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Neurologic Conditions > Dizziness > Flashcards

Dizziness Flashcards

1
Q

What is Vertigo?

A

Hallucination of movement

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2
Q

What causes Vertigo?

A

Disturbance of the vestibular system somewhere b/w receptor & the integrative sensory cortex

>90% peripheral

<10% CNS

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3
Q

What are the sx of Vertigo?

A
  • Worse w/ movement
  • Nystagmus
  • N/V
  • Gait disturbances/falls
  • Hearing disturbances
  • Sx worse in peripheral causes
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4
Q

What is Dysequilibrium?

A
  • “Off balanced”
  • Peripheral neuropathy
  • Lost vibration in proprioception
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5
Q

Who gets Benign Paroxysmal Positional Vertigo?

A

Middle & older age adults

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6
Q

How long do the attacks last in Benign Paroxysmal Positional Vertigo?

A

Seconds to minutes

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7
Q

What precipitates the attacks in Benign Paroxysmal Positional vertigo?

A
  • Movement
  • Lying down
  • Rolling over in bed
  • Bending over
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8
Q

What sx are common during attacks in BPPV?

A

N/V & blurred vision

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9
Q

What improves sx in BPPV?

A

Remaining motionless

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10
Q

What is found on PE in BPPV?

A
  • Normal neuro exam
  • Maybe nystagmus during attack
    • Baranay (Dix-Hallpike)
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11
Q

What is found on Baranay (Dix-Hallpike) test in BPPV?

A
  • Latency (5-10sec)
  • Fatiuges
  • Adapts (habituates to repetition)
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12
Q

What causes BPPV?

A

Degenerative dz d/t free floating otoconia w/in the semicircular canals that trigger hair cells w/ certain movement initiating the vertigo

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13
Q

What are Otoconia?

A

Calcified particles in inner ear that send info to the brain in regards to gravitational pull or verticle movement

(exerts pressure on hair cells to allow you to perceive up & down movement)

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14
Q

What is the best tx for BPPV?

A

Epley’s (canalith repositioning) maneuver

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15
Q

What are some other tx for BPPV that don’t have much support?

A

Antihistamines, anticholinergics or surgical therapies

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16
Q

Where is the membranous Labyrinth located?

A

Imedded in the pertrous ridge of temporal bone

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17
Q

Who can get Labyrinthitis?

A

Any age & gender

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18
Q

What is the duration of Labyrinithitis?

A

Measured in days. 2/3 of time its a monophasic illness & 1/3 it may be recurrent

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19
Q

What is an assoc sx of Labyrinthitis?

A

Maybe some hearing loss

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20
Q

What can aggravate Labyrinthitis?

A

Movement

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21
Q

What will be found on PE in Labyrinithitis?

A
  • Maybe nystagmus
  • Gait disorder
  • Rinne: AC> BC (normal)
  • Weber: doesn’t lateralize
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22
Q

What causes the sx assoc w/ Labyrinithitis?

A

Asymmetrical vestibular input to integrative cortex resulting from the viral infection

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23
Q

What is the tx for Labyrinithitis?

A
  • Same as any acute viral infection
  • Bed rest as needed
  • IV fluids if N/V is severe
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24
Q

What causes recurrent conditions of Labyrinthitis?

A

Injury to nerves in labyrinth

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25
Q

What is the Triad of sx in Meniere’s dz?

A
  • Vertigo
  • Tinnitus
  • Hearing loss
26
Q

What other sx may be assoc w/ Meniere’s dz?

A
  • Sense of fullness in ear (edema in vestibule)
  • N/V
  • Gait instability
  • Blurred vision
27
Q

Who gets Meniere’s dz?

A

Middle aged adults

28
Q

What is found on PE during attacks of Meniere’s dz?

A

Pts may be unable to walk & may have nystagmus

Sensori-neural hearing loss

29
Q

What is found on PE in b/w attacks of Menier’s dz?

A

Normal neurologial exam except for S-N hearing loss

30
Q

What are the technical features of Meniere’s dz?

A
  • S-N hearing loss on audiometrics
  • Electronystagmogrpahy (ENG) may be helpful
31
Q

What are the tx for Meniere’s dz?

A
  • Low sodium diet
  • Diuretics
  • Surgery
  • Antivertigo sx tx
32
Q

Who gets Acoustic Neruomas?

A

Middle age to older adults

33
Q

What is the duration of attacks in Acoustic Neuromas?

A

Progressively longer over time

34
Q

What are the assoc sx of Acoustic Neuroma?

