Vertigo Flashcards
Illusion of motion, either of self or the
environment
Vertigo
patient thinks that he/she is
moving, but is not actually moving
Illusion of motion
Why does vertigo occur?
Wrong data from receptors such as:
eyes
vestibular system
proprioceptive system
S/Sx of vertigo
Nausea and vomiting
Postural instability
Body malaise
Incapacity and anxiety
Gait disturbance
fastest receptor of motion
Vestibular receptors/SCC
To where does SCC gives information to?
CN VIII
What are the proprioceptors that give information to the vestibular nuclei?
Neck muscles/Muscle spindles
give information as to the position of the head
Eyes
What is the main function of the vestibular nuclei?
identify position
of head
Vestibular pathway
Vestibular nuclei→Cerebellum (FLARE)→Vestibulospinal pathway→Vestib tract→neck muscles
Function of the CNS
Interpretation
Learning
Adaptation
Compensation
VESTIBULAR DYSFUNCTION MAY PRESENT CLINICALLY
AS:
Acute loss or fluctuating function
Vestibular function is essential in what activities?
Motor learning
Maintaining complex postures
Standing or slow walking
Image stabilization
Vestibular nuclei, medulla, and cerebellum is affected in this type of vertigo
Central
Ears, eyes, and proprioceptors in the neck are affected in this type of vertigo
Peripheral
Transient vestibular dysfunction symptoms
Vertigo, nausea, imbalance
Sustained vestibular dysfunction symptoms
Slight nausea
NFW
loss of balance @ low speeds
loss of gaze stabilization
Neurologic causes of vertigo
Stroke
Brain ischemia
Tumors
Demyelinating dse
Traumatic head injury
Area involved in meniere’s dse
Semi-circular canals
Area involved in positional vertigo
cupula
Area involved in vestibular neuronitis
Distal CN VIII
Area involved in aminoglycoside toxicity
Labyrinths
A type of vertigo aggravated by head movement
Peripheral/Otologic
Head movement does not affect this type of vertigo
Neurologic
Frequency for peripheral/otologic vertigo
episodic
Frequency for neurologic vertigo
Periodic and is increasing in frequency
Present in any motion
Peripheral vertigo
Only present in walking and is relieved by sitting or lying down
Neurologic
Abnormal movements present in neurologic vertigo
Dysmetria
Dysdiadochokinesia
Result of Romberg’s in neurologic vertigo
positive w eyes close/open + titubation
Result of Romberg in otologic vertigo
Romberg’s is corrected w eye opening
Direction of nystagmus in neurologic vertigo
Bi-directional
Direction of nystagmus in otologic vertigo
Unidirectional
shows EOM abnormalities
neurologic
Examination for vestibular ocular reflex (VOR)
Hamalgyi maneuver (kiss & kill xD)
Head shake test procedure
Shake in 3 directions with eyes close for 30 seconds.
Positive sign for Halamgyi maneuver
Eyes correct/adjust
Indication for positive Hamalgyi
Peripheral vertigo
What is more prominent in neurologic vertigo
Bilateral nystagmus
Nystagmus direction in peripheral vertigo
Unidirectional, horizontal
Triggering vertigo during the dix hallpike maneuver indicates
geotropic nystagmus (toward the side of the ground)
Triggering vertigo when sitting after the dix hallpike maneuver indicates
rotatory nystagmus towards the opposite side
+ sign for peripheral vertigo in visual fixation
eyes are able to fixate
+ sign for central vertigo in visual fixation
eyes are still moving
+ sign and indication of eye cover test
eyes will correct, central vertigo
+ sign for peripheral vertigo in fuduka stepping test
rotate 45 degrees towards impaired side
+ sign for central vertigo in fuduka stepping test
ataxia
base enlargement
instability
+ sign for fast tandem walk and indication
slow walking is difficult and improves with fast walking; peripheral vertigo
Most common type of vertigo
Psychogenic vertigo
Examples of this type of vertigo are motion sickness and height vertigo. It is also self-limiting
Physiologic vertigo
anxiety and fears come out as a feeling of vertigo
Phobic postural vertigo
do not treat the vertigo, treat the anxiety
Persistent postural perceptual vertigo
is nystagmus present in psychogenic vertigo
no
Short attacks of vertigo (seconds to minutes) on
change of position. Often misdiagnosed
Benign Positional Vertigo
Occurs after hitting head and Labyrinth is affected by trauma to skull
Post-traumatic vertigo
A type of peripheral vertigo that is the easiest to diagnose
Meniere’s dse
Clinical presentations of Meniere’s dse
Vertigo c tinnitus and deafness
Triggers of meniere’s
Cats
Caffeine
Alcohol
Tobacco
Stress
Treatment approaches to peripheral vertigo
Pharmacologic
Vestibular rehab
Aim of treatment for peripheral vertigo
restore balance of bilat. vestibular systems
reduce the sensitivity of the vestibular system
A pharmacologic treatment that normalizes the firing of the neurons from the vestibular nuclei
Betahistine
Parameters for betahistine
48 mg (one dose)
24 mg (BID)
A pharmacologic treatment for prolonged vertigo
Flunarizine
Flunarizine parameters
10 mg @ HS
Vestibular rehabilitation for Vertigo
Epley’s maneuver
Semont’s liberation maneuver
Brandt and Daroff
