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CONA 2 > VERTIGO MT #1 > Flashcards

VERTIGO MT #1 Flashcards

1
Q

VERTIGO—Sensory System

Receives afferent information from the environment
Comprised of:
1) Visual
2) Somatosensory (proprioception)
3) Vestibular
A

KNOW THE 3 BASICS

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2
Q

VERTIGO–Vestibular System Components

1—Peripheral sensory apparatus

2—_______

1) Vestibular nuclei
2) Posterior Column
3) Cerebellum

3—_____ _________

1) Ocular motor muscles
2) Postural muscles

A

CNS:

Motor output:

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3
Q

VERTIGO–Peripheral Sensory Apparatus Components

1–Labyrinths
2–Semicircular canals (3) and U & S (2)
3–_____ ______

A

Hair cells

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4
Q

VERTIGO–Motor Output Reflexes

1—Vestibular Ocular Reflex (VOR)

  • -Semicircular canals–compensate for ______ head motion
  • -Utricles, Saccules–compensate for _________head motion

2—Vestibular Spinal Reflex (VSR)
Three tracts for compensatory body motion
1) Antigravity muscles
2) Cervical muscles
3) __________ reflex from auditory, visual, and tactile input

A

angular

translational

Balance

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5
Q

VERTIGO–Dizziness Categories X 4

1) _______________-faint or sense of LOC
cardiovascular

2) ______________-feeling of falling
locomotor (MS), cerebellar

A

Presyncope

Disequilibrium

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6
Q

VERTIGO–Dizziness Categories X 4

3) ______________
- –psychogenic (anxiety) or idiopathic

4) _____________-illusion of movement
- -benign
- -subjective versus objective

A

Lightheadedness

Vertigo

OTHER—-

1) Postural hypotension
2) Cerebellar disease
3) Cardiac dysrhythmia
4) Peripheral neuropathy
5) Hypoglycemia
6) Migraine
7) Multiple Sclerosis
8) Vertebrobasilar arterial transient ischemic attack (TIA)

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7
Q

VERTIGO—-______________ = ??

Definition: experience of false sensation of movement
Most commonly: Report of environment spinning around self
Nausea, vomiting, & some autonomic signs such as diaphoresis, pallor, and tachycardia
Either peripheral or central vestibular system could be affected

A

VERTIGO

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8
Q

VERTIGO—-__________ = ??

Patients often describe dizziness as “light-headedness” or “feeling like I am going to faint”
Associated symptoms: generalized weakness, visual blurring or blackout, diaphoresis, shortness of breath, or palpitations
Vertigo may be due to inadequate perfusion in the brainstem vestibular nuclei
Typically episodic
Primary cardiovascular problem (as opposed to neurological disorder)

A

Presyncope

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9
Q

VERTIGO—-____________ = ?

–Dizziness occurs upon standing or walking (tends to improve when seated or supine)
–Patients usually have difficulty describing what they feel
“bad balance”, poor equilibrium”, “I’m just dizzy”
–Result of dysfunction at one or more points in the complex system (required for bipedal balance and ambulation)
Cerebellar, motor, or posterior column problem (proprioception)

A

Disequilibrium

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10
Q

VERTIGO—-_________________ = ??

Alteration in the vestibulo-ocular reflex
Change in visual acuity 
1) Ocular pathology 
2) New eye glass prescription
3) Etc. . . .
A

Visual-Induced Dizziness

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11
Q

VERTIGO—-____________ =??

Often attributed to emotional causes
Hyperventilation is a common cause of dizziness in anxious young people
Often associated with panic attacks (neurological and/or psychological component)
“I’m as nervous as a kitty-cat”

A

“Giddiness”

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12
Q

VERTIGO—-

1—Peripheral Vertigo

  • -Disease of the peripheral vestibular apparatus or eighth cranial nerve
  • -Most common cause of vertigo
  • -Associated with more nausea, vomiting, and autonomic symptoms
  • -Approximately ____% of cases

2—Central Vertigo

  • -Disease of the central vestibular connections
  • -Less severe, and other neurological signs usually present
  • -More severe __________
A

90

imbalance

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13
Q

VERTIGO—-Central vs. Peripheral

1—Central

  • -Cerebellum, brainstem, and its attachments
  • -_________ nystagmus (no fatigue)
  • -Pontine tumor
  • -Acoustic neuroma
A

Vertical

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14
Q

VERTIGO—-Central vs. Peripheral

2---Peripheral
Labyrinths, nerve at inner ear, and any other external structures
\_\_\_\_\_\_\_\_\_\_ nystagmus (YES! FATIGUE!)
Benign paroxysmal positional vertigo (BPPV)
Labyrinthitis
VBI
Meniere’s
Cervicogenic
A

Horizontal

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15
Q

VERTIGO—History Questions X 10

Ask patient to describe the sensation (to categorize the type):
1) ____________(peripheral or central vertigo)
vestibular or central processing systems

2) ____________ (proprioception or cerebellar)

A

Spinning?

