Vertigo

Question 1

What is a finding that can regularly occur in peripheral vertigo but is rare in central?

Answer 1

tinnitus

Question 2

A pt experiences sudden vertigo that is so severe that he cannot walk or stand. What would you classify his sx as based on this alone?

Answer 2

Peripheral vertigo

Question 3

Will you have habituation or fatigue or vertigo/nystagmus sx in central vertigo?

Answer 3

no there is no latent period, fatiguability, or habituation in central lesions

Question 4

A pt presents with vertigo you notice purulent otitis media, and fever in the patient what would your most likely dx be?

Answer 4

labyrinthitis bacterial

Question 5

How does labyrinthitis differ from Meniere’s dz in the presentation of vertigo?

Answer 5

Spells of it last days to weeks

accompanied by hearing loss and or tinnitus

Question 6

What are the three major causes of peripheral vertigo?

Answer 6

• Meniere dz
• labyrinthitis
• benign paroxysmal positioning vertigo

Question 7

What are some unique sx of Meniere dz that could point to peripheral vertigo?

Answer 7

• ear pressure
• fluctuating hearing loss
• tinnitus
• discrete spells mins to hrs

Question 8

What is the general cause of central vertigo?

Answer 8

brain abnormality

• migraine
• ischemia
• ms
• mass
• vertebrobasilar artery insufficiency

Question 9

You induce nystagmus in a pt with vertigo, it is continuous, there is no latency, and redirecting the gaze does not help to stop it. Which type of vertigo would you suggest they have?

Answer 9

Central - nonfatgible nystagmus

Question 10

Which type of vertigo tends to get worse over time?

Answer 10

Central - unless hemorrhage induced

Question 11

How does peripheral vertigo differ from central vertigo?

Answer 11

Peripheral is typically
-horizontal with torsional component never purely vertical
-absent neurological signs
-hearing (tinnitus can be present)
Central
-any direction
-often neurological signs
-hearing issues usually absent

Question 12

What is peripheral vestibulopathy?

Answer 12

involves the inner ear structures itself such as cn VIII and distal structures

Question 13

What is a negative caloric test?

Answer 13

eyes remain forward during temperature induction

this is a disruption of the vestibular system.

Question 14

What is the caloric test?

Answer 14

thermal stimulation of the endolymph

cold water- nystagmus is to the opposite of the treated side

Warm water will have nystagmus to same side of the treated side

COWS- Cold opposite warm same side

Question 15

What is the occulocephallic reflex? What would it mean if the pt has a positive test?

Answer 15

doll’s eye response, eyes stay fixed on focus point with head movement
a positive test would be the absence of this

Question 16

An eye demonstrates nystagmus, as it scans left to right it bounces back to the left, what direction would you classify that nystagmus?

Answer 16

left nystagmus

Question 17

The utricle responds to what direction of movement?

Answer 17

all directions due to its tilted angle

Question 18

Rotation of the head to the left stimulates what semicircular canal?

Answer 18

Left semicircular canal, and the same is true for the right side

Question 19

How do the otolith organs work?

Answer 19

the gravitational force causes otolith mass to slide across the vestibular hair cells when the head is tilted, bending the stereocilia towards (depolarization) or away from (hyper-polarization) the kinocilium
Rotation of the head to the

Question 20

What is the function of the semicircular canals?

Answer 20

angular acceleration

Question 21

damage to the temporal bone is significant partly because what is located there?

Answer 21

Temporal damage is significant because the vestibular system is housed in it