Exam 2: Dizziness – Vertigo and Presyncope Flashcards
Presyncope vs. Vertigo
Presyncope
- Feelings of lightheadedness
- Cardiac etiologies (most common)
- Sudden onset, brief duration (most common)
Vertigo
- Feeling of room spinning (false sense of motion)
- Central and Peripheral processes can cause vertigo
Presyncope
Presyncope:
- Feelings of lightheadedness, losing consciousness, or blacking out
- Due to cardiac/cardiovascular events/processes with possible effects on oxygen delivery/blood flow to brain
(Arrhythmias, Orthostatic Hypotension, Hyperventilation)
• Sudden onset, brief duration (most common)
Vertigo
Vertigo:
- Feeling of room spinning; false movement
- Central and peripheral processes can result in vertigo
- Central: involves the brainstem or cerebellum
- Peripheral: includes problems affecting labyrinth or vestibular nerve
Unilateral lesions result in sudden imbalance** in **vestibular inputs.
Bilateral lesions result in imbalance and instability of vision when head moves
Disequilibrium
Disequilibrium:
• Off-balance or wobbly
Lightheadedness
Lightheadedness:
• Vague symptoms, often feeling disconnected with the environment.
Nystagmus
- _____ is almost always accompanied by nystagmus or _____ oscillation of the eyes.
- Nystagmus is generally _____ movement in one direction followed by _____ direction in the other direction. Nystagmus is named depending on the direction of the _____ direction.
Nystagmus:
- Vertigo is almost always accompanied by nystagmus** or **rhythmic oscillation of the eyes.
- Nystagmus is generally slow movement in one direction followed by fast direction in the other direction. Nystagmus is named depending on the direction of the fast direction.
Nystagmus
- Vestibular nystagmus can be due to ______ lesions; is primary _____; ___directional – _____ from vestibular lesion.
- Nystagmus is often greater when looking in the direction of the _____ phase.
Nystagmus:
- Vestibular nystagmus can be due to central or peripheral lesions; is primary horizontal**; _uni_directional** – away from vestibular lesion.
- Nystagmus is often greater when looking in the direction of the quick phase.
Nystagmus
- Central nystagmus (e.g. with _____ dysfunction) often changes direction depending on _____. Beat is _____ of gaze.
- Gaze-evoked nystagmus is often _____ in amplitude and _____ than vestibular nystagmus.
- A type of gaze-evoked nystagmus can be seen normally in _____ gaze. This is not associated with vertigo or dizziness.
Nystagmus:
- Central nystagmus** (e.g. with **cerebellar dysfunction) often changes direction depending on where** the **patient is looking (i.e. gaze-evoked nystagmus). Beat is indirection of gaze.
- Gaze-evoked nystagmus is often larger** in **amplitude** and **coarser than vestibular nystagmus.
- A type of gaze-evoked nystagmus can be seen normally in extreme gaze. This is not associated with vertigo or dizziness.
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
What is the direction of the associated nystagmus?
Nystagmus:
• Peripheral
Unidirectional; Fast phase opposite* lesion
* (In Menieres disease, fast phase direction is variable)
• Central
Bidirectional (direction changing) or unidirectional
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Purely horizontal nystagmus without torsional component?
Nystagmus:
• Peripheral
Uncommon
• Central
May be present
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Purely vertical or purely torsional nystagmus?
*combined vertical-torsional nystagmus suggests ?
Nystagmus:
• Peripheral
Never present
• Central
May be present
*combined vertical-torsional nystagmus suggests BPPV
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Visual fixation inhibits?
Nystagmus:
• Peripheral
Visual fixation inhibits nystagmus
• Central
No inhibition
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Tinnitus and / or deafness?
Nystagmus:
• Peripheral
Often present
• Central
Usually absent
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Associated C.N.S. abnormalities?
Nystagmus:
• Peripheral
None
• Central
Extremely common
(diplopia, hiccups, cranial neuropathies, dysarthia)
Nystagmus: Peripheral (Labyrinth or Vestibular Nerve)
vs. Central (Brainstem or Cerebellum)
Common causes?
