Vertigo

Question 1

Definition of vertigo

Answer 1

• used to describe a sense of movement and rotation of oneself or the surrounding environment
• typically a sensation of spinning but can also be falling
• may have peripheral or central origin

Question 2

Peripheral vertigo

Answer 2

• episodic and short duration
• autonomic symptoms
• precipitating factor
• pallor,sweating
• nausea
• auditory fullness
• tinnitus

Question 3

Central Vertigo

Answer 3

• autonomic symptoms less severe\
• LOC can occur
• may present with : diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria

Question 4

Peripheral Vertigo diagnosis

Answer 4

• BPPV
• Meniere’s
• infection
• trauma/ tumor
• metabolic disorders(DM)
• acute alcohol intoxication

Question 5

Central Vertigo diagnosis

Answer 5

• meningitis
• migraine HA
• complications of neurologic origin post ear infection
• trauma/tumor
• cerebellar degeneration disorders(alcoholism)
• MS

Question 6

BPPV: Benign paroxysmal positional vertigo

Answer 6

• repeated episodes of vertigo that occur subsequent to changes in head position
• only last a few sec
• most commonly affects post canal
• nystagmus is present and can be noted when assessing a pt using Dix-hallpike test

Question 7

dix-hallpike test

Answer 7

• test stimulates the posterior semicircular canal
  1. pt starts in long sitting and head rotated 45 deg to one side
  2. Pt rapidly moved to a supine position with the head ( still in 45 deg rotation) extended 30 deg beyond horizontal off the end of the table
  3. PT continues to hold the pt’s head in this position for 20-30 sec observing the potential for nystagmus

**if nystagmus exists, the direction of the eys and appearance of the nystagmus can determine inner ear vs CNS lesion

Question 8

CEntral lesion nystagmus

Answer 8

• Direction: either bidirectional or unidirectional
• visual fixation: continuous
• vertigo: Mild
• length of symptoms: may be chronic
• etiology: demyelination of nerves, vascular lesion, cancer/tumor

Question 9

Peripheral nystagmus

Answer 9

• Direction: unidirectional with the fast segment of movement indicating the opp direction of lesion
• visual fixation: will inhibit nystagmus and vertigo
• vertigo: significant
• length of symptoms: minutes, days, weeks but finite period of time; recurrent
• etiology: Meniere’s disease, vascular disorders, trauma, toxicity, infection of inner ear