Equilibrium and Dizziness - Cohen

Question 1

dizzy

Answer 1

vertigo vs. light-headed?

Question 2

dizziness

Answer 2

altered sense of orientation in space

Question 3

light-headed

Answer 3

blood flow to brain low

MC cause - hypotension

also medications

no cause - psychogenic dizziness

Question 4

vertigo

Answer 4

problem with vestibular system
-CN VIII

sense of room spinning

Question 5

MC cause of vertigo

Answer 5

peripheral - semicircular canals

central - brainstem/cerbellar - stroke, hemorrhage, MS, tumor, alcohol, degenerative, migraine

Question 6

benign paroxysmal positional vertigo

Answer 6

getting out of bed

• may cause N/V
• walking impaired

sometimes - recent cold or upper resp infection

full relief - being still

lasts 1-2 weeks - rarely more than 1 month

make sure they can walk

Question 7

BPPV pathology

Answer 7

detachment of otolithic crystals in macule of utricle or saccule

floating in semicircular canals

move these debris - sensation of vertigo

Question 8

diagnosis of BPPV

Answer 8

dix-hallpike maneuver
-quick head turn - sitting up and bring head down and to side

no hearing loss

Question 9

tx of BPPV

Answer 9

epley maneuver

meds - meclizine**, scopolamine patch, promethazine, diazepam

Question 10

menieres disease

Answer 10

recurrent attacks of vertigo, tinnitus, decline in hearing and sense of fullness or pressure in one ear

pt has hearing loss

terrible vertigo - less than hour - debilitating - immobilize patinet

endolymph expands - and bursts

Question 11

hearing loss

Answer 11

with menieres disease - eventually

Question 12

menieres tx

Answer 12

meclizine, promethazine, scopolamine

low salt diet - K sparing diuretic

surgical drainage

shunt for endolymph - hard to place

most patient - lose attack eventually w/out surgery

Question 13

migraines

Answer 13

one of MC causes of intermittent vertigo - young adults and children

Question 14

acoustic schwannoma

Answer 14

B9 tumor - or vestibular portion of CN VIII

pressure to deafness

hearing loss at first, then vertigo and HA

chronic sense of imbalance

roaring tinnitus - becomes constant - machine-like noises**

can then lose CN VII and V

Question 15

tx of acoustic schwannoma

Answer 15

surgical disease

gamma knife - smaller tumors

Question 16

B/L acoustic schwannoma

Answer 16

NF2

Question 17

cerebellar disease

Answer 17

ataxia

Question 18

ataxia

Answer 18

lack of coordination

inability to walk

Question 19

intention tremor

Answer 19

loss of direction or ability to control antagonist muscles of shoulder and arms

with cerebellar issue

Question 20

cerebellar stoke

Answer 20

sudden vertigo

not seen on CT for 24 hours

hard to walk after cerebellar stroke