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
Meniere's dz bilateral
Not normal (10-15%) Not simultaneously Most likely manifest in first 2-5 years
26
Vestibular migraine
h/o Migraine headache h/o Motion sensitivity FH of migraine heacahde
27
Symptoms of vestbiular migraine
Imabalanced, staggering, sometimes vertigo Visual triggers Often is presenting symptoms of migrains
28
Vestibular migraine duration
Varibale but most are 5-60 minutes...never really longer than a fday
29
Tx of vestibular migraine
Beta blocker is first TCA, Ca channel blockers, topiramate other options Need prophylactic...abortinve does not work***
30
Million dollar questions for BPPV, Meniere's, vest migraine
BPPV - dizziness lying down or out of bed? Meniere's - Hearing change during attack? Vestbiular migraine - light sensitive?