Neuro - Dizziness Flashcards
What is dizziness?
Lightheaded, Vertigo, Off balance, Clumsy
Most common cause of dizziness in elderly?
Up to 38% in the elderly
multiple sensory defect dizziness (multiple problems vision impairment exacerbating it)
What is Vertigo?
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
Differentiate between upbeat and downbeat nystagmus
Upbeat: Cerebellar degeneration, brainstem/cerebellar stroke, demylination, tumors
Downbeat: Same but including, Arnold Chiari, MS, Alcohol, Lithium/AEDs
Upbeat nystagmus causes
Cerebellar degeneration, brainstem/cerebellar stroke, demylination
What is a pendular nystagmus?
No real fast jerk phase. Could be from acquired, from vision loss or spasmus nutans
What is spasmus nutans?
A pediatric disorder
ocular oscillation, head nodding, and head turning
What are some S&S of preseyncope?
What do you need to rule out for presyncope?
Near fainting, pallor maybe diaphoresis
Rule out heart disease (dysrhythmias, CAD, CHF)
How will a central vertigo be different from a peripheral vertigo?
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
Peripheral vertigo symptoms
Hearing lost, ear discharge, Tinitus
Plus nystagmus will be opposite, habituated and not vertical
Dix-Hallpike maneuver
Creates a vertigo in a patient with peripheral vertigo or central
Central will have no latent period and is not fatiguable
BPPV
Benign paroxysmal positional vertigo. (A dislodged canalithiasis)
Repeated, brief episodes that continue for weeks or months, and may recur. Aggravated by head movement.
Meniere Disease
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)
How do patients differ in BPPV and Meniere Disease
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.
Patient presents with sudden and severe vertigo, N/V and gait instability. No hearing loss.
Vestibular Neuritis
If unilateral hearing loss than viral labrynthitis
What are the antihistamines vertigo medications?
Meclizine
Promethazine
Dimenhydrinate
What are vertigo anticholinergics?
Scopolamine
What are the benzodiazepines?
Diazepam
Epley maneuver is used for what condition?
Benign paroxysmal positional vertigo
Ramsay Hunt Syndrome
Herpes zoster oticus
Acute vertigo and/or hearing loss
Ipsilateral face palsy
Ear pain and vesicles (on auricle)
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.
Acoustic neuroma
Key word in here is progressive and affecting cranial nerve VII palsy
Migrainous vertigo
Episodic vertigo in patients with history or Sx of migraines
What is syncope?
Often referred to as having a spell, the “vapors” or passing out
blurred vision, roaring sound, paleness, clamminess or sweating
Vasovagal Syncope
Triggered by pain, emotion, unpleasant experiences
Orthostatic Hypotension central or peripheral etiologies
diabetes mellitus, syrinx, syphilis, Shy-Drager syndrome, idiopathic orthostatic hypotension
Orthostatic Hypotension Tilt test
BP drops > 20 mm Hg systolic/10 mm Hg diastolic
Heart rate normally increases 11-29 bpm
Carotid Sinus Syncope
unusual carotid sinus sensitivity in elderly
Pressure on neck or tight collars
Diagnose with ECG
Convulsive Syncope
A seizure which is triggered by a rapid decline in blood pressure
Rapid onset, in a sitting position, myoclonic movements, ECG decreased with rapid recovery and no incontinence
Syncope
Key things are rare incontinence and rapid recovery
Extremely rapid onset, in any position, wide variety of movements, normal ECG, with slow recovery and incontinence
Seizure
Key things are very rapid onset but a slow recovery. With incontinence
40% of all dizziness is caused by…
…Peripheral vestibular dysfunction
Distinguish vertigo with presyncope.
Vertigo is a spinning or a sensation of movement. Associated with vestibular system
Presyncope is a near fainting or lightheadedness. Associated with cardiovascular system
