NEURO- DIZZY SYNCOPE Flashcards
What ROS questions are specific to Vertgo?
Is the room spinning, are you moving around room
What are Ros question specific to synconpe?
loss of balance
loss of orientation in space
What happens prior to fainting/syncope?
Presyncope- lightheadedness
+/- collapse
What are causes of dizziness?
anxiety stress, pathology, substance use, motion, autonomic dysfunction, dehydration,
What is the MC cause of dizzyness?
40% vestibular ○ 25% other ■ Presyncope ■ Disequilibrium ■ Hypoglycemia ■ Hyperventilation ■ Head trauma/whiplash
What are concerns with elderly dizziness?
Many MC-Vertigo 20% Central brainstem vestibular dysfunction peripheral neuropathy, parkinsonism, cerebellar disease, cervical myelopathy. Depression Cardia dz
What is the DDx for younger adults and dizzyness?
Psych Presyncope-dizziness only in the upright posture, pallor 50% somatization, 25% depression, 25% anxiety/panic, substance use, personality d/o; fibromyalgia,
What is the key differential in vertigo?
illusion of movement, not spinning,
exacerbation by head movement.
nystagmus- eye movement rapid
Ms. Jessica has tinnitus assoc with movement dizzyness? Which location is his vertigo?
PERIPHERAL- middle ear
ABSENT Neuro
Nystagmus:
Unidirection
Fast to normal ear
Fixation suppressed
Ms. Cassidy has ataxia and vomiting assoc with her vertigo? What location is a concern?
CENTRAL- CNS \+: HA, double vision, visual loss, slurred speech, numbness of the face or body, weakness, clumsiness
Nystagmus
REverses any direction
Fixation Normal
Neuro present
NO auditory dysfx
What is DDX if pt has Sweating + dizziness ?
sympathetics → Anxiety or Thyroid issue
W/u
TSH
Blood glucose
What is DDX if pt Tinnitus or hearing loss +dizzy?
Meniere’s disease
What is DDX if pt Ataxia + dizzy?
cerebellum
CT or MRI
associated dysarthria and eye signs, such as gaze-evoked nystagmus, poor smooth pursuit, and downbeat nystagmus. If the cerebellar hemisphere is also involved, there will be incoordination of limbs.
What PE test are used for neuro DDX findings?
orthostatic changes
gait
nystagmus
During Weber test, Mr. space has hearing towards affected ear? What may that indicate?
CONDUCTIVE LOSS
TX cereumen removal
During Weber test, Mr. Air has hearing towards UNaffected ear? What may that indicate?
SENSIONEURAL LOSS
During Rinne’s the Pt hears the air more than vibration on mastoid?
NORMAL
During Rinne’s the Pt hears the vibration more than aire
Bone conduction greater than air=
CONDUCTIVE LOSS
A 38 yo female c/o dizziness x 2 days. She rolled over to get out of bed and has been episodic
with head movement. She describes the room as spinning and reports nausea, no vomiting. She had a URI last week, denies sinus pressure or fever. ROS neg.
BPPV- PERIPHERAl
MC elderly
W/u: Dixpike +
TX- Particle repositioning maneuevers
meclizine (dramamine)
REFER-Neuro sx develop
ENT if persistent peripheral vertigo
Why is dizzy with movement indicated vestibular problem?
endolymph in the inner ear moves with head movement and stimulate the hair cells → brain interprets how we are moving in space
What cause of vertigo is indicated below Time: single episode, last days CP: URI Nystagmus: Peripheral, toward normal ear Neuro sx: side of lesin, no brainstem Auditory:NOne Findings: Head thrust Normal
labrynthitis (vestibular neuritis)
What cause of vertigo is indicated below Time: single episode, last days CP: URI Nystagmus: Peripheral, toward normal ear Neuro sx: side of lesin, no brainstem Auditory:NOne Findings: Head thrust Normal
Meniere
What cause of vertigo is indicated below Time: seconds CP: sx w/ headmovement Nystagmus: Peripheral, toward normal ear Neuro sx: NONE Auditory: NONE Findings: + DixHalpike
Bening Paroxysmal position vertigo
What cause of vertigo is indicated below Time: recurrent, min-hrs CP: FHx. PMH, HA Nystagmus: Both Neuro sx: UL, n/v Auditory: NONE +/- Findings: Normal w/o sx
Migraine Vertigo
What cause of vertigo is indicated below Time: single recurrent, min-hrs CP: older, vascular risk, trauma Nystagmus: Central Neuro sx: brainstem sx Auditory: NONE +/- Findings: MRI lesion
TIA Vertebrebasillar
What cause of vertigo is indicated below Time: sudden, day-wks CP: older, vascular rsk, trauma Nystagmus: Central Neuro sx: brainstem, lateral medullary Auditory: +/- w/ cerebellar aa Findings: MRI lesion
Brainstem infraction
What cause of vertigo is indicated below Time: sudden, d-wks CP: older HTN Nystagmus: Peripheral, toward normal ear Neuro sx: gait, HA, dysphagia Auditory: NONE Findings: URGENT MRI/CT
Cerebellar infraction or hemorrhage
An 82 yo male with CAD s/p MI 2y. “nearly passing out” after breakfast. He was sitting in a chair, became diaphoretic & confused, which lasted a few mins then resolved; feels well now.
PE: orthostatic VS, Check vision, Complete neuro, complete CV/carotid /PV
DX-TIA d/t CAD and mental status
