Dizziness Flashcards
What is Vertigo?
Hallucination of movement
What causes Vertigo?
Disturbance of the vestibular system somewhere b/w receptor & the integrative sensory cortex
>90% peripheral
<10% CNS
What are the sx of Vertigo?
- Worse w/ movement
- Nystagmus
- N/V
- Gait disturbances/falls
- Hearing disturbances
- Sx worse in peripheral causes
What is Dysequilibrium?
- “Off balanced”
- Peripheral neuropathy
- Lost vibration in proprioception
Who gets Benign Paroxysmal Positional Vertigo?
Middle & older age adults
How long do the attacks last in Benign Paroxysmal Positional Vertigo?
Seconds to minutes
What precipitates the attacks in Benign Paroxysmal Positional vertigo?
- Movement
- Lying down
- Rolling over in bed
- Bending over
What sx are common during attacks in BPPV?
N/V & blurred vision
What improves sx in BPPV?
Remaining motionless
What is found on PE in BPPV?
- Normal neuro exam
- Maybe nystagmus during attack
- Baranay (Dix-Hallpike)
What is found on Baranay (Dix-Hallpike) test in BPPV?
- Latency (5-10sec)
- Fatiuges
- Adapts (habituates to repetition)
What causes BPPV?
Degenerative dz d/t free floating otoconia w/in the semicircular canals that trigger hair cells w/ certain movement initiating the vertigo
What are Otoconia?
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)
What is the best tx for BPPV?
Epley’s (canalith repositioning) maneuver
What are some other tx for BPPV that don’t have much support?
Antihistamines, anticholinergics or surgical therapies
Where is the membranous Labyrinth located?
Imedded in the pertrous ridge of temporal bone
Who can get Labyrinthitis?
Any age & gender
What is the duration of Labyrinithitis?
Measured in days. 2/3 of time its a monophasic illness & 1/3 it may be recurrent
What is an assoc sx of Labyrinthitis?
Maybe some hearing loss
What can aggravate Labyrinthitis?
Movement
What will be found on PE in Labyrinithitis?
- Maybe nystagmus
- Gait disorder
- Rinne: AC> BC (normal)
- Weber: doesn’t lateralize
What causes the sx assoc w/ Labyrinithitis?
Asymmetrical vestibular input to integrative cortex resulting from the viral infection
What is the tx for Labyrinithitis?
- Same as any acute viral infection
- Bed rest as needed
- IV fluids if N/V is severe
What causes recurrent conditions of Labyrinthitis?
Injury to nerves in labyrinth
What is the Triad of sx in Meniere’s dz?
- Vertigo
- Tinnitus
- Hearing loss
What other sx may be assoc w/ Meniere’s dz?
- Sense of fullness in ear (edema in vestibule)
- N/V
- Gait instability
- Blurred vision
Who gets Meniere’s dz?
Middle aged adults
What is found on PE during attacks of Meniere’s dz?
Pts may be unable to walk & may have nystagmus
Sensori-neural hearing loss
What is found on PE in b/w attacks of Menier’s dz?
Normal neurologial exam except for S-N hearing loss
What are the technical features of Meniere’s dz?
- S-N hearing loss on audiometrics
- Electronystagmogrpahy (ENG) may be helpful
What are the tx for Meniere’s dz?
- Low sodium diet
- Diuretics
- Surgery
- Antivertigo sx tx
Who gets Acoustic Neruomas?
Middle age to older adults
What is the duration of attacks in Acoustic Neuromas?
Progressively longer over time
What are the assoc sx of Acoustic Neuroma?
- Hearing loss
- Tinnitus
- Facial numbness
- Facial weakness
- Usually unilateral but may be bilateral in NF type 2
What will be MAY BE found on PE in Acoustic neuroma?
- Nystagmus
- Baranay (Dix-Hallpike)
- SN hearing loss
- Facial numbness
- Facial weakness
- Ipsilateral ataxia
What is found on Banray (Dix-Hallpike) test in Acoustic neuroma?
- No latency (dizzy immediately)
- No fatigue
- No adaptation
What are the technical features of Acoustic neuroma?
- 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
What structures are located at the cerebello-pontine angle?
- Cerebellum
- Pons
- CN V, VII & VIII
What is the MC neoplasm located at the cerebello-pontine angle?
Schwannoma or “Acoustic Neuroma”
What is the 2nd MC neoplasm to be located at the cerebello-pontine angle?
Meningioma
What sx are assoc w/ vertigo if the lesion is affecting the CNS rather than peripheral CN VIII?
Numbness, weakness or any sx not explained by CN VII dysfxn alone
Where do the vestibular ganglion fibers project?
Pons→ Brain stem thru the cerebello-pontine angle→ Thalamus→ BOTH hemispheres
What is the tx of Acoustic Neuroma?
- Antivertigo tx
- Definitive tx is surgical or laser-knife
- Surgery has high morbidity
Who gets Post-Traumatic Vertigo?
Any age or gender
What will be in the hx of Post-traumatic Vertigo?
Hx of head trauma proceding the vertigo
What is the duration of Post-traumatic vertigo?
Constant or intermittent
What will be found on PE in Post-traumatic vertigo?
- +/- nystagmus
- Unsteady gait during attacks
- Battle sign
What is Battle’s sign?
Mastoid ecchymosis suggesting basilar skull fx in middle cranial fossa & underlying brain trauma
What are the technical features of Post-traumatic vertigo?
- +/- brain imaging (CT or MRI) could show basilar skull fx in vicinity of labyrinth
- Electronystagmography could be helpful
What is the tx for post-traumatic vertigo?
sx vertigo tx
Who gets MS?
young adults
What sx would suggest CNS dyfxn in MS?
- Sensory disturbance
- Facial numbness or pain
- Focal weakness
What will be found on PE in MS?
ANY sx of CNS dysfx in a young adult w/ new onset vertigo should inc suspicion of MS
What are the technical features of MS?
Brain MRI w/ & w/o contrast***
CSF studies
How does MS cause vertigo?
Demyelinating fibers emanating from vestibular nucleus
Who does Cerebro-Vascular dz occur in?
Older age groups w/ multiple vascular RF
What is the duration of Cerebro-Vascular dz?
- Sudden onset
- <24 hrs: TIA
- <14 days: Reversible Ischemic Neuro Deficit (RIND)
- Longer if infarction has occured
What happens if the vascular even in cerebro-vascular dz effected the vestibular nucleus?
Since the nucleus is in the pons, there will be other signs of brain stem dysfx (UMN weakness, snesory or CN dysfxn)
What will be found on PE in Cerebro-vascular dz?
- 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
What are the technical features of cerebro-vascular dz?
- Normal MRI if labyrinth infarct
- ABN MRI if infarct of brain
Why can cerebro-vascular dz cause vertigo?
Vascular dz can affect the vestibular nucleus anywhere from the labyrinth in the inner ear to the integrative cortex
What is the tx for Cerebro-vascular dz?
Tx for stroke PLUS sx tx for vertigo
