vertigo and syncope Flashcards
vertigo is associated with what
- nystagmus
- postural instability
peripheral causes of vertigo implies
- a vestibular lesion
central causes of vertigo implies
- central (brainstem) lesion
horizontal and/or torsional nystagmus is associated with
- peripheral vertigo
vertical nystagmus is associated with
central vertigo
neurologic symtpoms are present in which type of vertigo
- central
which type of vertigo is associated with ear symptoms (hearing loss, tinnitus) and is usually acute onset
- peripheral
onset of central vertigo is usually
- gradual and progressive
disequilibirum is characterized by
- imbalance
- gait difficulties
Must rule out serious causes of vertigo such as
- vertebrobasilar insufficiency/cerebellar stroke
- multiple sclerosis
nystagmus is characterized by a
- slow drift in one direction followed by a fast response in the opposite direction
- referred to by direction of the fast component
hallpike maneuver is most helpful for diagnosis of
- benign paroxysmal positional vertigo
electronystagmography function
- assessment of vestibular function
what is the hallpike maneuver
- pt seated on table, head turned to one side, quickly lower to supine with head over edge
- observe eyes for nystagmus
- repeat on other side and with head facing straight
describe caloric testing for nystagmus
- COWS: direction of fast phase
- cold water/opposite side
- warm water/same side
describe the results of caloric testing for nystagmus
- impaired or absent thermally induced fast nystagmus indicates pathology in the labyrinth on the irrigated side
what is the most common inner ear disorder that causes vertigo
benign paroxysmal positional vertigo
benign paroxysmal positional vertigo is associated with changes in
head position
how long to the episodes of vertigo in benign paroxysmal positional vertigo last
-
transient
- 1-2 min
what condition is thought to be associated with prolonged bedrest and head trauma thought to be secondary to dislodged CaCO3 otoliths in the semicircular canals
benign paroxysmal positional vertigo
any associated changes in hearing with benign paroxysmal positional vertigo
no
what test can be done in people with benign paroxysmal positional vertigo to reproduce vertigo and horizontal nystagmus
hallpike maneuver
first line medications for benign paroxysmal positional vertigo
-
anticholinergics
- scopolamine
-
antihistamine
- meclizine, dimenhydrinate
What is vestibular neuronitis (acute labyrinthitis) and what is it associated with
- single attack of vertigo, sx usually last 2-3 d
- associated with
- viral URI
- N/V
will vestibular neuronitis (acute labyrinthitis) be associated with nystagmus, tinnitus, and/or hearing loss
- may see nystagmus
- no tinnitus or hearing loss
patient will report falling to the affected side and caloric testing will show vestibular paresis with what condition
vestibular neuronitis (acute labyrinthitis)
What is the triad associated with Meniere’s disease
- episodic vertigo
- tinnitus
- fluctuating hearing loss
onset of Meniere’s disease is usually
- sudden
Meniere’s disease is thought to be secondary to
- endolymphatic hydrops
in Meniere’s disease, hearing loss is
- progressive with each attack
- loose low tones -> high tones
- attacks of vertigo stop when deafness is complete
management of acute attack of Meniere’s disease
- bed rest
- symptomatic care
- anti-emetics
- vestibular suppressants
surgical management of refractory Meniere’s disease
- endolyphatic shunt
- vestibular nerve sectioning
- ablation of labrinth if total hearing loss present
What is a perilymphatic fistula
- abnormal connection between the perilymph and the middle ear
- inner ear fluid may leak into middle ear
cause of perilymphatic fistula
- sudden changes in pressure of the middle ear
- congenital
- head trauma, weight lifting, barotrauma (scubba diving)
perilymphatic fistula is associated with what symptoms
- hearing loss
- tinnitus
- +/- vertigo
what test can confirm presence of perilymphatic fistula
-
pneumatic otoscopy
- abn to see eye movements with changes in pressure
cause of syncope
- diminished cerebral blood flow
- need blow flow to reticular activating system and at least one cerebral cortex to maintain wakefullness
what prodrome is consistent with vasovagal syncope
- lightheadedness
- facial pallor
- diaphoresis
- nausea
what constitutes a positive orthostatic test
- drop in systolic pressure > 20
- drop in diastolic pressure > 10
what is the tilt table test
- pt tilted upright by 60-90 degrees
- normal - minimal drop in BP and increase HR
- abnormal - exaggerated drop in BP with or without drop in HR associated with dizziness or lightheadedness
indications for tilt table test
- indicated for recurrent episodes of unexplained syncope; no hx of cardiac disease
- provacative test for vasovagal syncope
indications for carotid sinus massage
- indicated for recurrent episodes of syncope with negative work up
- history of carotid sinus syncope
explain the carotid sinus massage
- carotid sinus massaged for 3 seconds while monitoring HR and BP
- positive: symptoms reproduced and period of asystole > 3 seconds or drop in BP ( > 50 mmHg)
risk factors for cardiac syncope
- abn ECG
- hx of ventricular arrhythmias
- hx of heart failure
- age > 45
what is sinus node dysfunction (sick sinus syndrome)
- intermittent pauses with alternating bradycardia and tachycardia
what is the most common outflow obstructive cause of cardiac syncope
- aortic stenosis
- associated with exertion
what is carotid sinus hypersensitivity
- carotid sinus is abnormally responsive to pressure
- tight shirt collars or shaving (pressure) produces bradycardia, even asystole with or without hypotension
tx for carotid sinus hypersensitivity
- cardiac pacemaker
cause of vasovagal syncope
- loss of sympathetic tone or increase in parasympathetic tone -> vasodilation and bradycardia -> hypotension and syncope
what is micturition syncope
- syncopal episode after emptying distended bladder
- seen after excess fluid ingestion
- secondary to vagal stimulation and or orthostasis
what is tussive syncope
- barrel chest/COPD; children with asthma
- severe coughing increases intrathoracic pressure and decreases CO
what is subclavian steal syndrome
- stenosis of subclavian artery near origin
- see flow reversal in ipsilateral vertebral artery -> decreased cerebral perfusion
test for subclavian steal syndrome
- look for symtpoms with arm exertion
- look for differences in pulses in upper extremities
