Exam 4 Vertigo Flashcards
Lightheaded is?
Vague, non-specific dizziness
Vertigo is?
Sensation of abn mvmt: spinning, falling
Vertigo caused by:
Peripheral?
Central?
Vestibular lesion
Central (brainstem) lesion
Peripheral Vertigo presentation? (4)
Acute onset
Hearing loss/tinnitus
Nystagmus (horizontal or torsional)
No neural sxs
Central Vertigo presentation? (5)
Gradual/progressive Rarely ear sxs Nystagmus in any direction (vertical) Neuro sxs: diplopia, ataxia, dysarthria P HA, N/V
Disequilibrium is?
P contributing factors? (3)
Sense of imbalance/gait difficulty
Visual acuity
Peripheral neuropathy
Degenerative joint dz
Approach to dizzy pt? (3)
Define dizziness
OLDCARTS
r/o cerebrovascular, MS, acoustic neuroma
Approach to dizzy pt: Pertinent ROS? (12)
Pertinent ROS: Meds/drugs/etoh Allergies Stress N/V Hearing HA, aura Vision Seizure Motor weak Trauma DM, HTN, migraines, URI Psych hx
Nystagmus is?
Slow drift in one direction followed by fast response in other direction
Horizontal nystagmus caused by?
peripheral or metabolic
Horizontal/torsional nystag caused by?
peripheral or positional
Vertical nystag caused by?
CNS
Hallpike maneuver is?
Sitting, turn head one direction, quickly lay
Supine w/ head turned same direction and head off table -> watch for nystag
Repeat on other side
Hallpike results tell us?
Ear issue if:
1) Latency – delay of up to 20 seconds before onset
of nystagmus
2) Fatigueability – nystagmus fades if head held in provoking position
3) Habituation – repeating DH test produces less vigorous response
Otherwise CNS
Audiometry is?
Tells us?
Test hearing
Sensory Neural vs Conduction loss
Caloric Testing is?
Tells us?
Cold or warm H2O in ear
Normal response COWS: Cold Opposite, Warm Same.
Cold water = FAST phase of nystagmus to the side Opposite cold water
Warm water = FAST phase of nystagmus to the side Same as warm water
Impaired or absent fast nystag = labyrinth pathology on irrigated side
Benign Paroxysmal Positional Vertigo (BPPV) is?
Most C inner ear cause of vertigo
Head position changes
BPPV presentation? (2)
Caused by?
Transient (< 1 min) episodes
Self-limited (wks-months)
No hearing change
PE normal
U Prolonged bed rest or head trauma dislodging CaCO3
BPPV test how?
Hallpike
BPPV mgmt? (3)
Reassurance self-limited
OT
Anti-vertigo meds
Vestibular Suppressants? (4)
Antichol
Antihist
Phenothiazines (phenergan)
BZs
Vestibular Neurontitis is?
Presentation? (6)
Single attack of vertigo
Last 2-3 days a/w Viral URI Falling to affected side N/V P nystag NO hearing changes
Vestibular Neurontitis testing?
Audiogram = N
Caloric testing = +
Vestibular Neurontitis tx?
Vest suppressants
Prednisone x 10 days
Meniere’s Dz is?
Ruptured labyrinth causing paralysis of vest nn and degeneration of hair cells
Meniere’s Dz presentation? (4)
Sudden attacks
Triad:
Episodic vertigo
Tinnitius
Fluctuating hearing loss (eventually irreversible)
Full ear
N/V
Meniere’s Dz testing?
Audiogram = Sensory Neural loss (low tones then high)
Meniere’s Dz tx: Acute? (3)
Prophy? (2)
Refractory? (3)
Rest
Antiemetics
Vest supp
Low salt
HCTZ diuretic
Endolymphatic shunt
Vest nn sectoning
Labyrinth ablation
Perilymphatic Fistula is?
a/w?
Abn connection b/w perilymph and middle ear
Inner ear fluid leaks into middle ear
Sudden ∆ in middle ear pressure
Perilymphatic Fistula presentation? (3)
Hearing loss
Tinnitus
P vertigo
Perilymphatic Fistula testing?
pneumatic otoscopy = eye mvmt w/ pressure ∆
Perilymphatic Fistula tx? (4)
Rest
Hydration
Sxs
Surgery
