Part 10 - Vertigo, Case Hx, ... Flashcards
Describe vertigo
- 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
Contrast Peripheral Vertigo to Central (Systemic) Vertigo
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
Name 3 examples of Non-Vertigo Dizziness
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
What are the 4 steps of the Case History?
- Describe the attacks (acute vs episodes vs chronic)
- Describe the dizziness
- Is there a chronic component?
- Subjective = Objective?
During Step 2 of the case hx, what are the 2 acronyms to remember?
SO STONED to describe the dizziness
Deadly D’s (6) and 3 S’s (Headache) for the acute phase
What does SO STONED stand for?
Since when?
Occurrence (how often)
Symptoms Triggers Otologic (hearing loss, tinnitus?) Neurological (Migraine, consciousness?) Evolution Duration
What are the 6 Deadly D’s of an acute phase?
Dysarthria - motor speech dx
Diplopia - double vision
Dysphagia - difficulty swallowing
Dysphonia - hoarse, strained, breathy voice
Dysmetria - lack of coordination
Dysesthesia - burning, prickling, aching feeling
What are the 3 S’s to look for during an acute phase?
Sudden
Severe
Sustained
Headache
What is the acronym for the chronic component (Step 3 of Case Hx)? What does it stand for?
DISCO HAT
Darkness Imbalance Supermarket effect/visual vertigo/optokinetic Cognitive functions Oscillopsia (DVA) (surroundings moving)
Head movements (fast) Autonomic functions Tiredness
T/F: Step 4 of the case hx is to ensure the subjective = objective
True
Any dizziness has a psychological component
- can use the dizziness handicap inventory to evaluate
- Anxiety (hyperventilation) can make a person lightheaded
Describe the ideal vestibular rehabilitation therapy candidate
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
Horizontal and torsional nystagmus is indicative of ________ (Peripheral/Central) vertigo
Peripheral
Central is indicated by purely vertical or horizontal or torsional
Inhibited fixation is indicative of ________ (Peripheral/Central) vertigo
Peripheral
Central is indicated by non-inhibited
With peripheral vertigo, gaze ____ (does/doesn’t) change
Doesn’t change
With central vertigo, the direction changes
Hearing loss or tinnitus is common with ________ (Peripheral/Central) vertigo
Peripheral
With peripheral vertigo, the latency after provocation is ____ (short/long)
Short
Central vertigo usually has a latency longer than 15 seconds
Is peripheral vertigo influenced by fatigability?
Yes
Is the duration of peripheral vertigo always long?
No, it varies
Central vertigo is always long
Will someone with peripheral vertigo usually show neurologic symptoms or loss of consciousness?
No
Both are possible with central vertigo
What are the 3 stages of positional alcohol nystagmus?
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
What are the symptoms of non-compensated UVD?
- 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)
What are common symptoms of VOR?
- 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)
Name 3 common symptoms of impaired VSR
- loss of sure-footedness
- lack of coordinated movement
- surface dependent or preference
- falls
- may be preceded by VOR symptoms which have resolved or improved
The Vertigo Symptom Scale (VSS) is a clinimetric designed to differentiate vertigo from what?
Anxiety symptoms
The Dizziness Handicap Inventory evaluates what 3 types of impacts on disability?
Functional, Physical, and Emotional
Is the ABC Scale subjective or objective?
Subjective
Activities-Specific Balance Confidence Scale is a questionnaire designed to to predict falls risk
