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Symptoms 2 > Dizziness > Flashcards

Dizziness Flashcards

1
Q

Mrs. Jones is a 67 year old woman with a PMH of smoking and HTN. She takes lisinopril 10mg daily. She presents to her primary physician complaining of dizziness. What is the first thing we need to do with this pt?

A

Have her define the dizziness.. what do you mean by dizzy?

Key to differentiate between vertigo from presyncope

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2
Q

define true vertigo

A

True vertigo should have an aspect of movement – spinning of self or room

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3
Q

Common shit people describe as dizziness

A
  • Presyncope
  • Unsteadiness of gait (peripheral neuropathy)
  • Blurry or double vision
  • Cloudy mentation - disorientation
  • Migraine aura
  • Seizure aura
  • Anxiety
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4
Q

You determine your pt has vertigo, what associated symptoms do you look for?

A
  • Cranial nerves
  • Hearing
  • Ataxia

• Cardiovascular

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5
Q

What is the difference between peripheral and central vertigo

A

Peripheral vertigo tends to have a delay after stimulation (a second or two) and does exhibit fatigue

C_entral vertigo_ has no delay and is usually much more profound and prolonged with little fatigue

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6
Q

• Imbalance in input from either inner ears, vestibular nuclei or vestibular tracts

  • Sensation of movement without any
  • Misperception of movements one is making
A

More ways to define vertigo

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7
Q

What do the following have in common?

BPPV
Meniere’s
Vestibular Neuronitis

Labyrinthitis
Direct trauma

A

All Peripheral causes of Vertigo

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8
Q

What do the following have in common?

Stroke – lateral medullary, cerebellum

Brainstem or cerebellar mass Medications
Migraine
MS

Anxiety

A

All central causes of vertigo

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9
Q

What part of the ear detects linear movment?

A

The maculae in the utricle and sacculae:

when otoconia and endolymph move over hair cells sends signal

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10
Q

Semicircular canals detect______ motion, each in its own plane.

A

angular

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11
Q

What are the labels in the image

A

• 1 = Lateral Semicircular Canal

  • 2 = Vestibule
  • 3 = Internal Auditory Canal
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12
Q

What are the labeled images

A
    1. Posterior Semicircular Canal
    1. Mastoids
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13
Q

Where are the superior and lateral vestibular nucleus located?

A

caudal pons

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14
Q

Where are the Medial and Inverior vesibular nucleus located?

A

Rostral Medulla

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15
Q

Pathway and function of Medial Vestibulospinal tract

A

helps balance in neck and axial muscles

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16
Q

Pathway and function of lateral vestibulospinal tract

A

Balance for ipsilateral proximal muscles

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17
Q

She describes two days of having a severe sensation of spinning when she sits up or rolls over, lies down or even when she turns to the left. She has to sit down or hold on and close her eyes to keep from falling or throwing up. It goes away after about 30 seconds. She does not have any hearing changes or other neurologic symptoms.

A

BPPV

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18
Q

You suspect your patient has BPPV based on her history, what is the next step?

A

Do a complete exam

• Look for nystagmus

Look for associated symptoms: ataxia, dyshpagia, diplopia, facial sensation loss, weakness, numbness, ect.

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19
Q

What types of nystagums are central?

A

Vertical and direction changing:

if there is no nystagmus, it’s NOT ear related

20
Q

If patient has vertigo as well as ataxia, what would you want to include on Ddx?

A

Cerebellar lesion

21
Q

What type of symptoms are suggestive of a brainstem stroke?

A

Dysphagia, diplopia, facial sensation loss, horners, skew deviation

22
Q

What special test do we do to dx Bppv?

A

Dix-Hallpike maneuvar

23
Q

How do you perform a Dix-Hallpike maneuver and what do you expect to see?

