Dizziness Flashcards
The sense of imbalance, usually while walking
disequilibrium
the sensation of moving/spinning
vertigo
sensation of near fainting or lightheadedness
pre-syncope
This is a special test that keeps patients from focusing their vision. It is used to help elicit certain types of nystagmas
Frenzel Goggles
MS and migraine with vertigo are types of _______ vertigo
central
Name 3 types of peripheral vertigo:
1) BPV
2) Menieres dz
3) vestibular neuritis
4) Ototoxic meds
5) Acoustic neuroma
Do you expect a patient with peripheral vertigo to have other neurological s/s (like dysarthria, vision change, etc)?
No, peripheral lesion is outside the CNS.
What direction is nystagmus in peripheral vertigo, if present?
HORIZONTAL and Unidirectional, toward normal ear
If you see nystagmus going in a purely vertical or torsional pattern, what can you say with high confidence?
Central source of vertigo
Patients with _______ vertigo can suppress nystagmus if they are allowed to focus on an object.
peripheral
Patients with nystagmus that persists even after vertigo resolves have likely experienced __________ vertigo.
central
During an acute vertigo episode, patients with ________ vertigo can still walk with only minor instability
peripheral
Deafness or tinnitus is ONLY present during an episode of _______ vertigo
peripheral
benign positional vertigo is commonly attributed to ________ in the posterior semicircular canal
calcium debris
How long do episodes of BVP last?
< 1 min/episode, intermittent episodes x months
The ________ maneuver can be done in the office to reposition the calcium debris
Epley
The ________ maneuver can be done in the office to reproduce and therefore diagnose BPV.
Dix-Hallpike
What medication provides the best relief of BPV?
Meclizine
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?
Meniere’s Dz
What causes Meniere’s?
“endolymphatic hydrops” aka fluid buildup in the labyrinth system…most common onset in 20-40’s.
Rapid onset of vertigo with n/v and gait instability following a virus….
Vestibular neuritis
How will you tx vestibular neuritis?
steroids
How will you tx Meniere’s?
diuretic
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?
Acoustic Neuroma
Vestibular schwannoma
Construction man from before wants to know how serious this is, and what you are going to do about it…
Typically benign, tx only if symptoms are intolerable. Then the options include radiation or surgery
Name a few ototoxic meds:
GENTAMICIN
Pretty much anything that ends in “mycin”
Marcus Gunn Pupil. That is all you know….what should you be thinking?
optic neuritis–>MS
How do you tx acute MS exacerbation?
IV steroids, methotrexate
Vertigo a/w Posterior circulation problems….highest risk is with pt’s who have stroke risk.
vertebrobasilar insufficiency
Is vertebrobasilar insufficiency central or peripheral?
central….poor perfusion of posterior circulation will include CNS symptoms like ataxia, dysmetria
This is a vertigo diagnosis of exclusion in patients with a history of migraine. The vertigo symptoms can occur with or without headache
Migrainous vertigo
what are some broad things that might cause presyncope?
arrhythmia, vascular, metabolic, neuro-mediated, psych
Causes of disequilibrium:
1) head trauma
2) CNS problem (Parkinson’s/MS)
3) vision problem
4) post vertigo
5) sensory deficit (ex: DMII)
What part of the neuro exam is abnormal for patients with disequilibrium?
cerebellar signs