Unbalanced?

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16
Q

VERTIGO—History Questions X 10

3) ______________(vascular, endocrine & psychogenic)

4) _______________(Have you hyperventilated or had depression?)
Are there neurologic, vascular, or systemic symptoms?
Medications?

A

Presyncope/Nausea?

Psychological?

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17
Q

VERTIGO—History Questions X 10

5–______- acute, gradual

6–_______- minutes, hours, days

7–________- constant, intermittent

A

Onset

DURATION

Frequency

18
Q

VERTIGO—History Questions X 10

8–____________- mild, moderate, severe

9–_______________- head movement vs. body position change

10–____________ - (tinnitus)

A

Severity

Positional relationship

Hearing loss

19
Q

VERTIGO—Onset

1—________ - peripheral causes ( BPPV, Labyrinthitis, VBAI, Meniere’s, cervicogenic)

2—________- central causes (Pontine tumor, acoustic neuroma, etc.)

A

Sudden

Gradual

20
Q

VERTIGO—Duration

1–Minutes
BPPV

2–Hours
Meniere’s

3–Days-weeks
Labyrinthitis, Vestibular Neuronitis, Acoustic Neuroma, _________

A

tumors

21
Q

VERTIGO—Frequency

1—Constant/Progressive
–_______ Causes (acoustic neuroma, pontine tumor, etc.)
Labyrinthitis, Neuronitis

2—Intermittent/Recurrent
–___________ Causes (except two listed above)

A

Central

Peripheral

22
Q

VERTIGO—Severity of Vertigo

1–Mild- Moderate
_________ Causes

2—Moderate - Severe
___________ Causes

A

Central

Peripheral

23
Q

VERTIGO—Head Position

BPPV
Cervicogenic
VBI
Labyrinthitis
Neuronitis
A

KNOW THE 5

24
Q

VERTIGO—Acoustic Alteration

1–________ Causes
Meniere’s
Labyrinthitis

2—_________ Causes
Acoustic Neuroma
Pontine Tumors

A

Peripheral

Central

25
Q

VERTIGO—Mental Status Examination

1—Examines a patient’s level of coherence
(alert to comatose)

2—Five states of cognition evaluated:

1) ___________ (10)
2) Registration (3)
3) Attention/Calculation (5)
4) Recall (3)
5) Language (9)
* NOTE: Less than 25/30 indicates significant cognitive impairment*

A

Orientation

26
Q

VERTIGO—Benign Paroxysmal Positional Vertigo (BPPV)

1---Single most common type of vertigo
2--Mean age = 50 y.o.
3--Women affected 2:1 (compared to men)
4--90% \_\_\_\_\_\_\_\_\_\_\_\_
5--90%: \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_  affected
A

unilateral

posterior semicircular canals

27
Q

VERTIGO—Benign Paroxysmal Positional Vertigo (BPPV)

6–Onset–Transient
(usually following rapid change in position)
7–Fatigable
8–Original onset often associated with nausea/vomiting
9–______________ = Gold standard test
10–_____________ (Q: horizontal or vertical?)

A

Dix-Hallpike

Nystagmus

28
Q

VERTIGO—Vestibular Neuronitis

1–Inflammation of vestibular nerve (duh)
2–Onset: acute nausea, vertigo and vomiting
(lasting for several days—ER)
3–50%: associated with recent _______ _________
4–Age range =___-____ y.o.
5–Nystagmus (Q: horizontal or vertical?)
6–Postural imbalance

A

viral infection

30-40

29
Q

VERTIGO—Labyrinthitis

1—Identical signs and symptoms as ____ _______ (etiology could also be from bacterial infection–leads to hearing loss, tinnitus, etc.)

2—Check for otitis media (ie: otoscopy)

A

vestibular neuronitis

30
Q

VERTIGO—Meniere’s Disease

1–Age range: ____-______ y.o

2–Genetic predisposition

3–Excessive accumulation of endolymph causing
distention and rupture of the membrane (ADH?)

4–Bilateral 30-50% of the time

5—Triad of symptoms:

1) Vertigo (severe) with nausea/vomiting
(duration: few hours-1 day)
2) _________
3) Hearing loss (fullness)

NOTE: Frequent reoccurrence; permanent ______ _______ may result

A

40-60

Tinnitus

hearing loss

31
Q

VERTIGO–Cervicogenic Vertigo

1—Etiology: vascular ___________, altered proprioceptive input, vasomotor response

2—-Symptoms:

1) Neck pain (duh)
2) Tinnitus
3) Balance instability (trauma?)

