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Vertigo Flashcards

1
Q

What are the two types of vertigo?

A

Central and peripheral

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2
Q

What is the cause of central vertigo?

A

Brainstem or cerebellar issue

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3
Q

What is the cause of peripheral vertigo?

A

Labyrinth or vestibular nerve issue

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4
Q

What are the three part of the semicircular canal?

A
  • Horizontal
  • Anterior
  • Posterior
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5
Q

What is the organ that interprets fluid movement in the semicircular canals?

A

Cupula

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6
Q

Where in the semicircular canals are the cupulas?

A

In the ampulla

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7
Q

What are the utricles?

A

Dilation of the semicircular canals in the horizontal plane

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8
Q

What are the saccules?

A

Dilation of the semicircular canals in the vertical plane

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9
Q

What are the macula?

A

Sensory areas in the semicircular canals that house the cupula

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10
Q

What are the hair cells on the cupula called? What is the one big one?

A

Stereocilia

Kinocilia

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11
Q

What is the most common cause of peripheral vertigo?

A

BPPV

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12
Q

What is the most common central cause of vertigo?

A

Cerebellopontine angle tumor

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13
Q

What percent of ED visits for vertigo are d/t peripheral causes?

A

85%

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14
Q

What is the age range that is usually affected with BPPV?

A

60-70

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15
Q

Which gender typically is more affected with BPPV?

A

Females

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16
Q

True or false: BPPV is rare

A

false–extremely common

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17
Q

What usually exacerbates the vertigo with BPPV?

A

Turning of the head, or bending over

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18
Q

Which has a latency associated: central or peripheral causes of vertigo?

A

Peripheral

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19
Q

Which can fatigue: peripheral or central causes of vertigo

A

Peripheral

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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

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21
Q

How do otoconia cause vertigo?

A

Otoliths keep moving, dragging endolymph and continuing receptor firing

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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.

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23
Q

What worsens labyrinthitis symptoms?

A

head movement

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24
Q

In whom does labyrinthitis usually occur in?

A

Young to middle aged adults

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25
Q

True or false: labyrinthitis is self limiting

A

True

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26
Q

What is the recent h/o labyrinthitis / vestibular neuritis?

A

Usually occurs after an URI

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27
Q

How do you differentiate labyrinthitis /vestibulitis from BPPV?

A

Labyrinthitis is much more persistent–lasting hours instead of minutes

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28
Q

Which can be suppressed with visual fixation: central or peripheral vertigos?

A

Peripheral

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29
Q

What is the natural h/o vestibular neuritis?

A
  • Develops over hours (sudden)

- Severe for a few days, then subsides over the course of 2 weeks (usually)

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30
Q

What are the long term sequelae of vestibular neuritis?

A

Some patient scan have residual symptoms and imbalance for months, or longer
-Some develop abnormal caloric testing at 1 year

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31
Q

What is the pathophysiology of vestibular neuritis?

A

Selective inflammation of the vestibular nerve, usually of viral origin

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32
Q

Which way is the fast phase of the nystagmus in vestibular neuritis: toward or away from the healthy ear?

A

Toward the healthy ear (away from affected)

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33
Q

What alters the intensity of the nystagmus in vestibular neuritis, in terms of gaze?

A

Intensity increases with gaze toward healthy ear, and decreases with gaze towas affected ear

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34
Q

What is the classic triad of Meniere’s disease?

A
  • Episodic vertigo
  • Tinnitus
  • Sensorineural hearing loss
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35
Q

What is the pathophysiology of Meniere’s disease?

A

Excess endolymph in the semicircular canals causes hydrops, bursting, and ionic mismatch. The canals heal, but are susceptible to it recurring.

36
Q

What is the treatment for Meniere’s disease?

A
  • Low salt diet / diuretics
  • Increased sleep, less stress
  • Vestibular suppressants
37
Q

What is the natural h/o Meniere’s disease?

A

Recurrent, acute attacks that usually last for about a day. Results in progressive sensorineural hearing loss.

38
Q

Is Meniere’s disease usually unilateral or bilateral?

A

Unilateral

39
Q

What characterizes the tinnitus with Meniere’s disease?

A

Crescendo, usually preceding the vertigo

40
Q

What is the surgical treatment for Meniere’s disease?

A

Labyrinthectomy

41
Q

What causes a perilymphatic fistula? Where are they located?

A

Trauma at the round or oval window

42
Q

What is the prognosis for a traumatic perilymphatic fistula?

A

Self-limiting

43
Q

What are the s/sx of a perilymphatic fistula?

44
Q

What are the types of trauma that can lead to a perilymphatic fistula?

A
  • Cough/ forceful sneeze
  • Scuba diving
  • Blow to the ear
45
Q

What is the role of a valsalva maneuver with a perilymphatic fistula?

A

Will induce s/sx

46
Q

Where do vestibular schwannomas usually grow? What is the significance?

A

Within the internal acoustic meatus

-Not much room to grow before compressing the nerve or facial nerve

47
Q

Are vestibular schwannomas benign or malignant?

