Vertigo Flashcards
What is Vertigo?
- describes a sense of movement and rotation of oneself or the surrounding environment
- typically a sensation of spinning, but can also present as linear motion or falling
- may have a peripheral or central origin
What are some characteristics of peripheral vertigo?
- episodic and short duration
- autonomic symptoms present
- precipitating factor
- pallor, sweating
- nausea and vomiting
- auditory fullness (fullness writhing ears)
- TINNITUS
What are some characteristics of central vertigo?
- autonomic symptoms—less severe
-loss of consciousness can occur
-neurological symptoms present including:
A. diplopia
B. Hemianopsia
C. Weakness
D. Numbness
E. Ataxia
F. dysarthria
What is the etiology of Peripheral vertigo?
- Benign paroxysmal positional vertigo (BPPV)
- Ménière’s disease
- Infection
- Trauma/tumor
- Metabolic disorders (diabetes mellitus)
- Acute alcohol intoxication
What is the etiology of Central Vertigo?
- Meningitis
- Migraine headache
- Complications of neurologic origin post ear infections
- Trauma/tumor
- Cerebellar degeneration disorders (i.e. alcoholism)
- Multiple sclerosis (MS)
What is Benign paroxysmal positional vertigo (BPPV) comprised of?
Comprised of repeated episodes of vertigo that occur subsequent to changes in head position
Describe BBPV
- Only lasts a few seconds and is typically first noted while in a recumbent position since it most commonly affects the posterior semicircular canal
- Nystagmus is present and can be noted using the Dix-Hallpike
What is the etiology of BPPV?
Usually otoconia (carnalith) that loosens and travels into the posterior semicircular canal, causing vertigo.
What is the treatment for BPPV?
Treated with carnality repositions maneuvers which are passive movements used to remove the otoconia from the canals, thus remediating vertigo
What is the Dix-Hallpike test?
Maneuver that is a vertiginous position test used in assessment and treatment
What does the Dix-Hallpike test stimulate?
Stimulates the posterior semicircular canal and attempts to determine if otoconia exist within the canal
What is Dix-hallpike test used for?
If pt experiences nystagmus and vertigo, the test is performed to determine if a pt presents with BPPV or a central lesion
Steps of the Dix-Hallpike
- Pt in long sitting w/ head rotated 45 degrees to one side
- Pt is rapidly moved to a supine position w/ the head (still in 45 degrees rotation) extended 30 degrees beyond horizontal off the end of the table
- PT continues to hold the pt’s head in this position for 20-30 seconds observing the potential nystagmus (direction and appearance can determine inner ear vs CNS lesion)
What is a Nystagmus?
- Abnormal eye movement that entails nonvolitional, rhythmic oscillation of the eyes
- Speed of movement is faster in one direction than the other direction
- Pts with Nystagmus often complain of vertigo, nausea, and oscillopsia
When observing Nystagmus what should the PT be observing?
Eye movement: Horizontal, vertical, rotatory or mixed movements
Type of eye movement: Pendular or jerk
Direction: Bidirectional or unidirectional
Nystagmus movement: Binocular or monocular with symmetrical or dissociated movement. Effects of change of position of the head or posture on Nystagmus
What is congenital Nystagmus?
Typically mild and does not change in severity over the person’s lifetime. It is not usually associated with other pathology
Spontaneous nystagmus
imbalance of vestibular signals to the oculomotor neurons that causes a constant drift in one direction that is countered by a quick moment in the opposite direction.
When does a spontaneous nystagmus typically occur?
Occurs after an acute vestibular lesion and will last approximately 24 hours
Peripheral nystagmus
Occurs with a peripheral vestibular lesion and is inhibited when the pt fixates their vision on an object
Central nystagmus
occurs with a central lesion of the brainstem/cerebellum and is not inhibited by visual fixation on an object
Positional nystagmus
Induced by a change in head position. The semicircular canals stimulate the nystagmus that typically lasts only a few seconds
Gaze-evoked nystagmus
Occurs when the eyes shift from a primary position to an alternate position. The nystagmus is caused by patient’s inability to maintain the stable gaze position
Typically indicative of CNS pathology and is associated w/ brain injury and multiple sclerosis
Compare the direction of a central lesion vs peripheral lesion nystagmus
Central lesion: Bidirectional or unidirectional
Peripheral lesion: Unidirectional w/ the fast segment of movement indicating the opposite direction of lesion
Compare visual fixation of a central lesion vs a peripheral lesion
Central lesion: No inhibition with fixation
Peripheral Lesion: Will inhibit nystagmus and vertigo
Compare Vertigo of a central lesion vs peripheral lesion
Central lesion: Mild
Peripheral lesion: Significant
Compare the length of symptoms of a central lesion vs peripheral lesion
Central lesion: May be chronic
Peripheral lesion: Minutes, days, weeks, but finite period of time; recurrent
Compare the etiology of a central lesion to a peripheral lesion
Central lesion: Demyelination of nerves, vascular lesion, cancer/tumor
Peripheral lesion: Ménière’s disease, vascular disorders, trauma, toxicity, infection of inner ear
Describe the Berg Balance Scale
Purpose: Assess a pt’s risk for falling
Structure: 14 tasks (static activities, transitions movements, and dynamic activities in sitting/standing positions) ; scored on an ordinal scale form 0-4
Maximum score: 56 w/ a score of <45 indicating an increased risk of falling
Describe Fregly-Graybiel Ataxia Test Battery
Purpose: Consists of eight tests conditions used in the batter with each leg measured on two accounts, the time spent in each position and the # of steps that a pt takes w/o falling
Structure: Pass/Fail; Best suited for higher level pts; 5 Trials of:
- stand on beam w/ eyes open
- Stand on beam w/eyes close
- Walk on beam w/EO
- sharpened Romberg (heel-toe static positioning)
- standing w/ EO
- standing w/EC
- standing on one leg w/ EC
- walking on the floor w/ EC
Describe the Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery
Purpose: assess balance specifically for pts with hemiplegia
Structure: 7 items; scored form 0-2
Maximum score: 14; even tho 14 is the best score a person can receive, pt may still not have Normal balance
Describe the functional reach test
Purpose: screening tool used to assess standing balance and risk of fall
Structure: Person required to stand upright with a static BOS and the pt reaches without moving the feet (3 trials performed and averaged); Then they close their eyes and balance for 30 seconds.
Describe the Romberg Test
Purpose: assessment tool of balance and ataxia that initially positions the pt in unsupported standing, feet together, UE folded, looking at a fixed point straight ahead w/ eyes open (visual, vestibular, somatosensory)
*If pt demonstrates ataxia and has (+) Romberg test, this indicates sensory ataxia not cerebellar ataxia
Describe the sharpened Romberg
Same as Romberg, but pt’s feet re heel-to-toe (tandem stance) with non-dominant foot in front. EO first; EC second
Describe the Timed up and Go (TUG)
Purpose: screening tool that assesses a person’s level of mobility and balance
Structure: person sits, transfers to standing, walking 10 feet and turns and walks back to chair; returns to sitting position; 5-point ordinal scale
Normal: <10seconds; >20seconds are at the limit for functional independence; >30 seconds are at high risk of fall
Describe Tinetti Performance Oriented Mobility Assessment
Purpose: Tool used to screen pts and identify if there is an increased risk for falling
Structure: First section: assesses balance; 0-2 scale (16 max) Second section: assess gain; 0-2 scale (12 max)
Maximum score: 28 w/risk of falling increasing as the total score decreases (<19 indicates high risk for fall)