3—Provoked with increased _______ __________

4—Trigger points/muscle spasm/ISD

5–+ Swivel test

6–Postural alteration/scapulothoracic dysfunction

7–Difficulty on head relocation

A

compression

neck motion

32
Q

VERTIGO—Central Cause of Vertigo-Acoustic Neuroma

1—Schwannoma of vestibular nerve within the cerebellopontine angle

2–Gradual onset of ___________________

3–Mild hearing loss (with or without tinnitus)

4–Can progress to cause pressure on the facial nerve and cause ____________

A

dizziness

paralysis

33
Q

VERTIGO—Management

  • -Medication
  • -_____ ________ diet
  • -Surgery
  • -Decompression 8th cranial nerve/laser
  • -Habituation exercises (2d/2wk)
  • -Optokinetic stimulation
  • -Manipulation
  • -_______ muscle stimulation (cervical musculature)
  • -Canalith Repositioning Procedures (CRP)
  • – -Epley/Semont Maneuvers
A

Low salt

Electric

34
Q

VERTIGO—BPPV

1—Symptoms
Severe bouts of vertigo that last from _______TO___________ related to movement of the head, but without hearing loss
Movements include any of the following:
Rotation or extension of head, bending over, straightening up, rolling over in bed

2—Signs
(+) Hallpike, Horizontal nystagmus
(-) Neurologic exam, cervical exam

—-Note: this is suggested in the literature as the most common cause of vertigo

A

seconds to minutes

35
Q

VERTIGO—Treatment

1---Usually resolves in 1 month without treatment
2---Refer for Rx if incapacitating
3---Reposition \_\_\_\_\_\_\_\_\_: (66% - 92% successful) 
---Modified Epley Maneuver (page 493)
---Semont’s Maneuver (page 494)
4---Habitation exercises (page 492): 
----\_\_\_\_\_\_-\_\_\_\_\_\_\_ weeks for max result
----high success rate
A

otoliths

2-8

36
Q

VERTIGO—Meniere’s Disease

1—-Symptoms:

  • —-Severe bouts of vertigo lasting from hours to a day that are NOT related to head position, but do leave the patient with _____ ________. Tinnitus and a sense of “__________” in the ear are also related.
  • —-May have months between attacks

2—Signs:
—–Gross hearing loss may be present, all other procedures are generally negative

A

hearing loss

fullness

37
Q

VERTIGO—Treatment: reducing endolymph

1—Natural course is to “burn itself out” over months to years, but may have permanent hearing loss as a result

2—-Two-thirds of patients will respond to:
—Herbal or Rx diuretic coupled with a low salt diet

3—-Refer for _______ __________ if not effective

A

surgical decompression

38
Q

VERTIGO—Vestibular Neuronitis

1—-Symptoms:
Sudden bout of constant, severe vertigo that lasts for days to weeks.
===== Nausea & Vomiting ==============
NO ______ _______
Head movement provokes

2—-Signs:
Differentiate from Cerebellar disease
Most procedures will be negative, except for those that produce ____________

A

HEARING LOSS

nystagmus

TREATMENT
= Self-limiting, but be sure it is not a STROKE  in progress
-Balance training 
--Supportive nutrition
---Rx may be needed for symptom relief
39
Q

VERTIGO—Labyrinthitis

1—–Symptoms:
Acute onset of severe vertigo, with (_________) or without (viral) hearing loss, lasting for a week or so (provoked by head movement)
May be associated with recent meningitis or otitis media

2—Signs:
Nystagmus, hearing loss, and findings of ________ or otitis media if still active

TREATMENT

1–Check for ______ _______-
ear pull maneuver, warm compress, avoid sugar and dairy, etc.
2–If ___________, antibiotics may be required to prevent destruction of the inner ear
3–Balance training
4–Supportive nutrition

A

bacterial

meningitis

Otitis Media

bacterial

40
Q

VERTIGO—Acoustic Neuroma

1—Symptoms:
Gradual onset of mild, constant, vertigo with hearing loss and __________
2—Signs:
Unless the tumor is large the only finding is hearing loss

TREATMENT

  • —MRI is diagnostic for this condition
  • —_________ if compression of other cranial nerves or neural structures occur
A

tinnitus

Surgery

41
Q

VERTIGO—Cervicogenic Vertigo

1—-Symptoms:
Moderate to severe vertigo associated with HOLDING head positions (NOT getting INTO position). Usually has a history of _____ _______ 0R _______ (1/3rd of patients).

2—-Signs:

  • -MFPS, Tender points, and joint restriction
  • -(+) swivel test (AKA Fitz-Ritson)

TREATMENT

—-CMT treatment trial (if you are sure it is not a VBI, or concussion, or worse)
Might want to start off with distraction

—–C/S soft tissue work = Muscle proprioceptors

——Rehab for posture, balance, strength and flexibility

A

neck complaints or traumas

CONA 2 (7 decks)

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