Vertigo Flashcards
Vertigo relating to dizziness
- false sensation of movement or spinning
- nausea/vomiting/diaphoresis
- swaying, tilting, sense of being “pushed” in all directions
Pre-syncope relating to dizziness
- mostly a Cardiovascular/circulating etiology presenting as a neuro symptom
- lightheadedness
- blurry vision
- diaphoresis, heart palpitations, nausea
- occasionally develops into syncope
Disequilibrium relating to dizziness
- common in elderly
- more constant and provoked with standing or ambulation
- they “feel” off balance and display an unsteady gait
When does vertigo occur?
- occurs when some pathological process disrupts the input from one labyrinth to the brain and the other side tries to compensate and gets confused.
- Its like unplugging an auxiliary cord
Syncope relating to dizziness
- sudden loss of consciousness patient has either:
decreased amount of nutrients to brain (oxygen or glucose)
OR - a surge of electrical discharge that wipes out portion of their memory (seizure or arrhythmia)
Dysequilibrium related to dizziness
Difficulty sensing where they are in the world
- instability
- elderly with multi sensory deficits
- diabetic with peripheral neuropathy
Nonspecific dizziness
- they fit into none of our categories
- normal neuro exam
- chances of being emergent arent likely
- refer to ENT
What is vertigo
Dysfunction within the vestibular system
divided into peripheral and central
What is peripheral vertigo
-labyrinth and the vestibular portion of the VIII CN (vestibulocochlear nerve)
-CN VIII connects the labyrinth and the brainstem
Labyrinth located in the inner ear
-3 semicircular canals make up the LABYRINTH
-Otoliths (“rocks”) within the fluid filled canals that sense head position in relation to gravity and communicates it to the brain (canals, joints, brain)
What is central vertigo
- brain stem, cerebellum, peripheral labyrinths
- Vertebrobasilar artery system supplies the above
- Central and peripheral ischemic vertigo syndromes can overlap
What is the onset of peripheral vs. central vertigo?
- peripheral = sudden
- central = slow
What is the severity of peripheral vs. central vertigo?
- peripheral = intense spinning
- central = less intense, poorly defined
What is the pattern of peripheral vs. central vertigo?
- peripheral = intermittent, resolves with Tx
- central = constant
Is peripheral worse on movement or central?
- peripheral = yes
- central = yes and no
Match frequency of nausea/diaphoresis with central v. peripheral vertigo
- peripheral = frequently
- central = infrequently
What is the direction of peripheral vs. central nystagmus direction?
- peripheral = horizontal lateral, rotary
- central = vertical, pure torsional
Does peripheral or central vertigo fatigue?
peripheral
Does hearing loss/tinnitus occur with peripheral hearing loss/tinnitus?
- may occur with peripheral
- does not occur with central
Will peripheral or central have abnormal TM?
- peripheral may occur
- central no
Are there CNS findings in peripheral or central vertigo?
- peripheral = absent (neuro exam is normal)
- central = present
Describe the peripheral gait vs central
- peripheral = can walk with assistance
- central = walking with very difficult, often unable to
How do you differentiating peripheral nystagmus?
- nystagmus will be in same direction ALWAYS
- it will change direction with gaze changes and visual fixation (fatigues)
How do you differentiate central nystagmus?
- vertical nystagmus
- pure torsional nystagmus
- midline gaze nystagmus
- does not fatigue
What are the Romberg test result for peripheral and central vertigo?
- peripheral = falls towards same side
- central = variable, changes direction with repeat testing
Peripheral causes of vertigo
Vertigo occurs as a result of pathology that involves the middle, inner ear, and acoustic portion of the 8th CN
The worse the vertigo the more _______ the process
benign
The less severe the motion and longer duration of vertigo the more ______ the cause is such as central or cerebellar lesion
severe
What is ataxia
inability to coordinate muscle movements (limb, truncal, and gait)
What is nystagmus
rhythmic oscillating movements of eyes and may be vertical or horizontal
What does BPPV stand for?
Benign paroxysmal positional vertigo
Patient population of BPPV
mid 50’s, females 2: 1 males
Symptoms/signs of BPPV
- N/V
- nystagmus
- needs help walking
What triggers BPPV
Precipitated by movement (head turning, bending over, position changes)
How long does BPPV occur for
EPISODIC
Patients are plagued with short episodes
NO HEARING LOSS OR TINNITUS
Sensitive diagnostic test for BPPV
Dix-hallpike maneuver
Lateral canalolithiasis for BPPV test
Lempert’s maneuver
Superior canalolithiasis for BPPV test
Deep Head Hanging Maneuver
Treatment for BPPV
- Epley maneuver (particle repositioning)
- PT
- Benzodiazepines
Onset of Labyrinthitis
mostly acute onset
associated illness of Labyrinthitis
- URI*: infection usually viral, but can be bacterial
- look for OM
- mastoiditis
How long does Labyrinthitis last?
lasts days to weeks, gradually settling down
Symptoms/signs of Labyrinthitis
Nausea/vomiting Hearing loss (infection/inflammation)
Positioning patient with Labyrinthitis
Position makes it worse
patient with Labyrinthitis has issues with
vestibular and hearing issues
Onset of Meniere’s Disease
gradual and paroxysmal (episodic)
What is the cause of Meniere’s Dz?
- overproduction of endolymph
- can be lateral or bilateral
How long does Meniere’s Disease last?
Spells last hours, weeks, months, years
Symptoms/signs of Meniere’s Disease
N/V
Triad: vertigo, tinnitu, hearing loss
Positioning patient with Meniere’s Disease
doesn’t make it worse, feel fine apart from “spells”
patient with Meniere’s Disease has issues with
hearing loss and tinnitus
Treatment for peripheral vertigo
Bed rest NO DRIVING -IV fluids PRN -phernothiazines to reduce nausea -antihistamines to reduce dizziness -vestibular exercises/maneuvers (PT)
Miscellaneous causes of vertigo
- 8th cranial nerve lesions
- tumors of the cerebellopontine angle
- herpes zoster oticus
Central causes of vertigo
Vertigo that occurs as a result of pathology or a lesion that involves the brainstem, the cerebellum, or the peripheral labyrinths.
Central vertigo most common causes
- cerebellar or brainstem hemorrhages and infarctions (STROKE)
- vertebrobasilar insufficiency in brain stem
- MS
- Migranes
- Heavy metals
- ETOH
The 5 Ds in a Neuro Exam with CC: Dizziness
-Diplopia
-Dysphagia
-Dysarthria
-Dysphonia
-Dysmetria (ataxia)
DO NOT SEND HOME
Central vertigo treatment
- MRI/Neuro Consult
- Hospital or ER admission
- Supportive care
