Vertigo (Ferguson) Flashcards
- ____________ indicates global cerebral hypoperfusion such as that noted in presyncope
- ______________ is a term that generally implies gait instability from balance impairment and does not necessarily implicate vertigo
- Lightheadedness
- Disequilibrium
What is the definition of vertigo?
- What is the most common manifestation of vertigo?
- What is of paramount importance to correctly identify the etiology of vertigo?
A sensation of false movement
- Room spinning
- Localizing vertigo to central or peripheral
How is vertigo treated?
- Vestibulosuppressants such as _______ or _______
- Antinausea medications such as ________
SYMPTOMATICALLY
- Meclizine, benzodiazepines
- Prochlorperazine
What type?
- Emanates from the vestibular nuclei or the cerebellum
- Typically associated with:
- Nystagmus, ataxia
- Dysarthria
- Dysphagia
- Diplopia
Central Vertigo
What type?
- Emanating from the labyrinth or vestibular nerve
- Typically associated with:
- Nystagmus, ataxia
- Tinnitus
- Hearing loss
Peripheral vertigo
What is the definition of nystagmus?
- May be horizontal, vertical, torsional, or any combination superimposed upon each other
- Etiologies? ______ or _______
A periodic rhythmic ocular oscillation of the eyes
- Congenital or acquired
What type?
- Multidirectional nystagmus
- Changes directions depending on gaze
- Pure nystagmus
- Rotary, horizontal, vertical presentation - NOT combinations
- Purely vertical, or tosional is highly suspicious for _________
NEED TO IMAGE THESE PATIENTS
Centrally derived nystagmus
- Central origin
What type?
- Unidirectional nystagmus
- Fast phase ALWAYS goes in the direction of _______
- Rotary component combined with either horizontal or vertical nystagmus in most patients, although pure presentations are also observed
- Fast phase ALWAYS goes in the direction of _______
Peripherallly derived nytagmus
- OF the LESION
___________ are key to developing a good differential.
- Use the previously described localization tools to help discern central from peripheral
What tests can be done?
- ____ - can be abnormal in peripheral causes
- _____ - with and without Gadolineum with THIN cuts through the brainstem** preferred
- ____ - can help to localize the lesion to peripheral or central cause, not particularly reliable, seldom used
History and Physical
- Audiograms
- Neuroimaging
- Brainstem Auditory Evoked Potentials (BAER)
In central vertigo -
Lesions emanating from the _______, _______, or ______ connections
Etiologies:
- (5)?
NEED NEUROIMAGING with MRI Brain!
Vestibular nuclei, cerebellum, cerebellar
- Cerebellar, or brainstem stroke
- Migraine
- Demyelinating lesions (MS, sarcoidosis)
- Abscess
- Malignancy (primary tumor vs mets)
In peripheral vertigo -
what are the differential diagnoses for each:
- Single episode? (2)
- Relentless/Progressive? (2)
- Recurrent? (4)
- Acute labyrinthitis, acute idiopathic peripheral vestibulopathy
- Mass/malignancy, medication induced
- Benign paroxysmal positional vertigo, meniere’s disease, perilymph fistula, vestibular paroxysmia
Diagnose:
- Sudden or subacute onset of severe vertigo
- Associated hearing loss
- Sx. usually last for days to weeks before gradually subsiding
- Generally thought to be viral but bacterial etiologies occur as well
Tx. If bacterial - antibiotics
- No clear indication for steroids
Acute labyrinthitis
Diagnose:
- Symptoms develop over hours
- Intense vertigo with head movements and to a lesser degree at rest
- NO associated hearing loss
- Generally considered a viral or post-viral phenomenon
Tx. Corticosteroids - 100 mg prednisone for 3-5 days followed by a gradual taper; anti-nausea medications as well as meclizine
Acute Idiopathic Peripheral Vestibulopathy
What medications can induce relentless/progressive vertigo?
- Toxic effects to the cochleovestibular system!
- ____
- ____ - ___ and to a lesser degree? (widely used in gyn, lung, cns, head and neck, testicular cancers)
- ____
- ____
- ____
- Aminoglycosides
- Platinum based antineoplastic agents (Cisplatin, Carboplatin)
- Salicylates
- Quinine
- Loop diuretics
Diagnose:
- Most common etiology of recurrent vertigo
- Due to otoliths that are dislodged from normal positioning in the semicircular canals (mc - posterior canal)
- Clinically patients complain of vertigo typically with head position change (extending neck and looking up, rolling over in bed)
- Within 5 seconds of position change and last ~30 seconds
- Can be provoked with the Dix Hallpike Maneuver (+ test burst of upbeat or torsional nystagmus 10-30 seconds
Benign Paroxysmal Positional Vertigo