Quiz 4 - headache and vertigo

Question 1

4 things people actually mean by dizziness

Answer 1

1) vertigo
2) pre-syncopal lightheadedness
3) disequilibrium
4) other (floating)

Question 2

vertigo is best described as…

Answer 2

an illusion of movement

Question 3

presyncope best described as…..

Answer 3

faintness, lightheadedness

Question 4

disequilibrium is best described as…..

Answer 4

• unsteadiness on one’s feet

- often resolves by touching an object

Question 5

peripheral vs central causes of vertigo

Answer 5

peripheral - damage to inner ear

central - damage to CNS

Question 6

presentation of peripheral vertigo

Answer 6

• horizontal or rotary nystagmus
• worsens when looking in direction of fast motion
• possible hearing loss or tinnitus
• no other neurologic signs

Question 7

nystagmus and room spinning in relation to side of peripheral vestibular damage

Answer 7

• horizontal nystagmus will have tonic phase toward side of damage
• room will be spinning away from side of damage in direction of fast phase

Question 8

object vs subject vertigo

Answer 8

object - seen in vestibular damage, appearance that room is spinning
subject - seen when eyes closed, feeling that patient is spinning

Question 9

PE for peripheral vertigo

Answer 9

• head thrust

- inability to maintain fixation indicates vestibular damage

Question 10

central vertigo presentation

Answer 10

• nystagmus in any direction
• vertigo is milder than peripheral
• nystagmus greater than person’s illusion of movement
• no hearing loss
• often other neurological signs

Question 11

vestibular neuronitis/acute labrynthitis presentation

Answer 11

• monophasic attack of vertigo that lasts days to weeks

- type of peripheral vertigo

Question 12

3 peripheral vertigos provoked by movement

Answer 12

• benign positional vertigo (BPV, liberated otoliths)
• cervicogenic vertigo (sustained neck position)
• vertebrobasilar insufficiency (cutting off of verterbrobasilar artery by neck movement)

Question 13

2 peripheral vertigos provoked by noise

Answer 13

• meniere syndrome

- perilymph fistula

Question 14

meniere pathophysiology and presentation

Answer 14

• increased pressure in endolymph from diminished resorption
• attacks minutes to hours
• long term damage, can’t hear low tones
• low tone tinnitus

Question 15

perilymph fistula pathophys and presentation

Answer 15

• leak between middle and inner ear

- associated with changes in pressure

Question 16

what is chiari malformation?

Answer 16

cerebellum herniates through foramen magnum

Question 17

chiari presentation

Answer 17

• central vertigo
• occipital headache
• downbeat nystagmus

Question 18

causes of pre-syncope and presentation

Answer 18

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

Question 19

only intracranial structures that are pain-sensitive

Answer 19

• meningeal arteries
• proximal portions of cerebral arteries
• dura at base of brain
• venus sinuses
• CN V, VII, IX, X
• cervical nerves 1-3

Question 20

why does CSF drainage cause headache?

Answer 20

traction on venus sinuses as brain sinks