Dizziness

Question 1

The sense of imbalance, usually while walking

Answer 1

disequilibrium

Question 2

the sensation of moving/spinning

Answer 2

vertigo

Question 3

sensation of near fainting or lightheadedness

Answer 3

pre-syncope

Question 4

This is a special test that keeps patients from focusing their vision. It is used to help elicit certain types of nystagmas

Answer 4

Frenzel Goggles

Question 5

MS and migraine with vertigo are types of _______ vertigo

Answer 5

central

Question 6

Name 3 types of peripheral vertigo:

Answer 6

1) BPV
2) Menieres dz
3) vestibular neuritis
4) Ototoxic meds
5) Acoustic neuroma

Question 7

Do you expect a patient with peripheral vertigo to have other neurological s/s (like dysarthria, vision change, etc)?

Answer 7

No, peripheral lesion is outside the CNS.

Question 8

What direction is nystagmus in peripheral vertigo, if present?

Answer 8

HORIZONTAL and Unidirectional, toward normal ear

Question 9

If you see nystagmus going in a purely vertical or torsional pattern, what can you say with high confidence?

Answer 9

Central source of vertigo

Question 10

Patients with _______ vertigo can suppress nystagmus if they are allowed to focus on an object.

Answer 10

peripheral

Question 11

Patients with nystagmus that persists even after vertigo resolves have likely experienced __________ vertigo.

Answer 11

central

Question 12

During an acute vertigo episode, patients with ________ vertigo can still walk with only minor instability

Answer 12

peripheral

Question 13

Deafness or tinnitus is ONLY present during an episode of _______ vertigo

Answer 13

peripheral

Question 14

benign positional vertigo is commonly attributed to ________ in the posterior semicircular canal

Answer 14

calcium debris

Question 15

How long do episodes of BVP last?

Answer 15

< 1 min/episode, intermittent episodes x months

Question 16

The ________ maneuver can be done in the office to reposition the calcium debris

Answer 16

Epley

Question 17

The ________ maneuver can be done in the office to reproduce and therefore diagnose BPV.

Answer 17

Dix-Hallpike

Question 18

What medication provides the best relief of BPV?

Answer 18

Meclizine

Question 19

Your patient reports having had 2 spontaneous episodes of vertigo that lasted about 25 minutes each. During each episode, she reports a full feeling in her ears and heard ringing. What are you thinking?

Answer 19

Meniere’s Dz

Question 20

What causes Meniere’s?

Answer 20

“endolymphatic hydrops” aka fluid buildup in the labyrinth system…most common onset in 20-40’s.

Question 21

Rapid onset of vertigo with n/v and gait instability following a virus….

Answer 21

Vestibular neuritis

Question 22

How will you tx vestibular neuritis?

Answer 22

steroids

Question 23

How will you tx Meniere’s?

Answer 23

diuretic

Question 24

A 50 year old male pt who works in a loud construction site comes in c/o tinnitus in one ear, he has vertigo and numbness in his face. After you r/o stroke, what is the next most likely cause?

Answer 24

Acoustic Neuroma

Vestibular schwannoma

Question 25

Construction man from before wants to know how serious this is, and what you are going to do about it…

Answer 25

Typically benign, tx only if symptoms are intolerable. Then the options include radiation or surgery

Question 26

Name a few ototoxic meds:

Answer 26

GENTAMICIN

Pretty much anything that ends in “mycin”

Question 27

Marcus Gunn Pupil. That is all you know….what should you be thinking?

Answer 27

optic neuritis–>MS

Question 28

How do you tx acute MS exacerbation?

Answer 28

IV steroids, methotrexate

Question 29

Vertigo a/w Posterior circulation problems….highest risk is with pt’s who have stroke risk.

Answer 29

vertebrobasilar insufficiency

Question 30

Is vertebrobasilar insufficiency central or peripheral?

Answer 30

central….poor perfusion of posterior circulation will include CNS symptoms like ataxia, dysmetria

Question 31

This is a vertigo diagnosis of exclusion in patients with a history of migraine. The vertigo symptoms can occur with or without headache

Answer 31

Migrainous vertigo

Question 32

what are some broad things that might cause presyncope?

Answer 32

arrhythmia, vascular, metabolic, neuro-mediated, psych

Question 33

Causes of disequilibrium:

Answer 33

1) head trauma
2) CNS problem (Parkinson’s/MS)
3) vision problem
4) post vertigo
5) sensory deficit (ex: DMII)

Question 34

What part of the neuro exam is abnormal for patients with disequilibrium?

Answer 34

cerebellar signs