Hall dizziness lecture Flashcards
Sensation of motion when no motion is occuring
Vertigo
Sensation of disturbed spatial orientation
Dizziness
you have a patient that is sitting in front of you and you notice that their eyes are moving horizontally seemingly involuntarily, this is called?
Nystagmus
The oscillations of ones visual surroundings usually secondary to nystagmus is called
Oscillopsia
central vertigo originates in the ______. This can include a lesion of CN______
central vertigo originates in the CNS. This can include a lesion of CNVIII
a vertigo that is due to a disease that affects the labyrinth of the inner ear or the vestibular branch of CN VIII can is called _____
Peripheral vertigo
in contrast to peripheral vertigo central vertigo comes on ____
Slowly
Central vertigo may be ________ where peripheral may be _______ (referring to frequency)
Central: constant and progressive
Peripheral: episodic and recurrent
Your patient states that their vertigo is triggered if they turn their to the side and is relieved with motionlessness. From this description it is safe to assume that their veritgo is ______ in nature
Peripheral
Shit, your patients eyes are moving up and down vertically. This is bad. and idicative of what kind of vertigo
Central
a vertigo that is associated with tinnitus and nausea is _____
Peripheral
nystagmus associated with Central vertigo is _______ where peripheral is ______ (fatigable or not?)
Central: not fatigable
Peripheral: fatigable
What can cause both central and peripheral vertigo
trauma
vertigo associated with migraines is _______(central or periph?)
peripheral
Match the pathology with central or peripheral assocaited vertigo: CNS tumor Infection Vestibular neuritis Menieres disease BPPV acoustice neuroma MS
CNS tumor: C
Infection: C
Vestibular neuritis: P (think the vestibular part of the vestibularcochlear nerve)
Menieres disease: P
BPPV: P
Acoustic neuroma: C (think the cochlear part of the vestibularcochlear nerve)
MS: C
vertigo is often a benign complaint but these are some dangerous causes:
arrhythmia vascular pathology MI Hypoxemia Hypoglycemia AVM CVA
You’re at the grocery store and the 65 year old gentleman in front of you starts shouting ahhhhhhhhh! everything is spinning suddenly! instead of pretending to know nothing about medicine, you jump into action knowing that…..
usually sudden onset of sponaneous vertigo is coming from a dangerous cause especially for those over 60, may the odds be ever in his favor
though nystagmus is not always present with central vertigo, _______ and _______nystamus is indicative of a central cause
Direction changing, down beat
______ is the gold standard of dx for posterior canal BPPV
Dix hallpikes manuever
______ is the gold standard of dx for posterior canal BPPV
Dix hallpikes manuever (yes its on here twice, he was really stressing it!)
but do not perform if someone has spontaneus nystagmus
This test is 100 percent sensitive for the presence of a central lesion
HINTS:
HI: head impulse
N: nystagmus
TS: test of skew
Work up for a vertigo complaint
Labs: CMP CBC ESR
Imaging: CT, CTA (head and neck), MRI/ MRA
Other: EKG, Audiologic eval, ENG, VNG, Caloric testing (COWS)
Caloric testing
Cold or warm water into the ear canal. When cold water or cold air enters that ear and changes temp it will cause nystagmus
ENG (electronystagmogram)
measures nystagmus nad normal eye movements
VNG: Videonystagmography
documents a personal ability to follow visual objects
Meds for the treatment of vertigo itself (obviously tx underlying cause)
Antihistamines Anticholinergics Benzos Sympathomimetics epley manuever (for BPPV specifically)
Your patient presents with vertigo that she says lasts 30 minutes to two hours. this happens every couple of days. She also has some hearing loss and ringing in her ears. She states that there is some pressure feeling in her right ear from time to time. What is the most likely dx for this patient and what is the cause?
Menieres disease,
cause is unknown
how would you treat menieres dz
Low salt diet
diuretics (acetazolamine)
Meclizine or valium
your patient comes to the urgent care in very apparent discomfort. She has some gait ataxia and says she has been very very dizzy for about a week. This is following a URI the week prior to that. she has some tinnitus but that discomfort is nothing compared to her vertigo, what is the dx?
Viral labrynthitis. Sorry lady we cant do much for you, want some meclizine or diazepam?
vertigo lasting for only 1- several seconds, but happens multiple times per day.
It is caused by a vasculpression of the vestibular nerve., similar to trigeminal neuralgia and is similarly treated with carbamazepine. Nystagmus is provoked by hyperventilation
Vestibular paroxysmia
as many as _____ percent of migraine patients experience dizziness with their migraines.
50
The four criteria for a patient to meet for a vestibular migraine
- meet criteria set forth by the International headache society
- Episodic or fluctuating symptoms suggestive of a balance disorder
- no other neuro-otologic diagnosis
- Experience migraine symptoms during periods of vertigo or imbalace
you have a 76 year old patient present with symptoms that SEEM like BPPV. He has no nystagmus with dix-hallpike. Should you get a CT?
YAS! that mofo had an aortic dissection caught on CT of head and neck
The mortality of a type 1 debakey aortic dissection increases _____% per hour
6 percent
which of the following is a characteristic of central vertigo?
A. Symptoms are not triggered by motion/ head postion
B. Symptoms are triggered by motion/ head position
C. Nystagmus us fatiguable and horizontal
symptoms are sudden and episodic
A
At what degree of rotation do you hold the patients head during the dix-hallpike’s manuever?
45 degrees
What is a positive dix-halpike
a. patient has relief of symptoms
b. patient exhibits torsional fatiguable nystagmus
c. patient experiences no change in symptoms
d. provider feels audible crack in the patients cervical spine
B.
Which of the following is most likely to produce central vertigo symptoms over peripheral vertigo symptoms? A. Meniers b. vestibular neuritis c. migrainous vertigo d. acoustic neuroma
D
