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Internal Medicine > Dizziness > Flashcards

Dizziness Flashcards

1
Q

What symptoms may a patient experience which they call dizziness (4)

A

Vertigo
Lightheadedness
Syncope
Imbalance

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2
Q

Most common causes of vertigo (3)

A

Migraine-related
BPPV
Meniere’s

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3
Q

Categories of etiology

A 
Vestibular
Neurological
Cardiovascular
Psychological
Metabolic
Autoimmune
Drug related
Trauma/surgical
Infectious
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4
Q

Vestibular causes (7)

A
  1. Benign paroxysmal positional vertigo
  2. Meniere’s->episodic, fluct hearing loss, tinnitis, aural pressure/fullness
  3. Temporal bone fracture, hypothyroid (hydrops), syphillis
  4. Labrynthitis->URTI
  5. Superior semi-circular canal dishiscience
  6. Perilymphatic fistula
  7. Middle ear->OM, labrynthitis
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5
Q

Neurological causes

A 
Migraine related->history of migraines
Posterior fossa tumors->vestibular scwannomas, meningiomas
Multiple sclerosis->prolonged, spontaneous
Cerebellar stroke
Vertebrobasilar stroke
Wallenberg
Hereditary ataxias
BIH
Normal pressure hydrocephalus
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6
Q

How does vertebrobassilar stroke present

A

episodic vertigo lasting 1 to 15 minutes, with diplopia, dysarthria, ataxia, drop attack, and clumsiness of the extremities.

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7
Q

Clinical features of BIH->pseudotumor cerebri

A

raised intracranial pressure that is not caused by a mass lesion (e.g., a tumour); associated with headache and transient poor vision. These patients are often obese and complain of clumsiness, imbalance, and dizziness rather than true vertigo.

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8
Q

How does normal pressure hydrocephalus present

A

Ataxia
Urinary incontinence
Cognitive dysfunction

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9
Q

Cardiovascular causes

A

Syncope
Presyncope
Orthostatic hypotension
Autonomic dysregulation

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10
Q

Psychological

A

Psychophysiological->after labrynthe disorder

Psychogenic->agoraphobia, personality, anxiety

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11
Q

Metabolic causes

A

Diabetes->hypoglycemia

Hypothyroidism->+in patient’s with meniere’s

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12
Q

Autoimmune causes

A

Rheumatoid arthritis
Systemic lupu erythromatosous
Wegener’s
Bechet’s

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13
Q

Medication induced

A

Ototoxic drugs: gentamycin, neomycin
Chemotherapeutic->cisplatin
Alcohol
AntiHTN, anesthetic, antiarrythmia

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14
Q

Risk factors for medication induced

A

age >60 years, high serum drug levels, previous sensorineural hearing loss, concomitant renal impairment, attendant noise exposure, duration of therapy >10 days, and simultaneous administration of other ototoxic agents, such as loop diuretics or aspirin

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15
Q

Trauma causes

A

Post head injury

Complication of middle-ear surgery

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16
Q

Infectious causes

A 
Lyme disease
Syphillis
CMV
HSV-1
HIV
17
Q

Red flags

A 
Red flags
 Meniere's disease
 Vestibular neuritis
 Syncope or presyncope
 Labyrinthitis
 Cholesteatoma
 Posterior fossa tumour
 Multiple sclerosis
 Cerebellar stroke
 Vertebrobasilar insufficiency
 Wallenberg's syndrome
 Paraneoplastic cerebellar degeneration
 Lyme disease
 Syphilis
 HIV
18
Q

History- charactristics of current episode

A

Dizziness, vertigo or syncope
Vertigo better or worse with eyes closed/open (more central does not change)
Duration: seconds (BPPV), mins-hours (migraine, meniere’s, CV), hours-days (labrynthitis, neuritis, central)
Positional
Tinnitus or hearing loss: meniere’s, labrynthitis (sudden hearing loss, NV), MS, SLE, infections
How the episodes began: URTI, trauma, surgery
General symptoms
-chest pain, exertiona dyspnea
-aura, visual disturbance, photo/phonophobia, headache
-nausea
-gait, limb weakness, dysarthria
-diplopia, dysarthria, ataxia, drop
-ataxia, urinary, cognitive
-clumsy, imbalance, dizziness
Psychiatric

19
Q

History- identification of a cause

A 
Trauma/surgery
Medical illness-> DM, thyroid, MS, migraines
FHx of illness->migraine, ataxias
Contact with infectious
Medication and drugs
CVD risk factors
Neoplastic disease
20
Q

Physical examination

A
  1. Ear examination
  2. Eye: nystagmus, movements (palsies in MS, ICL), neurological signs (central)
  3. Clinical balance tests
    - Head impulse test->differentiates acute vestibular neuritis, cerebellar stroke
    - Dix-hallpike
  4. CNS
    - Cranial nerves
    - cerebellar
    - Gait
    - Rombergs
    - Limbs
    - Speech
  5. Cardiovascular
21
Q

What is the head impulse test

A

The examiner turns the patient’s head as rapidly as possible 15 degrees to one side and observes the patient’s ability to keep fixating on a distant target. With a peripheral vestibular lesion, a saccade occurs as the vestibulo-ocular reflex fails, the patient cannot keep focusing on the target, and a catch-up movement occurs. After a cerebellar stroke, no catch-up saccade occurs. The head-impulse test is negative (no saccadic adjustment of the eyes on sudden head twisting) in people with cerebellar stroke, ruling out acute vestibular neuritis or labyrinthitis.

22
Q

Describe the dix-hallpike

A

The test is performed by sitting the patient upright on a bed; for the right side, the examiner stands on the patient’s right side, rotates the patient’s head 45° to the right, and then moves the patient, whose eyes are open, to the supine right-ear down position, and then extends the patient’s neck slightly so that the chin points slightly upwards. Patient’s symptoms are noted and any nystagmus is observed

23
Q

Results in dix hallpike if central lesion

A

test causes nystagmus that is not fatigable, is down-beating, and is associated with minimal vertigo.

24
Q

What is the supine roll test and when is it performed

A

If the Dix-Hallpike test is negative in a patient who has a history suggestive of BPPV

positioning the patient supine with the head in the neutral position, then quickly rotating the head 90° to one side –>?nystagmus.
The head is returned to the face up position, allowing all dizziness and nystagmus to subside; the head is then turned rapidly to the opposite side

25
Q

Findings in wallenbergs (5)

A

occlusion of the ipsilateral vertebral artery that supplies the posterior inferior cerebellar artery) causes:

  1. prolonged vertigo,
  2. abnormal eye movements,
  3. ipsilateral Horner’s syndrome,
  4. ipsilateral limb ataxia, and
  5. loss of pain and temperature sensation of the ipsilateral face and contralateral trunk
26
Q

Investigations and findings

A
  1. Audiogram
  2. CT->if suspect SSCD
  3. MRI->posterior fossa tumor, cerebellar stroke, MS, head injury
  4. ECG, echo, 24 hour holter, tilt-table
  5. Special blood tests depending on history: antibodies, thyroid glucose, drug levels
27
Q

Medications that cause orthostatic hypotension

A

Antihypertensives
Antidepressants
Anticholinergics

Internal Medicine (67 decks)

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