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Neuro 2 > Introduction to Vestibular Disease > Flashcards

Introduction to Vestibular Disease Flashcards

1
Q

Vertigo and imblanace vs/ presyncope and syncope

A

Presynciope and syncope almost never have inner ear etiology

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2
Q

Duration of BPPV
Meiere’s
Vestbiular Neuritis
Migraine

A

BPPV - less than a minute associated with head movmts

Men - episodic attacks 20 min -hrs

Vestibular neuritis - hrs to days receding to imabalance over weeks

Migrain - varaible

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3
Q

Rapid alternating mvmts
FInger to nose
Tandem gait
oculomotor mvmts

A

Dysdiadochokineisa
Dysmetria
Truncal ataxia could be vermis

Abnormal smooth purusit - flocculus
Saccadic dysmetria - vermis

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4
Q

Widened or shuffling gait means

A

Central

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5
Q

Romberg

A

Tests central balance

Could be abormal between labyrintheine attakc but normal between

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6
Q

Pronator drift

A

UMN disorders

IN CVA will be contralateral to side of CVA

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7
Q

Fukuda step test

A

Patient will drift toward side of lesion

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8
Q

Peripheral nystagmus

A

Jerk
Direction fixed
SUppresses with visual fixation

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9
Q

Central nystagmus

A

Purely vertical and direction changing

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10
Q

BPPV

A

Most iwhtout warning

Caused by canalithiasis (90% post semicricular cnaal)

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11
Q

BPPV clinical

A

Nausea and vomiting may accompany

Make sure they don’t confuse clustering of episode with long duration

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12
Q

BPPV diagnosis

A

Posterior - geotropic rotary nystagmus with affected ear down (90%)

Horizontal - pure horizonal nystagmus direction changing

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13
Q

Posterior BPPV vs. central positioning nystagmus

A

Posterior has latency of 5-20 secs, duration <60, fatiguje with repeated testing and reversed sitting upright…cupulothiasis may cause no latency and porlonged duration

Central - no associated vertigo

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14
Q

Tx of BPPV

A

Canal particle repositiong manuevers

Epley for posterior and log roll for horizontal

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15
Q

Post CRP instruction

A

Sleep upright for 48 and use recliner or pilows

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16
Q

Vestibular neuritis

A

Superior divison of nerve more common

Due to inflammation of vestibular nerve or labyrtinth

Could be from HSV1 or vascular ischmie a

17
Q

Presentation of vestibular neuritis

A

Acute - severe vertigo with n/v…lasts hrs - days…closing eyes may decrese but symptoms will still remain (unlike BPPV)

Subacute - more imbalance…especially pivoting and turing

18
Q

Acute labyrnthitis

A

Vestibular neuritis with hearing loss

19
Q

Vestibular neuritis exam

A

Acute phae will show nystagmus away from affected ear

No ataxia or other neurologic findings

20
Q

Signs of vestibular hypofunction

A

Leaning toward side of decreased function during Romberg

Migrate toward side on Fukuda step test

Head impulse toward affected side with catch up saccades

21
Q

Vest neuritis labs

A

Audiogram
VNG
Calorics

22
Q

Vest neuritis tx

A

Early coriticosteroids

Antiemetics or vestibular suppressants for acute but don’t want long term

23
Q

Meniere’s dz

A

Endolymphatic hydrops

Episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness

MRI to rule out retrocochlear lesion

24
Q

Meniere’s dz timeline

A

Unpredictable
Hearing loss initially fluctuates but gets worse as time goes on

Burns out

25
Q

Meniere’s dz bilateral

A

Not normal (10-15%)

Not simultaneously

Most likely manifest in first 2-5 years

26
Q

Vestibular migraine

A

h/o Migraine headache
h/o Motion sensitivity
FH of migraine heacahde

27
Q

Symptoms of vestbiular migraine

A

Imabalanced, staggering, sometimes vertigo

Visual triggers

Often is presenting symptoms of migrains

28
Q

Vestibular migraine duration

A

Varibale but most are 5-60 minutes…never really longer than a fday

29
Q

Tx of vestibular migraine

A

Beta blocker is first
TCA, Ca channel blockers, topiramate other options

Need prophylactic…abortinve does not work***

30
Q

Million dollar questions for BPPV, Meniere’s, vest migraine

A

BPPV - dizziness lying down or out of bed?

Meniere’s - Hearing change during attack?

Vestbiular migraine - light sensitive?

Neuro 2 (26 decks)

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