Part 10 - Vertigo, Case Hx, ...

Question 1

Describe vertigo

Answer 1

• a feeling of yourself or the objects around you moving when they are not
• often feels like spinning or swaying
• may be associated with nausea, vomiting, sweating, or difficulty walking
• typically worse when head moving
• most common type of dizziness

Question 2

Contrast Peripheral Vertigo to Central (Systemic) Vertigo

Answer 2

Peripheral

• dysfunction of the end organs or nerve
• e.g. BPPV, Labyrinthitis, Meniere’s Disease

Central

• dysfunction of the vestibular nuclei, cerebellum, or oculomotor, vestibulospinal, and proprioceptive pathways
• e.g. brain tumour, Cerebrovascular disease, MS

Question 3

Name 3 examples of Non-Vertigo Dizziness

Answer 3

Presyncope - sensation of near fainting; orthostatic hypotension, vasovagal attacks, arrhythmias

Disequilibrium - slight dizziness or imbalance not related to head movement; panic attacks, hyperventilation, motion sickness

Ataxia - uncoordinated muscle movement; usually CNS

Question 4

What are the 4 steps of the Case History?

Answer 4

1. Describe the attacks (acute vs episodes vs chronic)
2. Describe the dizziness
3. Is there a chronic component?
4. Subjective = Objective?

Question 5

During Step 2 of the case hx, what are the 2 acronyms to remember?

Answer 5

SO STONED to describe the dizziness

Deadly D’s (6) and 3 S’s (Headache) for the acute phase

Question 6

What does SO STONED stand for?

Answer 6

Since when?
Occurrence (how often)

Symptoms
Triggers
Otologic (hearing loss, tinnitus?)
Neurological (Migraine, consciousness?)
Evolution 
Duration

Question 7

What are the 6 Deadly D’s of an acute phase?

Answer 7

Dysarthria - motor speech dx
Diplopia - double vision
Dysphagia - difficulty swallowing
Dysphonia - hoarse, strained, breathy voice
Dysmetria - lack of coordination
Dysesthesia - burning, prickling, aching feeling

Question 8

What are the 3 S’s to look for during an acute phase?

Answer 8

Sudden
Severe
Sustained
Headache

Question 9

What is the acronym for the chronic component (Step 3 of Case Hx)? What does it stand for?

Answer 9

DISCO HAT

Darkness
Imbalance
Supermarket effect/visual vertigo/optokinetic
Cognitive functions
Oscillopsia (DVA) (surroundings moving)

Head movements (fast)
Autonomic functions
Tiredness

Question 10

T/F: Step 4 of the case hx is to ensure the subjective = objective

Answer 10

True

Any dizziness has a psychological component

• can use the dizziness handicap inventory to evaluate
• Anxiety (hyperventilation) can make a person lightheaded

Question 11

Describe the ideal vestibular rehabilitation therapy candidate

Answer 11

Stabilized

• past the acute-debilitating of the acute episode
• an example of non-stabilized would be someone with Meniere’s Disease

Non-compensated

• can be a unilateral or bilateral vestibular deficit (UVD or BVD)
• patients are left with a chronic, often debilitating group of symptoms with are typically triggered by head or body motion, position, or moving external visual fields

Question 12

Horizontal and torsional nystagmus is indicative of ________ (Peripheral/Central) vertigo

Answer 12

Peripheral

Central is indicated by purely vertical or horizontal or torsional

Question 13

Inhibited fixation is indicative of ________ (Peripheral/Central) vertigo

Answer 13

Peripheral

Central is indicated by non-inhibited

Question 14

With peripheral vertigo, gaze ____ (does/doesn’t) change

Answer 14

Doesn’t change

With central vertigo, the direction changes

Question 15

Hearing loss or tinnitus is common with ________ (Peripheral/Central) vertigo

Answer 15

Peripheral

Question 16

With peripheral vertigo, the latency after provocation is ____ (short/long)

Answer 16

Short

Central vertigo usually has a latency longer than 15 seconds

Question 17

Is peripheral vertigo influenced by fatigability?

Answer 17

Yes

Question 18

Is the duration of peripheral vertigo always long?

Answer 18

No, it varies

Central vertigo is always long

Question 19

Will someone with peripheral vertigo usually show neurologic symptoms or loss of consciousness?

Answer 19

No

Both are possible with central vertigo

Question 20

What are the 3 stages of positional alcohol nystagmus?

Answer 20

PAN I

• 30 mins post-ingestions
• alcohol infuses into cupula making it lighter
• positionally provoked geotropic nystagmus towards lower ear

Intermediate

• alcohol infuses into endolymph as well
• no nystagmus

PAN II

• 5-10 hrs after ingestion has ended
• alcohol defuses from cupula making it heavier than surrounding endolymph
• positionally provoked ageotropic nystagmus towards upper ear

Question 21

What are the symptoms of non-compensated UVD?

Answer 21

• blurred vision with head movement - oscillopsia (VOR)
• spatial disorientation and imbalance with head/body motion or everyday activities
• sense of after-motion or feeling of exaggerated movement with head movement (VSR, multifactorial)

Question 22

What are common symptoms of VOR?

Answer 22

• trouble reading/focusing with head motion (ie. oscillopsia)
• may be provoked with specific direction or plane of movement
• trouble reading signs when walking
• side to side head turns
• BVD may be so severe that gum chewing or eating while watching TV may be bothersome
• once attack stops, there is oscillopsia only when head is moving (central - oscillopsia with head still)

Question 23

Name 3 common symptoms of impaired VSR

Answer 23

• loss of sure-footedness
• lack of coordinated movement
• surface dependent or preference
• falls
• may be preceded by VOR symptoms which have resolved or improved

Question 24

The Vertigo Symptom Scale (VSS) is a clinimetric designed to differentiate vertigo from what?

Answer 24

Anxiety symptoms

Question 25

The Dizziness Handicap Inventory evaluates what 3 types of impacts on disability?

Answer 25

Functional, Physical, and Emotional

Question 26

Is the ABC Scale subjective or objective?

Answer 26

Subjective Activities-Specific Balance Confidence Scale is a questionnaire designed to to predict falls risk