Quiz 4 - headache and vertigo Flashcards
4 things people actually mean by dizziness
1) vertigo
2) pre-syncopal lightheadedness
3) disequilibrium
4) other (floating)
vertigo is best described as…
an illusion of movement
presyncope best described as…..
faintness, lightheadedness
disequilibrium is best described as…..
- unsteadiness on one’s feet
- often resolves by touching an object
peripheral vs central causes of vertigo
peripheral - damage to inner ear
central - damage to CNS
presentation of peripheral vertigo
- horizontal or rotary nystagmus
- worsens when looking in direction of fast motion
- possible hearing loss or tinnitus
- no other neurologic signs
nystagmus and room spinning in relation to side of peripheral vestibular damage
- horizontal nystagmus will have tonic phase toward side of damage
- room will be spinning away from side of damage in direction of fast phase
object vs subject vertigo
object - seen in vestibular damage, appearance that room is spinning
subject - seen when eyes closed, feeling that patient is spinning
PE for peripheral vertigo
- head thrust
- inability to maintain fixation indicates vestibular damage
central vertigo presentation
- nystagmus in any direction
- vertigo is milder than peripheral
- nystagmus greater than person’s illusion of movement
- no hearing loss
- often other neurological signs
vestibular neuronitis/acute labrynthitis presentation
- monophasic attack of vertigo that lasts days to weeks
- type of peripheral vertigo
3 peripheral vertigos provoked by movement
- benign positional vertigo (BPV, liberated otoliths)
- cervicogenic vertigo (sustained neck position)
- vertebrobasilar insufficiency (cutting off of verterbrobasilar artery by neck movement)
2 peripheral vertigos provoked by noise
- meniere syndrome
- perilymph fistula
meniere pathophysiology and presentation
- increased pressure in endolymph from diminished resorption
- attacks minutes to hours
- long term damage, can’t hear low tones
- low tone tinnitus
perilymph fistula pathophys and presentation
- leak between middle and inner ear
- associated with changes in pressure
what is chiari malformation?
cerebellum herniates through foramen magnum
chiari presentation
- central vertigo
- occipital headache
- downbeat nystagmus
causes of pre-syncope and presentation
all forms of cerebral ischemia
autonomic failure - orthostatic hypotension
vasovagal episode - low HR and BP, associated with high stress and anxiety
hyperventilation and cerebral vasoconstriction
migraine
only intracranial structures that are pain-sensitive
- meningeal arteries
- proximal portions of cerebral arteries
- dura at base of brain
- venus sinuses
- CN V, VII, IX, X
- cervical nerves 1-3
why does CSF drainage cause headache?
traction on venus sinuses as brain sinks
