Neuro - Dizziness

Question 1

What is dizziness?

Answer 1

Lightheaded, Vertigo, Off balance, Clumsy

Question 2

Most common cause of dizziness in elderly?

Up to 38% in the elderly

Answer 2

multiple sensory defect dizziness (multiple problems vision impairment exacerbating it)

Question 3

What is Vertigo?

Answer 3

Any false sensation of movement (of the body or environment) commonly spinning but can be swaying or tilting.

Caused by a dysfunction of the vestibular system

Question 4

Differentiate between upbeat and downbeat nystagmus

Answer 4

Upbeat: Cerebellar degeneration, brainstem/cerebellar stroke, demylination, tumors

Downbeat: Same but including, Arnold Chiari, MS, Alcohol, Lithium/AEDs

Question 5

Upbeat nystagmus causes

Answer 5

Cerebellar degeneration, brainstem/cerebellar stroke, demylination

Question 6

What is a pendular nystagmus?

Answer 6

No real fast jerk phase. Could be from acquired, from vision loss or spasmus nutans

Question 7

What is spasmus nutans?

Answer 7

A pediatric disorder

ocular oscillation, head nodding, and head turning

Question 8

What are some S&S of preseyncope?

What do you need to rule out for presyncope?

Answer 8

Near fainting, pallor maybe diaphoresis

Rule out heart disease (dysrhythmias, CAD, CHF)

Question 9

How will a central vertigo be different from a peripheral vertigo?

Answer 9

In central vertigo the nystagmus will change directions and can be immediate. It also will not have habituation. It will be in any direction. Involves brainstem and cerebellum. and will include other CNS clinical findings (weakness, ataxic gait, headache, diplopia, incoordination, slurred speech)

Delayed nystagmus that habituates. Horizontal or rotatory but peripheral will not be vertical. Fast phase is towards normal ear. Hearing loss or tinnutus

Question 10

Peripheral vertigo symptoms

Answer 10

Hearing lost, ear discharge, Tinitus

Plus nystagmus will be opposite, habituated and not vertical

Question 11

Dix-Hallpike maneuver

Answer 11

Creates a vertigo in a patient with peripheral vertigo or central

Central will have no latent period and is not fatiguable

Question 12

BPPV

Answer 12

Benign paroxysmal positional vertigo. (A dislodged canalithiasis)
Repeated, brief episodes that continue for weeks or months, and may recur. Aggravated by head movement.

Question 13

Meniere Disease

Answer 13

endolymphatic hydrops
Vertigo, Unilateral tinnitus, deafness
Vertigo lasts minutes to hours

Caused by increase in endolumphatic volume with ballooning of the cochlear duct (utricule and saccule)

Question 14

How do patients differ in BPPV and Meniere Disease

Answer 14

Meniere is associated with nausea and vomiting. BPPV is not. Meniere vertigo lasts minutes to hours while BPPV is positional and rarely lasts more than a minute.

Question 15

Patient presents with sudden and severe vertigo, N/V and gait instability. No hearing loss.

Answer 15

Vestibular Neuritis

If unilateral hearing loss than viral labrynthitis

Question 16

What are the antihistamines vertigo medications?

Answer 16

Meclizine
Promethazine
Dimenhydrinate

Question 17

What are vertigo anticholinergics?

Answer 17

Scopolamine

Question 18

What are the benzodiazepines?

Answer 18

Diazepam

Question 19

Epley maneuver is used for what condition?

Answer 19

Benign paroxysmal positional vertigo

Question 20

Ramsay Hunt Syndrome

Answer 20

Herpes zoster oticus
Acute vertigo and/or hearing loss
Ipsilateral face palsy
Ear pain and vesicles (on auricle)

Question 21

65 year old male with progressive left sided tinnitus and hearing loss. He also complains of a vague swaying feeling. On exam he has a mild left facial droop.

Answer 21

Acoustic neuroma

Key word in here is progressive and affecting cranial nerve VII palsy

Question 22

Migrainous vertigo

Answer 22

Episodic vertigo in patients with history or Sx of migraines

Question 23

What is syncope?

Answer 23

Often referred to as having a spell, the “vapors” or passing out
blurred vision, roaring sound, paleness, clamminess or sweating

Question 24

Vasovagal Syncope

Answer 24

Triggered by pain, emotion, unpleasant experiences

Question 25

Orthostatic Hypotension central or peripheral etiologies

Answer 25

diabetes mellitus, syrinx, syphilis, Shy-Drager syndrome, idiopathic orthostatic hypotension

Question 26

Orthostatic Hypotension Tilt test

Answer 26

BP drops > 20 mm Hg systolic/10 mm Hg diastolic

Heart rate normally increases 11-29 bpm

Question 27

Carotid Sinus Syncope

Answer 27

unusual carotid sinus sensitivity in elderly

Pressure on neck or tight collars

Diagnose with ECG

Question 28

Convulsive Syncope

Answer 28

A seizure which is triggered by a rapid decline in blood pressure

Question 29

Rapid onset, in a sitting position, myoclonic movements, ECG decreased with rapid recovery and no incontinence

Answer 29

Syncope

Key things are rare incontinence and rapid recovery

Question 30

Extremely rapid onset, in any position, wide variety of movements, normal ECG, with slow recovery and incontinence

Answer 30

Seizure

Key things are very rapid onset but a slow recovery. With incontinence

Question 31

40% of all dizziness is caused by…

Answer 31

…Peripheral vestibular dysfunction

Question 32

Distinguish vertigo with presyncope.

Answer 32

Vertigo is a spinning or a sensation of movement. Associated with vestibular system

Presyncope is a near fainting or lightheadedness. Associated with cardiovascular system