Evaluation of the Dizzy Patient Flashcards
Define vertigo.
Vertigo is the illusion of movement. - It may be subjective (the patient feels like they are moving) or objective (the patient feels that the environment is moving).
Define presyncope.
Presyncope is a feeling of faintness or lightheadedness. It occurs with a global decrease in perfusion of the brain.
Define desequilibrium.
Disequilibrium is the feeling of being unsteady on ones feet.
What is Meniere Syndrome?
Meniere syndrome is a condition in which there is increased pressure in the endolymph of the inner ear (probably due to diminished resorption of endolymph). -This may result in “blowouts” of the membranes of the inner ear, with sudden attacks of vertigo lasting hours. - It usually also results in gradually progressive, low-pitch hearing loss, often with a humming or buzzing type of tinnitus.
What is Benign Paroxysmal Positional Vertigo?
- Benign paroxysmal postional vertigo is a condition in which some otoliths are free to move around the inner ear.
- They provoke sudden attacks of vertigo beginning after several seconds of delay and lasting less than a minute.
- Looking up at the ceiling, down at the floor or turning over in bed often provoke the symptom
- (Dix)Hall Pike (Nylan-Barany) maneuver often reproduces symptoms of vertigo and provokes rotatory nystagmus that also lasts less than a minute.
What is the canilith repositioning maneuver?
The canilith repositioning (Epley) maneuver is used to treat benign paroxysmal postional vertigo by moving the patient through a series of postions that move otoliths from the semicircular ducts into the utricles
What is a perilymph fistula?
Perilymph fistula is a condition in which there is a small tear in the wall separating the perilymph of the inner ear from the middle ear cavity.
- This is often near the round window. - Changes in pressure in the middle ear or in the fluids of the inner ear can provoke movement of fluid and symptoms of vertigo.
What is the Hennebert sign?
Hennebert sign is the provocation of vertigo by pressure introduced to the external ear canal via insufflation.
- This can be seen in perilymph fistula or Meniere syndrome.
- This is similar to a “fistula test.”
What is the fistula test?
A “fistula test” is the reproduction of vertigo by changing pressure (either increasing or decreasing) in the external ear canal through an otoscope. -This can provoke symptoms in perilymph fistula, but also in Meniere syndrome. -This is similar to Hennebert sign.
What is a chiari malformation?
Chiari malformation is the congenital herniation of the cerebellum through the foramen magnum.
- Results in vertigo and occipital headaches.
- There may be vertical nystagmus and, when severe, dysfunction of long tracts of the spinal cord.
What is an acoustic neuroma?
Acoustic neuroma is a relatively common, benign tumor that is comprised of Schwann cells of the vestibular nerve. - It is characterized by progressive hearing loss and some (usually mild) vertigo.
What types of dizziness are there?
- Vertigo (the illusion of movement) - Presyncope (light-headedness or faintness) - Disequilibrium (unsteadiness on the feet) - “other” (usually a floating type of sensation).
What questions would lead you to suspect that the patients “dizziness” is vertigo? presyncope? disequilibrium?
- Vertigo would be suggested by affirmative answer to the question: - “Does this feel like you are on an amusement ride?” - Significant nausea with the event. - Presyncope - Feel “faint, light-headed or “like passing out.” - Disequilibrium - “feeling unsteady on the feet” - Markedly improving when touching a stationary object.
What are the possible causes of vertigo?
There are peripheral causes and central causes.
- Peripheral causes => pathology of the inner ear or the vestibulocochlear nerve.
- Central => conditions affecting the caudal brain stem or vestibulocerebellum.
- Conditions that irritate the cerebral cortex, such as migraine or very rare seizures, can produce vertigo if they involve cortical locations that are involved in perception of motion.
How can you distinguish peripheral vertigo from that caused by damage to the central nervous system?
- Peripheral vertigo (damage to the inner ear or vestibulocochlear nerve):
- Nystagmus appears rotational and horizontal but is almost never in a vertical (up or down) direction.
- Imbalance is mild-moderate
- Central vertigo (cerebellum, vestibular nuclei and brain stem):
- Nystagmus is purely vertical, horizontal, or torsional.
- Imbalance is severe
