope include
cardiac origin mostly/ decreased perf to brain- OH, volume depletion, carotid stenosis, arrhythmia, reflex, MI, autonomic failure
3 classes of medications that can cause presyncope/ syncope
cardiac- any antihypertensive or vasodilator
CNS- psychotropic drugs, anticonvulsants, dopaminergic, skeletal muscle relaxants
uroloogic drugs- anticholinergics, PDE5i
what is the guideline definition of orthostasis
SBP decrease of at least 20 mmHg or DCP decrease of at least 10 mmHg within 3 minutes of standing
what is a nonpharm tx for vertigo
pressure stockings
syncope/ presyncope pharm tx (list 3)
midodrine
fludrocortisone
caffeine
erythropoetin
desmopressin
pseudoephedrine
n disequilibrium, we are most concerned about
1. standing from sitting
2. standing to laying down
3. holding posture against gravity for long time
4. quick movements
4