A
  • Hearing loss
  • Tinnitus
  • Facial numbness
  • Facial weakness
  • Usually unilateral but may be bilateral in NF type 2
35
Q

What will be MAY BE found on PE in Acoustic neuroma?

A
  • Nystagmus
    • Baranay (Dix-Hallpike)
  • SN hearing loss
  • Facial numbness
  • Facial weakness
  • Ipsilateral ataxia
36
Q

What is found on Banray (Dix-Hallpike) test in Acoustic neuroma?

A
  • No latency (dizzy immediately)
  • No fatigue
  • No adaptation
37
Q

What are the technical features of Acoustic neuroma?

A
  • Brain MRI w/ & w/o contrast reveals mass at either cerebello-pontine angle or w/in the internal auditory canal
  • ABN brainstem auditory evoked potentials
38
Q

What structures are located at the cerebello-pontine angle?

A
  • Cerebellum
  • Pons
  • CN V, VII & VIII
39
Q

What is the MC neoplasm located at the cerebello-pontine angle?

A

Schwannoma or “Acoustic Neuroma”

40
Q

What is the 2nd MC neoplasm to be located at the cerebello-pontine angle?

A

Meningioma

41
Q

What sx are assoc w/ vertigo if the lesion is affecting the CNS rather than peripheral CN VIII?

A

Numbness, weakness or any sx not explained by CN VII dysfxn alone

42
Q

Where do the vestibular ganglion fibers project?

A

Pons→ Brain stem thru the cerebello-pontine angle→ Thalamus→ BOTH hemispheres

43
Q

What is the tx of Acoustic Neuroma?

A
  • Antivertigo tx
  • Definitive tx is surgical or laser-knife
  • Surgery has high morbidity
44
Q

Who gets Post-Traumatic Vertigo?

A

Any age or gender

45
Q

What will be in the hx of Post-traumatic Vertigo?

A

Hx of head trauma proceding the vertigo

46
Q

What is the duration of Post-traumatic vertigo?

A

Constant or intermittent

47
Q

What will be found on PE in Post-traumatic vertigo?

A
  • +/- nystagmus
  • Unsteady gait during attacks
    • Battle sign
48
Q

What is Battle’s sign?

A

Mastoid ecchymosis suggesting basilar skull fx in middle cranial fossa & underlying brain trauma

49
Q

What are the technical features of Post-traumatic vertigo?

A
  • +/- brain imaging (CT or MRI) could show basilar skull fx in vicinity of labyrinth
  • Electronystagmography could be helpful
50
Q

What is the tx for post-traumatic vertigo?

A

sx vertigo tx

51
Q

Who gets MS?

A

young adults

52
Q

What sx would suggest CNS dyfxn in MS?

A
  • Sensory disturbance
  • Facial numbness or pain
  • Focal weakness
53
Q

What will be found on PE in MS?

A

ANY sx of CNS dysfx in a young adult w/ new onset vertigo should inc suspicion of MS

54
Q

What are the technical features of MS?

A

Brain MRI w/ & w/o contrast***

CSF studies

55
Q

How does MS cause vertigo?

A

Demyelinating fibers emanating from vestibular nucleus

56
Q

Who does Cerebro-Vascular dz occur in?

A

Older age groups w/ multiple vascular RF

57
Q

What is the duration of Cerebro-Vascular dz?

A
  • Sudden onset
  • <24 hrs: TIA
  • <14 days: Reversible Ischemic Neuro Deficit (RIND)
  • Longer if infarction has occured
58
Q

What happens if the vascular even in cerebro-vascular dz effected the vestibular nucleus?

A

Since the nucleus is in the pons, there will be other signs of brain stem dysfx (UMN weakness, snesory or CN dysfxn)

59
Q

What will be found on PE in Cerebro-vascular dz?

A
  • Labyrinth ischemia neuro exam is normal except vertigo findings
  • ABN CN exam, sensory exam & motor exam if ischemia involves the vestibular nucleus in the pons
60
Q

What are the technical features of cerebro-vascular dz?

A
  • Normal MRI if labyrinth infarct
  • ABN MRI if infarct of brain
61
Q

Why can cerebro-vascular dz cause vertigo?

A

Vascular dz can affect the vestibular nucleus anywhere from the labyrinth in the inner ear to the integrative cortex

62
Q

What is the tx for Cerebro-vascular dz?

A

Tx for stroke PLUS sx tx for vertigo

Neurologic Conditions (15 decks)

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