VERTIGO MT #1 Flashcards
VERTIGO—Sensory System
Receives afferent information from the environment Comprised of: 1) Visual 2) Somatosensory (proprioception) 3) Vestibular
KNOW THE 3 BASICS
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
CNS:
Motor output:
VERTIGO–Peripheral Sensory Apparatus Components
1–Labyrinths
2–Semicircular canals (3) and U & S (2)
3–_____ ______
Hair cells
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
angular
translational
Balance
VERTIGO–Dizziness Categories X 4
1) _______________-faint or sense of LOC
cardiovascular
2) ______________-feeling of falling
locomotor (MS), cerebellar
Presyncope
Disequilibrium
VERTIGO–Dizziness Categories X 4
3) ______________
- –psychogenic (anxiety) or idiopathic
4) _____________-illusion of movement
- -benign
- -subjective versus objective
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)
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
VERTIGO
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)
Presyncope
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)
Disequilibrium
VERTIGO—-_________________ = ??
Alteration in the vestibulo-ocular reflex Change in visual acuity 1) Ocular pathology 2) New eye glass prescription 3) Etc. . . .
Visual-Induced Dizziness
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”
“Giddiness”
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 __________
90
imbalance
VERTIGO—-Central vs. Peripheral
1—Central
- -Cerebellum, brainstem, and its attachments
- -_________ nystagmus (no fatigue)
- -Pontine tumor
- -Acoustic neuroma
Vertical
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
Horizontal
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)
Spinning?
Unbalanced?
VERTIGO—History Questions X 10
3) ______________(vascular, endocrine & psychogenic)
4) _______________(Have you hyperventilated or had depression?)
Are there neurologic, vascular, or systemic symptoms?
Medications?
Presyncope/Nausea?
Psychological?
VERTIGO—History Questions X 10
5–______- acute, gradual
6–_______- minutes, hours, days
7–________- constant, intermittent
Onset
DURATION
Frequency
VERTIGO—History Questions X 10
8–____________- mild, moderate, severe
9–_______________- head movement vs. body position change
10–____________ - (tinnitus)
Severity
Positional relationship
Hearing loss
VERTIGO—Onset
1—________ - peripheral causes ( BPPV, Labyrinthitis, VBAI, Meniere’s, cervicogenic)
2—________- central causes (Pontine tumor, acoustic neuroma, etc.)
Sudden
Gradual
VERTIGO—Duration
1–Minutes
BPPV
2–Hours
Meniere’s
3–Days-weeks
Labyrinthitis, Vestibular Neuronitis, Acoustic Neuroma, _________
tumors
VERTIGO—Frequency
1—Constant/Progressive
–_______ Causes (acoustic neuroma, pontine tumor, etc.)
Labyrinthitis, Neuronitis
2—Intermittent/Recurrent
–___________ Causes (except two listed above)
Central
Peripheral
VERTIGO—Severity of Vertigo
1–Mild- Moderate
_________ Causes
2—Moderate - Severe
___________ Causes
Central
Peripheral
VERTIGO—Head Position
BPPV Cervicogenic VBI Labyrinthitis Neuronitis
KNOW THE 5
VERTIGO—Acoustic Alteration
1–________ Causes
Meniere’s
Labyrinthitis
2—_________ Causes
Acoustic Neuroma
Pontine Tumors
Peripheral
Central
