Vertigo Flashcards
1
Q
What are the two types of vertigo?
A
Central and peripheral
2
Q
What is the cause of central vertigo?
A
Brainstem or cerebellar issue
3
Q
What is the cause of peripheral vertigo?
A
Labyrinth or vestibular nerve issue
4
Q
What are the three part of the semicircular canal?
A
- Horizontal
- Anterior
- Posterior
5
Q
What is the organ that interprets fluid movement in the semicircular canals?
A
Cupula
6
Q
Where in the semicircular canals are the cupulas?
A
In the ampulla
7
Q
What are the utricles?
A
Dilation of the semicircular canals in the horizontal plane
8
Q
What are the saccules?
A
Dilation of the semicircular canals in the vertical plane
9
Q
What are the macula?
A
Sensory areas in the semicircular canals that house the cupula
10
Q
What are the hair cells on the cupula called? What is the one big one?
A
Stereocilia
Kinocilia
11
Q
What is the most common cause of peripheral vertigo?
A
BPPV
12
Q
What is the most common central cause of vertigo?
A
Cerebellopontine angle tumor
13
Q
What percent of ED visits for vertigo are d/t peripheral causes?
A
85%
14
Q
What is the age range that is usually affected with BPPV?
A
60-70
15
Q
Which gender typically is more affected with BPPV?
A
Females
16
Q
True or false: BPPV is rare
A
false–extremely common
17
Q
What usually exacerbates the vertigo with BPPV?
A
Turning of the head, or bending over
18
Q
Which has a latency associated: central or peripheral causes of vertigo?
A
Peripheral
19
Q
Which can fatigue: peripheral or central causes of vertigo
A
Peripheral
20
Q
What is different about the h/o BPPV compared to a central lesion?
A
- BPPV is episodic, whereas central is persistent
- BPPV is positional, whereas central is not
21
Q
How do otoconia cause vertigo?
A
Otoliths keep moving, dragging endolymph and continuing receptor firing
22
Q
How do you tell which ear is affected in the dix-hallpike maneuver?
A
During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closer to the ground.
23
Q
What worsens labyrinthitis symptoms?
A
head movement
24
Q
In whom does labyrinthitis usually occur in?
A
Young to middle aged adults
25
True or false: labyrinthitis is self limiting
True
26
What is the recent h/o labyrinthitis / vestibular neuritis?
Usually occurs after an URI
27
How do you differentiate labyrinthitis /vestibulitis from BPPV?
Labyrinthitis is much more persistent--lasting hours instead of minutes
28
Which can be suppressed with visual fixation: central or peripheral vertigos?
Peripheral
29
What is the natural h/o vestibular neuritis?
- Develops over hours (sudden)
| - Severe for a few days, then subsides over the course of 2 weeks (usually)
30
What are the long term sequelae of vestibular neuritis?
Some patient scan have residual symptoms and imbalance for months, or longer
-Some develop abnormal caloric testing at 1 year
31
What is the pathophysiology of vestibular neuritis?
Selective inflammation of the vestibular nerve, usually of viral origin
32
Which way is the fast phase of the nystagmus in vestibular neuritis: toward or away from the healthy ear?
Toward the healthy ear (away from affected)
33
What alters the intensity of the nystagmus in vestibular neuritis, in terms of gaze?
Intensity increases with gaze toward healthy ear, and decreases with gaze towas affected ear
34
What is the classic triad of Meniere's disease?
- Episodic vertigo
- Tinnitus
- Sensorineural hearing loss
35
What is the pathophysiology of Meniere's disease?
Excess endolymph in the semicircular canals causes hydrops, bursting, and ionic mismatch. The canals heal, but are susceptible to it recurring.
36
What is the treatment for Meniere's disease?
- Low salt diet / diuretics
- Increased sleep, less stress
- Vestibular suppressants
37
What is the natural h/o Meniere's disease?
Recurrent, acute attacks that usually last for about a day. Results in progressive sensorineural hearing loss.
38
Is Meniere's disease usually unilateral or bilateral?
Unilateral
39
What characterizes the tinnitus with Meniere's disease?
Crescendo, usually preceding the vertigo
40
What is the surgical treatment for Meniere's disease?
Labyrinthectomy
41
What causes a perilymphatic fistula? Where are they located?
Trauma at the round or oval window
42
What is the prognosis for a traumatic perilymphatic fistula?
Self-limiting
43
What are the s/sx of a perilymphatic fistula?
Vertigo
44
What are the types of trauma that can lead to a perilymphatic fistula?
- Cough/ forceful sneeze
- Scuba diving
- Blow to the ear
45
What is the role of a valsalva maneuver with a perilymphatic fistula?
Will induce s/sx
46
Where do vestibular schwannomas usually grow? What is the significance?
