Vertigo Flashcards
Define Vertigo
- produced by vestibular system
- sensation of movement
- nausea, emesis, diaphoresis, tachycardia, anxiety, adrenergic response
Define Lightheadedness
- non-vertiginous
- feel faint or like you will pass out
- orthostatic +
volume loss, anemia, antihypertensives, diuretics, antidepressants
- diabetes/hypoglycemia
- hyperventilation
Define syncope
- non-vertiginous
- loss of consciousness
- arrhythmia, sick sinus syndrome, heart valve, reduction in cerebral circulation, subclavian steal syndrome
What do you do in a physical exam for vertigo?
- otologic and vestibular exam (head/neck, tuning forks, nystagmus, Fakuda step test, Dix-Hallpike)
- neurological exam (CN, cerebellar function, gate)
- vision
- proprioception
Benign Paroxysmal Positional Vertigo (BPPV) causes and risk factors
multiple quick, recurrent atttacks of vertigo triggered by position changes that quickly resolve with in 10-15 seconds
-most common
- caused by dislodged utricle otoconia
- risk factors: CVA, acquired birthdays, previous vestibular neuronitis, Meniere’s Disease, migraine
BPPV signs/symptoms and physical exam
- intense brief (seconds) positional vertigo
- vertigo fatigues upon repeating position
- Dix-hallpike maneuver
BPPV treatment
- repositioning (Epley) Maneuver 75%
- Brandt-Daroff exercise
- Semont Maneuver
Meniere’s Disease
Episodic vertigo (2 or more events) w/ fluctuating hearing loss, increased tinnitus or aural fullness with no other explination -common in middle age
- debilitating, viral or autoimmune etiology
- endolymphatic hydrops
Meniere’s Disease Signs/Symptoms
vertigo that lasts 20 min to 24 hours
unilateral aural fullness, tinnitus, and hearing loss
occurs daily or 2/3years
nausea and emesis
Meniere’s Disease treatments
depends on hearing status, labrinthine function, health status, patient wishes
non-destructive and destructive
always start with diet and diuretic (70% control)
Non-destructive treatment for Meniere’s Disease
low sodium diet
diuretic
short term vestibular suppressants
oral steroids
immunotherapy
trans-tympanic steroids (90% control 1-2yrs)
endolymphatic mastoid shunt
Destructive treatment for Meniere’s Disease
trasntympanic gentamycin (90% control)
sacculotomy
labyrinthectomy (>90%)
vestibular nerve section (>90%)
Vestibular Neuronitis/Acute Labyrinthitis
Sudden onset of vertigo lasting minutes to hours followed by several weeks of recovery of equilibrium
aka Epidemic Vertigo
vestibular nerve inflammation-temporal bone histology
virus implications (HSV, flu, epstein-barr, cytomegalovirus)
Vestibular Neuronitis Signs/Symptoms/tests
Occasionally recurrent
sudden onset lasting days to week, no hearing loss
nausea, emesis, sever disequilibrium
motion induced disequilibrium for weeks to months
ENG usually reveals unilateral caloric weakness
Test
Fakuda Step Test
falls to side of weakness
Vestibular Neuronitis treatment
short term vestibular supressants (benzo, antihist.,anticholi.)
antiemetics
seroids
vestibular rehab ASAP
Labyrinthitis
similar presentation to VN
*unilateral hearing loss
inflammation w/in vestibular labyrinth - viral>bacterial
Labyrinthitis treatment
short term vestibular supressants, antiemetics, steroids.. if bacterial use antibiotics
vestibular rehab
Migrainous Vertigo
10x more common than peripheral vestibulopathy
young female
history vertigo common
Migranious Vertigo Signs/symptoms
migraine headaches and episodic vestibular sx and migraine HA together
vestibular symptoms- minutes to hours, possible nausea
photophobia, panophobia
nausea w/ HA
dietary triggers
normal hearing, possible tinnitus
Migrainous Vertigo Treatment
prophylactic migraine therapy improves HA and vestibular
(CCC, BB,topiramate)
migraine diet
Aucoustic Neuroma
Benign tumor of vestibular nerve
Acoustic Neuroma Signs/Symptoms
unilateral SNHL
tinnitus
vestibular symptoms
Unchecked growth
- HL
- cranial neuropathies
- obstructive hydrocephalus
Acoustic Neuroma treatment
depends on hearing status, age, general health
observation
sterotactic radiosurgery
microsurgical resection
possible vestibular rehabilitation
Perilymph Fistual
perilymph leak from oval window due to trauma, barotrauma, coughing, congenital
Perilymph Fistual signs/symptoms
vertgo
nystagmus (fistula test)
disequilibrium
SNHL-unilateral
tinnitus
Perilymph Fistual treatment
Occurs after a 7 day cruise
females>males, usually subside after 1 month
etiology unclear
rocking motion, still on boat feeling
Mal de Debarquement Syndrome
Occurs after a 7 day cruise
females>males, usually subside after 1 month
etiology unclear
rocking motion, still on boat feeling
Mal De Debarquement prevention and treatment
Prevention
-scopolamine, dramamine, meclizine
Treatment
- vestibular supressants
- vestibular rehab
Multifactorial Dizziness/Disequilibrium of Aging
function declines with age
obesity, arthritis, joint replacements, low muscle mass, poor vision, diabetes, CVA, ect
aging affects vestibular, visual, and proprioceptive available
aging affects ability of CNS to process sensory and elicit motor
47% men
61% women
fall over age 65
20-40%
33% significant fall by 80, 50% preceded by vertigo
Multifactorial Dizziness/Disequilibrium of aging treatment
identify any vestibular disorder and treat
no prolonged vestibular suppressants
night lights, glasses, shoes
vestibular rehab and fall prevention
physical terapy
Central Vertigo
lesion affects central vestibular pathways
- multiple sclerosis
- cerebellar atrophy, stroke, tumor, bleed
- brain stem stroke
- vestibular insufficiency
- Arnold Chiari malformation
- hydrocephalus; pseudo tumor
- B12 deficiency, mag depletion, lithium or dilantin toxicity
Central Vertigo Signs/Symptoms and treatment
signs/symptoms
- HA, tinnitus/HL, disequilibrium, possible visual changes
- vertical nystagmus, disequilibrium, severe gait abnormalities, multiple neurological findings
Treatment
- treat underlying problem
- vestibular rehab
- PT
Acute Unilateral Peripheral Vestibular Loss
caused by sudden asymmetric change in afferent vestibular nerve input
one is sending more info than the other
cerebellum (cerebellar clamp) stops output from both nuclei w/in 24-72 hrs
reduces severe symptoms, disequilibrium and motion induced symptoms continue
