Neurology_Dizziness and Syncope

Question 1

What is dizziness?

Answer 1

A subjective sensation of movement of the head and/or body

• vertigo
• presyncope
• disequilibrium

Question 2

What are the common causes of dizziness?

Answer 2

• Peripheral vestibular dysfunction (40%)
• presyncope or disequilibrium (25%)
• psychiatric disorders such as depression anxiety, or somatization (15%)
• central vestibular lesion (10%)
• unknown cause (10%)

Question 3

What is vertigo ?

Answer 3

• vertigo - sense of spinning or movement of self or environment
• A dysfunction of a part of the vestibular system, including the inner ear, vestibular nerve, nuclei within the medulla, and the connections to the vestibular sections of the cerebellum

Question 4

Presyncope is

Answer 4

• presyncope - sense of being about to faint

Question 5

Dysequilibrium -

Answer 5

• dysequilibrium - feeling of unsteadiness that is less well defined than vertigo, also known as wooziness

Question 6

What is peripheral vertigo?

Answer 6

• Vertigo that results from dysfunction of the inner ear or the vestibular nerve

Question 7

What is central vertigo?

Answer 7

• Vertigo that results from dysfunction of the vestibular nuclei within the medulla or connections to the cerebellum

Question 8

Peripheral vs Central Vertigo - Imbalance

Answer 8

• Imbalance is severe with central vertigo and mild to moderate with peripheral vertigo.

Question 9

Peripheral vs Central Vertigo - Hearing Loss

Answer 9

• Hearing loss is rare with central vertigo and common with peripheral vertigo.

Question 10

Peripheral vs Central Vertigo - non-auditory neurologic deficits

Answer 10

• Nonauditory neurologic deficits are common with central vertigo and rare with peripheral vertigo.

Question 11

What conditions can cause peripheral vertigo?

Answer 11

• Benign paroxysmal positional vertigo
• vestibular neuritis
• Meniere disease
• Ramsay-Hunt syndrome (herpes zoster oticus)
• perilymphatic fistula
• vestibular schwannoma
• aminoglycoside toxicity
• otitis media

Question 12

What causes vestibular neuritis?

Answer 12

• Viral or postviral disorder of the vestibular portion of the eighth cranial nerve

Question 13

What are the clinical manifestations of vestibular neuritis?

Answer 13

• Acute onset of vertigo
• nausea
• vomiting
• gait instability
• nystagmus

Question 14

What is labyrinthritis?

Answer 14

• when unilateral hearing loss accompanies vestibular neurits

Question 15

Can steriods be used to treat vestibular neuritis?

Answer 15

• Yes, steroids have been shown to improve vestibular function at 12 months compared to placebo in patients with Vestibular neuritis or labyrinthitis

Question 16

What triad of symptoms is associated with Meniere disease?

Answer 16

• Vertigo
• hearing loss (low frequency initially)
• tinnitus.

Question 17

What conditions can cause central vertigo?

Answer 17

• Migraines
• brainstem ischemia
• cerebellar infection or hemorrhage
• Multiple Sclerosis.