48
Q

What is the first symptom of a vestibular schwannoma?

A

Hearing loss

49
Q

What are the characteristic hearing test findings with acoustic schwannomas?

A

Ability to discriminate words is out of proportion to the hearing loss

50
Q

What, besides hearing loss, can occur with vestibular schwannomas? (4)

A
  • Tinnitus
  • Vertigo
  • Otalgia
  • Facial nerve palsy
51
Q

What are the diseases that can mimic vestibular schwannomas?

A
  • Migraine HAs
  • MS
  • Stroke
52
Q

True or false: for the most part, absence of associated neurological symptoms with vertigo excludes a central infarct as an etiology

53
Q

True or false: most of the presentations of central causes of vertigo have associated neurologic signs

54
Q

What is the first CN that comes off below the level of the pons?

55
Q

What is lateral medullary syndrome (Wallenberg syndrome)? S/sx?

A

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
Q

What causes the dysphagia, dysarthria, and dysphonia in lateral medullary syndrome (Wallenberg syndrome)?

A

Infarct of the nucleus ambiguus

57
Q

What causes the loss of sensation contralateral to the side of the infarct in lateral medullary syndrome (Wallenberg syndrome)?

A

Spinothalamic tract is damaged

58
Q

What causes the vertigo in lateral medullary syndrome (Wallenberg syndrome)?

A

involvement in vestibular nuclei

59
Q

What is characteristic of the nystagmus with lateral medullary syndrome?

A

Vertical nystagmus

60
Q

How is the vertigo with MS different than in peripheral causes of vertigo?

A
  • Variable
  • Occurs randomly
  • associated with facial paresis or diplopia
61
Q

What is the suggested diagnosis for episodes of vertigo that last: a few seconds?

A

peripheral cause or TIAs

62
Q

What is the suggested diagnosis for episodes of vertigo that last: several seconds to a few minutes

A

BPPV or perilymphatic fistula

63
Q

What is the suggested diagnosis for episodes of vertigo that last: Several minutes to hours

A
  • Meniere’s disease
  • Perilymphatic fistula
  • Acoustic neuroma
64
Q

What is the suggested diagnosis for episodes of vertigo that last: days

A

Early acute vestibular neuritis

Stroke

65
Q

What is the suggested diagnosis for episodes of vertigo that last: weeks

A

Psychogenic

66
Q

What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in head position?

67
Q

What is the suggested diagnosis for episodes of vertigo that are spontaneous, without consistent provoking factors? (4)

A
  • Acute vestibular neuronitis
  • Meniere’s disease
  • migraine
  • MS
68
Q

What is the suggested diagnosis for episodes of vertigo that comes on after a recent viral illness?

A

Acute vestibular neuritis

69
Q

What is the suggested diagnosis for episodes of vertigo that is made worse with: stress

A

Psychogenic

70
Q

What is the suggested diagnosis for episodes of vertigo that is made worse with: immunosuppression

71
Q

What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in ear pressure

A

Perilymphatic fistula

72
Q

Aural fullness suggests what vertigo etiology?

A

Acoustic neuroma or Meniere’s disease

73
Q

What is the characteristic of the hearing loss with acoustic neuromas? (progression, uni/bilateral, type)

A

Progressive, unilateral, sensorineural

74
Q

What is the characteristic of the hearing loss with cholesteatomas? (progression, uni/bilateral, type)

A

Progressive, unilateral, conductive

75
Q

What is the characteristic of the hearing loss with Ramsay Hunt syndrome? (progression, uni/bilateral, type)

A

Subacute onset, unilateral

76
Q

What is the characteristic of the hearing loss with Meniere’s disease? (progression, uni/bilateral, type)

A

Sensorineural

Initially fluctuating

77
Q

What is the characteristic of the hearing loss with otosclerosis? (progression, uni/bilateral, type)

A

Progressive, conductive

78
Q

What is the characteristic of the hearing loss with perilymphatic fistulas? (progression, uni/bilateral, type)

A

Progressive, unilateral

79
Q

What is the characteristic of the hearing loss with TIA or CVA? (progression, uni/bilateral, type)

A

Sudden onset, unilateral

80
Q

What is the sensitivity of having vertical nystagmus for a central lesion

81
Q

What is the general type of nystagmus for peripheral lesions?

A

Horizontal

82
Q

Which has hearing loss more commonly: peripheral, or central vertigo

A

Peripheral

83
Q

Which has hearing loss more commonly more severe vertigo: peripheral, or central vertigo

84
Q

Fixation improves symptoms of central or peripheral vertigo?

A

Peripheral

85
Q

What type of medication should be used for vertigo? Why should these be used sparingly?

A

Benzos and meclizine (antihistamine)

-Suppresses the brain’s ability to adapt

86
Q

How successful are the Epley maneuvers with BPPV?

A

80% (A recommendation)

87
Q

What is the role of vestibular rehab exercises?

A

Trains the brain to rely on other sensory information for balance

Specialty Medicine (36 decks)

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