Within the internal acoustic meatus
| -Not much room to grow before compressing the nerve or facial nerve
47
Are vestibular schwannomas benign or malignant?
Benign
48
What is the first symptom of a vestibular schwannoma?
Hearing loss
49
What are the characteristic hearing test findings with acoustic schwannomas?
Ability to discriminate words is out of proportion to the hearing loss
50
What, besides hearing loss, can occur with vestibular schwannomas? (4)
- Tinnitus
- Vertigo
- Otalgia
- Facial nerve palsy
51
What are the diseases that can mimic vestibular schwannomas?
- Migraine HAs
- MS
- Stroke
52
True or false: for the most part, absence of associated neurological symptoms with vertigo excludes a central infarct as an etiology
False
53
True or false: most of the presentations of central causes of vertigo have associated neurologic signs
True
54
What is the first CN that comes off below the level of the pons?
CN 6
55
What is lateral medullary syndrome (Wallenberg syndrome)? S/sx?
PICA infarct, leading to an infarct in the lateral medulla
- Sensory deficits of the trunk and contralateral, and CN sensory deficits ipsilateral
- vertigo
- Ipsilateral Horner's syndrome
- ataxia
56
What causes the dysphagia, dysarthria, and dysphonia in lateral medullary syndrome (Wallenberg syndrome)?
Infarct of the nucleus ambiguus
57
What causes the loss of sensation contralateral to the side of the infarct in lateral medullary syndrome (Wallenberg syndrome)?
Spinothalamic tract is damaged
58
What causes the vertigo in lateral medullary syndrome (Wallenberg syndrome)?
involvement in vestibular nuclei
59
What is characteristic of the nystagmus with lateral medullary syndrome?
Vertical nystagmus
60
How is the vertigo with MS different than in peripheral causes of vertigo?
- Variable
- Occurs randomly
- associated with facial paresis or diplopia
61
What is the suggested diagnosis for episodes of vertigo that last: a few seconds?
peripheral cause or TIAs
62
What is the suggested diagnosis for episodes of vertigo that last: several seconds to a few minutes
BPPV or perilymphatic fistula
63
What is the suggested diagnosis for episodes of vertigo that last: Several minutes to hours
- Meniere's disease
- Perilymphatic fistula
- Acoustic neuroma
64
What is the suggested diagnosis for episodes of vertigo that last: days
Early acute vestibular neuritis
| Stroke
65
What is the suggested diagnosis for episodes of vertigo that last: weeks
Psychogenic
66
What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in head position?
BPPV
67
What is the suggested diagnosis for episodes of vertigo that are spontaneous, without consistent provoking factors? (4)
- Acute vestibular neuronitis
- Meniere's disease
- migraine
- MS
68
What is the suggested diagnosis for episodes of vertigo that comes on after a recent viral illness?
Acute vestibular neuritis
69
What is the suggested diagnosis for episodes of vertigo that is made worse with: stress
Psychogenic
70
What is the suggested diagnosis for episodes of vertigo that is made worse with: immunosuppression
HSV
71
What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in ear pressure
Perilymphatic fistula
72
Aural fullness suggests what vertigo etiology?
Acoustic neuroma or Meniere's disease
73
What is the characteristic of the hearing loss with acoustic neuromas? (progression, uni/bilateral, type)
Progressive, unilateral, sensorineural
74
What is the characteristic of the hearing loss with cholesteatomas? (progression, uni/bilateral, type)
Progressive, unilateral, conductive
75
What is the characteristic of the hearing loss with Ramsay Hunt syndrome? (progression, uni/bilateral, type)
Subacute onset, unilateral
76
What is the characteristic of the hearing loss with Meniere's disease? (progression, uni/bilateral, type)
Sensorineural
| Initially fluctuating
77
What is the characteristic of the hearing loss with otosclerosis? (progression, uni/bilateral, type)
Progressive, conductive
78
What is the characteristic of the hearing loss with perilymphatic fistulas? (progression, uni/bilateral, type)
Progressive, unilateral
79
What is the characteristic of the hearing loss with TIA or CVA? (progression, uni/bilateral, type)
Sudden onset, unilateral
80
What is the sensitivity of having vertical nystagmus for a central lesion
80%
81
What is the general type of nystagmus for peripheral lesions?
Horizontal
82
Which has hearing loss more commonly: peripheral, or central vertigo
Peripheral
83
Which has hearing loss more commonly more severe vertigo: peripheral, or central vertigo
Central
84
Fixation improves symptoms of central or peripheral vertigo?
Peripheral
85
What type of medication should be used for vertigo? Why should these be used sparingly?
Benzos and meclizine (antihistamine)
| -Suppresses the brain's ability to adapt
86
How successful are the Epley maneuvers with BPPV?
80% (A recommendation)
87
What is the role of vestibular rehab exercises?
Trains the brain to rely on other sensory information for balance