Nystagmus:
• Peripheral
Benign paroxysmal positional vertigo (BPPV), infection (labyrinthitis), vestibular neuritis, Menieres disease, labyrinth ischemia, trauma, toxin
• Central
Vascular, demyelinating, neoplasm
Dix-Hallpike
Tests for ?
Dix-Hallpike:
Tests for:
• Benign paroxysmal positional vertigo (BPPV)* caused by otolith debris (canalith) floating in the semicircular canals (canalithiasis) or adhering to the cupula (cupulolithiasis)
• BPPV is due to posterior semicircular canal canalithiasis about 90% of the time.
Dix-Hallpike
How is it performed?
Dix-Hallpike:
Performed by:
• guiding the patient rapidly** from a sitting position with the head turned 45° to one side to a supine position.
• For torsional nystagmus, observation or video recording is more sensitive than electronystagmography (ENG). (Medscape)
Dix-Hallpike
With peripheral lesions, there is _____ delay before the onset of nystagmus and vertigo. Many sources indicate the nystagmus is horizontal or rotary (not vertical) an ____\_ change direction(s) when the patient remains in the same position. Adaptation (i.e. more brief an less intense) ______ with subsequent testing.
Central lesions have _____ delay in nystagmus and _____ adaptation. Nystagmus can be horizontal, rotary, or vertical and _____ change direction(s).
Dix-Hallpike:
With peripheral lesions, there is a delay before the onset of nystagmus and vertigo. Many sources indicate the nystagmus is horizontal or rotary (not vertical) an does not change directions when the patient remains in the same position. Adaptation occurs with subsequent testing.
Central lesions have no delay in nystagmus and no adaptation. Nystagmus can be horizontal, rotary, or vertical and may change direction.
Vertigo – Peripheral Conditions
Name some of the common peripheral conditions
Vertigo – Peripheral Conditions:
• Acute Prolonged Vertigo – Acute Labyrinthitis, Vestibular Neuritis
http://www.nejm.org/doi/full/10.1056/NEJM199809033391007
• Benign Paroxysmal Positional Vertigo http://www.nejm.org/doi/full/10.1056/NEJMcp1309481
http://www.nejm.org/doi/full/10.1056/NEJMcp021154
- Meniere’s Disease
- Vestibular Schwannoma (Acoustic Neuroma)
- Benign Vestibular Hypofunction
- Psychosomatic Dizziness
Vertigo – Central Conditions
Name some of the common central conditions
Vertigo – Central Conditions:
- Vertebrobasilar Stroke / TIA
- Neoplasia
- Encephalitis
- Demyelinating Disorder
Vertigo Treatment
Know and understand the treatments for Vertigo from the attached chart
Vertigo Treatment:
Know and understand the treatments for Vertigo from the attached chart
Meniere Disease
- Usually associated with _____ and nausea.
- Length of attacks?
- Due to imbalance between production and absorption ______.
- Aslo known as _____ _____.
- _____ _____ hearing loss.
- Has been treated with _____ restriction and _____
Meniere Disease:
- Usually associated with tinnitus and nausea.
- Longer attacks (hours)
- Due to imbalance between production and absorption endolyph.
- Aslo known as Endolymphatic hydrops.
- Fluctuating progressive hearing loss.
- Has been treated with salt restriction** and **diuretics
Benign Paroxysmal Positional Vertigo
- Secondary to _____
- _____ hearing loss
- _____ hereditary
- _____ test is used for clinical testing.
Benign Paroxysmal Positional Vertigo:
- Secondary to otholiths
- No hearing loss
- Some hereditary
- Dix-Hallpike test is used for clinical testing.
Acoustic Neuroma (Schawannoma)
- Common in _____ angle.
- Can be unilateral or bilateral
- Bilateral leads to consideration of _____.
Acoustic Neuroma (Schawannoma):
- Common in cerebellopontine angle.
- Can be unilateral or bilateral
- Bilateral leads to consideration of neurofibromatosis.
Acute Positional Vertigo
• Includes _____ neuritis
Acute Positional Vertigo:
• Includes vestibular neuritis
Vertebrobasilar Ischemia/Infarction
- Central
- What nuclei are affected?
Vertebrobasilar Ischemia/Infarction:
- Central
- What nuclei are affected? A bunch! lol I have no idea I will update this later! message me if you have a good explanation i can use.
