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Setha: Neuro > Reisert: Dizziness and Syncope > Flashcards

Reisert: Dizziness and Syncope Flashcards

1
Q

Having disturbed ambulation

Associated sx:

Changes in vision

Orthostasis

….just about anything else

A

Dizziness

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2
Q

Change in blood pressure and cerebral blood flow due to transient low blood pressure

A

Orthostasis

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3
Q

Alteration in normal response to standing

May occur with aging due to loss of vascoconstriction (With standing, blood falls to feet adn you get dizzy or pass out)

A

Orthostasis

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4
Q

Lie for 10 mins, stand for at least 2 mins though response in worst case may last 10 mins

A

Test of orthostasis

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5
Q

Fall in systolic BP > ____ mmHg

Fall in diastolic BP > ____ mmHg

Increase in heart rate ______ beats per min

With orthostasis

A

20

10

10-25

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6
Q

___% of people have orthostasis

A

24%

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7
Q

Mineralcorticoids like fludrocortisone

Midodrine

Atomoxetine

Pyridostigime

Droxidopa: new med approved 2015

A

Tx for Orthostasis

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8
Q

Loss of buffers to remain conscious

Syncope prodrome

A

Fainting

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9
Q

Cardiac

Neurological

Simple (anxiety, stress)

A

Causes of syncope

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10
Q

What is the most common type of syncope?

A

Simple fainting from anxiety/stress

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11
Q

Arrythmia/dysrrhythmia

Heart block

Aortic stenosis (severe)

Medications (orthostasis)

MOST WORRISOME

A

Cardiac causes of syncope

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12
Q

Echocardiogram

Electrophysiological study

Signal average EKG

A

Cardiac syncope workup

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13
Q

Implantable cardiac defbrillator

Anti-arrhythmics less so

A

Tx of true cardiac syncope

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14
Q

Impaired vestibular system

May be due to disturbance of inner ear

Altered head position in space –> aleration of CN VIII

Some say room spinning or they feel like they are spinning

A

Vertigo

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15
Q

Visiual imput

Somatosensory input (skin, joints, muscles, spinal cord)

Cerebellum

Cerebrum

A

Normal balance maintenance

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16
Q

What happens to people with true syncope?

A

They get injured!

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17
Q

Alerations of eye movement with oscillation to lateral gaze

A

Nystagmus

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18
Q

Two types of vertigo?

A

Physiologic

Pathologic

19
Q

Abnormal input to stabilize (car sickness)

Unfamiliar head position (sea sickness)

Unusual head position (painting ceiling)

Spinning

Physiologic causes of ______?

A

Vertigo

20
Q
  • Disturbance of vision
  • Disturbance of somatosensory system
  • Disturbance of vestibular system
  • CNS tries to correct
    • Change in frequency of normal firing (homeostasis is disrupted), unequal signal results, abnormal head sensation
  • Worse with rapid head movement
  • Often nausea and ataxia

Pathological causes of _____?

A

Vertigo

21
Q

MOA of Fludrocortisone?

A

Causes fluid retention

22
Q

Table that goes up in down

Indication: Patient that is having repeat syncope

To test of orthostasis

A

Tilt table test

23
Q

What should you think of when you see a young athelete pass out on the field?

A

hypertrophic cardiomyopathy

24
Q

Loss of bowel/bladder control

Bite tongue

More common in seizures or syncope?

A

SEIZURES!

25
Q

Triad of aortic stenosis

A

Syncope, chest pain, dyspnea

26
Q

Most common cause of orthostatic HTN?

A

Dehydration!

27
Q

Fast phase of nystagmus goes away from lesion (affected side)

Rotation goes away from affected side

Falling toward side of lesion

A

Patterns of vertigo

28
Q

2-3 beats at when look extreme left or right

Is this normal or abnormal (mystagmus)?

A

Normal!

29
Q

Acute labrynthitis

Vestibular neruitis

Causes of _____ vertigo

A

Idiopathic

30
Q

Idiopathic

Infection (HSV 1)

Trauma

Ischemia (nausea and vomiting)

Drugs (Alcohol, Aminoglycoside antibx)

A

Causes of significant vertigo

31
Q

Cochlear disease

Progressive hearing loss (low frequency)

Tinnitus

Dizziness

A

Meniere’s disease

32
Q

Etiology unknown

Possibly infection, autoimmune, inflammatory, demyelization, tumor, trauma

A

Meniere’s disease

33
Q

Diuretics (Hydrochlorothiazide)

Very low salt restriction, <1g per day

A

Tx for Meniere’s Disease

34
Q

Unilateral hearing loss

Tinnitus

Schwannoma or meningioma

A

Acoistic neuroma

35
Q

What CN does acoustic neuroma effect?

A

CN VIII

36
Q

What is the diagnostic test of choice for Acoustic neuroma?

A

MRI

37
Q

Due to changes in head position

No clear known cause

May last months

A

Benign Positional Vertigo

38
Q

What maneuver can you do to treat BPPV?

A

Epley maneuver

39
Q

H&P

Orthostatic vitals

Swivel chair

Cardiac testing

Provocative tests: head shaking, Frenzel glasse

A

Evaluation of dizzy patient

40
Q
  • EKG
    • Rules out heart block
  • Echocardiogram
    • Rules out structural heart disease (cardiomyopathy)
  • Holter monitor
    • 24 hour hear monitor
    • Tape recording device
    • Good for symptomatic evaluation (palpitations) and tachycardia
  • Event monitor
    • Wear up to a month
    • Trans-telephonic transmission of data
  • Exercise stress testing (low yield)
  • Electrophysiologic study (EP study)
    • Looks for risk for Ventricular tachycardia
  • Tilt table test for orthostatic hypotension
A

Cardiac testing for syncope

41
Q

Treat cause if known

Bed rest

Vestibular rehabilitation (PT)

Medications: Vesticular suppresants (Meclizine, Dimenhydrinate, Promethazine), Benzodiazepines (Diazepam), Steroids

Epley maneuver (BPPV)

A

Treatment for dizziness

42
Q

Alteration when the vestibular sense, visual sense, and somatosensory sense are not congruent

A

Sea sickness/motion sickness

43
Q

Principle sx: nausea/vomiting

Other sx: Dizziness, salvation, diaphoresis, and malaise.

May look pale

A

Sea sickness/motion sickness

44
Q

Antihistamines like dimenhydrinate

Anticholinergics like scopalamine

both are SEDATING

A

Tx for sea sickness/motion sickness

Setha: Neuro (9 decks)

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