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Clin Med I - ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

Vertigo relating to dizziness

A
  • false sensation of movement or spinning
  • nausea/vomiting/diaphoresis
  • swaying, tilting, sense of being “pushed” in all directions
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2
Q

Pre-syncope relating to dizziness

A
  • mostly a Cardiovascular/circulating etiology presenting as a neuro symptom
  • lightheadedness
  • blurry vision
  • diaphoresis, heart palpitations, nausea
  • occasionally develops into syncope
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3
Q

Disequilibrium relating to dizziness

A
  • common in elderly
  • more constant and provoked with standing or ambulation
  • they “feel” off balance and display an unsteady gait
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4
Q

When does vertigo occur?

A
  • 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
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5
Q

Syncope relating to dizziness

A
  • 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)
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6
Q

Dysequilibrium related to dizziness

A

Difficulty sensing where they are in the world

  • instability
  • elderly with multi sensory deficits
  • diabetic with peripheral neuropathy
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7
Q

Nonspecific dizziness

A
  • they fit into none of our categories
  • normal neuro exam
  • chances of being emergent arent likely
  • refer to ENT
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8
Q

What is vertigo

A

Dysfunction within the vestibular system

divided into peripheral and central

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9
Q

What is peripheral vertigo

A

-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)

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10
Q

What is central vertigo

A
  • brain stem, cerebellum, peripheral labyrinths
  • Vertebrobasilar artery system supplies the above
  • Central and peripheral ischemic vertigo syndromes can overlap
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11
Q

What is the onset of peripheral vs. central vertigo?

A
  • peripheral = sudden

- central = slow

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12
Q

What is the severity of peripheral vs. central vertigo?

A
  • peripheral = intense spinning

- central = less intense, poorly defined

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13
Q

What is the pattern of peripheral vs. central vertigo?

A
  • peripheral = intermittent, resolves with Tx

- central = constant

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14
Q

Is peripheral worse on movement or central?

A
  • peripheral = yes

- central = yes and no

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15
Q

Match frequency of nausea/diaphoresis with central v. peripheral vertigo

A
  • peripheral = frequently

- central = infrequently

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16
Q

What is the direction of peripheral vs. central nystagmus direction?

A
  • peripheral = horizontal lateral, rotary

- central = vertical, pure torsional

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17
Q

Does peripheral or central vertigo fatigue?

A

peripheral

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18
Q

Does hearing loss/tinnitus occur with peripheral hearing loss/tinnitus?

A
  • may occur with peripheral

- does not occur with central

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19
Q

Will peripheral or central have abnormal TM?

A
  • peripheral may occur

- central no

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20
Q

Are there CNS findings in peripheral or central vertigo?

A
  • peripheral = absent (neuro exam is normal)

- central = present

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21
Q

Describe the peripheral gait vs central

A
  • peripheral = can walk with assistance

- central = walking with very difficult, often unable to

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22
Q

How do you differentiating peripheral nystagmus?

A
  • nystagmus will be in same direction ALWAYS

- it will change direction with gaze changes and visual fixation (fatigues)

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23
Q

How do you differentiate central nystagmus?

A
  • vertical nystagmus
  • pure torsional nystagmus
  • midline gaze nystagmus
  • does not fatigue
24
Q

What are the Romberg test result for peripheral and central vertigo?

A
  • peripheral = falls towards same side

- central = variable, changes direction with repeat testing

25
Q

Peripheral causes of vertigo

A

Vertigo occurs as a result of pathology that involves the middle, inner ear, and acoustic portion of the 8th CN

26
Q

The worse the vertigo the more _______ the process

A

benign

27
Q

The less severe the motion and longer duration of vertigo the more ______ the cause is such as central or cerebellar lesion

A

severe

28
Q

What is ataxia

A

inability to coordinate muscle movements (limb, truncal, and gait)

29
Q

What is nystagmus

A

rhythmic oscillating movements of eyes and may be vertical or horizontal

30
Q

What does BPPV stand for?

A

Benign paroxysmal positional vertigo

31
Q

Patient population of BPPV

A

mid 50’s, females 2: 1 males

32
Q

Symptoms/signs of BPPV

A
  • N/V
  • nystagmus
  • needs help walking
33
Q

What triggers BPPV

A

Precipitated by movement (head turning, bending over, position changes)

34
Q

How long does BPPV occur for

A

EPISODIC
Patients are plagued with short episodes
NO HEARING LOSS OR TINNITUS

35
Q

Sensitive diagnostic test for BPPV

A

Dix-hallpike maneuver

36
Q

Lateral canalolithiasis for BPPV test

A

Lempert’s maneuver

37
Q

Superior canalolithiasis for BPPV test

A

Deep Head Hanging Maneuver

38
Q

Treatment for BPPV

A
  • Epley maneuver (particle repositioning)
  • PT
  • Benzodiazepines
39
Q

Onset of Labyrinthitis

A

mostly acute onset

40
Q

associated illness of Labyrinthitis

A
  • URI*: infection usually viral, but can be bacterial
  • look for OM
  • mastoiditis
41
Q

How long does Labyrinthitis last?

A

lasts days to weeks, gradually settling down

42
Q

Symptoms/signs of Labyrinthitis

A 
Nausea/vomiting
Hearing loss (infection/inflammation)
43
Q

Positioning patient with Labyrinthitis

A

Position makes it worse

44
Q

patient with Labyrinthitis has issues with

A

vestibular and hearing issues

45
Q

Onset of Meniere’s Disease

A

gradual and paroxysmal (episodic)

46
Q

What is the cause of Meniere’s Dz?

A
  • overproduction of endolymph

- can be lateral or bilateral

47
Q

How long does Meniere’s Disease last?

A

Spells last hours, weeks, months, years

48
Q

Symptoms/signs of Meniere’s Disease

A

N/V

Triad: vertigo, tinnitu, hearing loss

49
Q

Positioning patient with Meniere’s Disease

A

doesn’t make it worse, feel fine apart from “spells”

50
Q

patient with Meniere’s Disease has issues with

A

hearing loss and tinnitus

51
Q

Treatment for peripheral vertigo

A 
Bed rest
NO DRIVING
-IV fluids PRN
-phernothiazines to reduce nausea
-antihistamines to reduce dizziness
-vestibular exercises/maneuvers (PT)
52
Q

Miscellaneous causes of vertigo

A
  • 8th cranial nerve lesions
  • tumors of the cerebellopontine angle
  • herpes zoster oticus
53
Q

Central causes of vertigo

A

Vertigo that occurs as a result of pathology or a lesion that involves the brainstem, the cerebellum, or the peripheral labyrinths.

54
Q

Central vertigo most common causes

A
  • cerebellar or brainstem hemorrhages and infarctions (STROKE)
  • vertebrobasilar insufficiency in brain stem
  • MS
  • Migranes
  • Heavy metals
  • ETOH
55
Q

The 5 Ds in a Neuro Exam with CC: Dizziness

A

-Diplopia
-Dysphagia
-Dysarthria
-Dysphonia
-Dysmetria (ataxia)
DO NOT SEND HOME

56
Q

Central vertigo treatment

A
  • MRI/Neuro Consult
  • Hospital or ER admission
  • Supportive care

Clin Med I - ENT (13 decks)

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