A

Drop the patient backwards and then turn the head sideways and down towards the floor

  • Ask the patient to look toward the floor and watch for nystagmus
  • In peripheral nystagmus you will see it develop after a few seconds and last for under a minute
24
Q

Pt has Peripheral vertigo with Long duration dizziness and hearing loss

A

Labryinthitis

25
Q

Pt has peripheral vertigo with Short duration dizziness and Hearing loss

A

Meniere’s Disease

26
Q

Pt has peripheral vertigo with intact hearing and Long duration dizziness

A

Vestibular Neuritis

27
Q

Pt has peripheral vertigo, intact hearing and short duration dizziness

A

BPPV

28
Q

What causes BPPV and what is a way to tx it?

A

cause by misplaced otolinth, can treat with the Epley maneuvar to try and get otolith back into utricle

29
Q

What would you want to look into if your patient informs you they feel dizzy when they are sitting for a time then stand up?

A

Suggestive of orthostatic hypotension: usually more lightheaded then vertigo:

check pts Medication, if they are Hyponatremic or dehydrated, have autonomic failure

30
Q

How do you test orthostasis correctly?

A

Start supine, then sitting, then standing with >3 minutes in each position prior to testing

• >20mmHG drop in SBP or >10mmHg drop in DBP after 3 minutes is diagnostic

Tilt table testing for autonomic insufficiency

31
Q

True vertigo (not lightheadedness) with standing up for a period of time

• Consider :

A

vertebrobasilar insufficiency

32
Q

What can cause vertebrobasilar insufficiency?

A

Stenosed or occluded vertebral arteries BILATERALLY or stenosed or occluded basilar

artery

Ischemia of vestibular nuclei in the pons and medulla can present with vertigo Often with other associated symptoms such as weakness, diplopia, dysarthria

33
Q

He describes the sensation of falling to the left which particularly occurs when he is walking. He often bumps into things when he walks. He feels like he is walking on a boat sometimes and sometimes feels himself swaying when he stands still. He has been dropping things in his left hand as well. He denies hearing changes and is not aware of any other neurologic symptoms.

DDx

A

Cerebellar ataxia, cerebellar stroke, alcoholism

Left side cerebellar lesion

Prion disease, MS, truama

34
Q

Your pt comes in with symptoms of a cerebellar lesion, you are thinking this may be due to a stroke. What imaging would you want done and why?

A

CT: quick and cheap and better for screening

or

MRI: masses, ischemia, and MS changes (go with this one)

35
Q

What is the differential dx for a solid enhansing mass in the posterior fossa?

A

May be glioblastoma, schwannoma, meningioma

36
Q

Mass is seen on MRI described as solid, enhancing and has a tail on it. Dx?

A

Meningioma: will have dural tails on them

often slow growing and benign

37
Q

What tumors are more commonly seen in children in the brainstem or cerebellum

A
  • Medulloblastoma
  • PNET
  • Pineal tumors
  • Ependymoma
  • Astrocytomas of BS and cerebellum (25% of kids tumors)

• Gliomas – almost exclusively children/young adults

38
Q

Metastases to the brain are more common in

A

adults

39
Q

What type of brain tumors cause extra-axial cerebellar compression?

A

Extra-axial cerebellar compression from meningioma, acoustic neuroma

40
Q

What are the signs and symptoms of a Lateral Medullary syndrome

A

dysphagia, Horner’s syndrome, ataxia, sensory loss, nystagmus, vertigo

41
Q

What age population is lateral medullary syndrome common in and what is the cause?

A

Seen in young people; often from vertebral artery dissection

42
Q

What do we see on MRI of ind with MS?

A

See plaques throughout CNS; show up bright white

43
Q

What type of meds cause Lightheadedness/presyncope

A
  • BP meds
  • Psych meds
  • Neuro meds
44
Q

What two drugs cause true vertigo

A

Phenytoin and ethenol lead to cerebellar degeneration

45
Q

What drugs will cause vestibulotoxicity?

A
  • Aminoglycosides–gentamicin,tobramycin
  • Chemotherapy–Cisplatin,vincristine

Symptoms 2 (11 decks)

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