Vertigo & Syncope (Exam #4) Flashcards
What definition involves sensation of abnormal motion; nystagmus, postural instability?
Vertigo
What type of lesion is likely present with Peripheral Vertigo?
Vestibular lesion
What type of lesion is likely present with Central Vertigo?
Brain lesion
What condition involves sudden/acute, horizontal/torsional nystagmus, NO neuro sxs?
Peripheral Vertigo
What condition involves gradual/progressive, vertical and non-fatigable nystagmus, neuro sxs?
Central Vertigo
What type of nystagmus is present with Peripheral Vertigo (2)? What about with Central Vertigo (2)?
- Peripheral = horizontal/torsional
- Central = vertical and non-fatigable
What is the general onset of Peripheral Vertigo? What about with Central Vertigo?
- Peripheral = sudden/acute
- Central = gradual/progressive
What three conditions should always be R/O with a presentation of dizziness?
- CVA
- MS
- Acoustic Neuroma
What three associated sxs often present with dizziness?
- N
- V
- Hearing loss
What three changes constitute as orthostasis?
- Drop in SBP of 20+
- Drop in DBP of 10+
- Drop in HR of 20+
What is nystagmus? How do you classify it?
Slow drift one direction → fast response in opposite direction
- Direction of nystagmus is the direction of the fast response
What does Caloric Testing test, and what is it used to differentiate?
Caloric Testing: tests vestibulo-ocular reflex
- Peripheral (vestibular) vs. Central (brainstem)
What does a normal Caloric Test looks like?
Normal = COWS
- Cold water = opposite nystagmus
- Warm water = same side nystagmus
If the Caloric Testing is abnormal, what is this called and what might this indicate?
Vestibular paresis = Peripheral Vertigo
What two drug classes are considered vestibular suppressants, and what is an example med for each?
Anticholinergics
- Scopolamine
Antihistamines
- Meclizine
- Dimenhydrinate
What is the MOST common cause of vertigo?
Benign Paroxysmal Positional Vertigo (BPPV)
What are two possible etiologies of Benign Paroxysmal Positional Vertigo (BPPV)?
- Prolonged bedrest
- Head trauma
What condition involves brief vertigo episodes (<1 minute)?
Benign Paroxysmal Positional Vertigo (BPPV)
What might induce Benign Paroxysmal Positional Vertigo (BPPV)?
Changes in head position
What dx test can confirm Benign Paroxysmal Positional Vertigo (BPPV), and how?
Dix-Hallpike Maneuver
- Reproduce vertigo and horizontal nystagmus
What is the tx for Benign Paroxysmal Positional Vertigo (BPPV)?
Self-limiting
- Education/reassurance
- Positioning maneuvers
- Vestibular rehab
What condition involves single attack of severe vertigo lasting days/weeks?
Vestibular Neuritis
- AKA Vestibular Neuronitis, Labyrinthitis
What age group does Benign Paroxysmal Positional Vertigo (BPPV) present in (2)?
- 50s
- 70s
What age group does Vestibular Neuritis present in?
Young/middle-aged adults
How can you differentiate Vestibular Neuritis from Labyrinthitis?
- Vestibular Neuritis: no hearing sxs
- Labyrinthitis: hearing sxs present
How can you differentiate Benign Paroxysmal Positional Vertigo (BPPV) from Vestibular Neuritis?
What sxs is NOT seen with either?
- BPPV = brief vertigo (<1 minute),
- Vestibular Neuritis = severe vertigo lasting days/weeks
NO hearing sxs in either
What condition is secondary to endolymphatic hydrops? What two conditions/events may precipitate this?
Meniere Disease
- Possible precipitating Syphilis or head trauma
What condition involves TRIAD of episodic vertigo, tinnitus, fluctuating hearing loss?
Meniere Disease
What is the TRIAD associated with Meniere Disease?
- Episodic vertigo
- Tinnitus
- Fluctuating hearing loss
What two dx tests are positive with Vestibular Neuritis?
- +Head Thrust Test
- Abnormal Caloric Testing shows vestibular paresis
What is the tx for Vestibular Neuritis (2)?
Self-limiting
- Supportive care (bed rest, vestibular suppressants, anti-emetics, Prednisone taper?)
How does the fluctuating hearing loss with Meniere Disease typically progress? How does this effect the vertigo sxs?
Gradually progressive → eventually irreversible
- Vertigo sxs stop when deafness is complete
How do the episodic vertigo attacks differ for BPPV, Meniere Disease or Vestibular Neuritis?
- BPPV: brief, <1 minute
- Meniere Disease: sudden, last 20 minutes to 24 hours
- Vestibular Neuritis: severe, lasts days/weeks
What finding is seen on audiogram with Meniere Disease?
Sensorineural hearing loss
What is the acute tx for Meniere Disease? What is the prophylactic tx (2)?
- Acute = supportive
- Prophylactic = low salt diet; limit caffeine/nicotine/alcohol/MSG
What condition involves an abnormal connection between perilymph and middle ear?
Perilymphatic Fistula
What two sxs may present with Perilymphatic Fistula?
- Hearing loss
- Tinnitus
What is pneumatic otoscopy, and what condition can it present with?
Eye movement w/ pressure change
- Seen with Perilymphatic Fistula
With what two conditions are hearing sxs present?
With what two conditions are hearing sxs NOT present?
Present = Perilymphatic Fistula, Meniere Disease
NOT present = BPPV, Vestibular Neuritis
What condition involves sudden, transient LOC with spontaneous recovery?
Syncope
What three sxs present with the prodrome of Vasovagal Syncope?
- Pallor
- Diaphoresis
- Nausea
What dx test can be used to evaluate recurrent episodes of unexplained syncope OR vasovagal syncope?
Tilt Table Test
What two conditions can be diagnosed with a Tilt Table Test, and what is an abnormal result?
What is a normal result?
- Recurrent episodes of unexplained syncope
- Vasovagal syncope
Abnormal = exaggerated drop in BP (+/- change in HR)
- Normal = mild drop in BP AND increase in HR
What two tests can be used to evaluate Syncope?
- Tilt Table Test
- Carotid Sinus Massage
What two conditions can be diagnosed with a Carotid Sinus Massage?
- Recurrent episodes of unexplained syncope
- Hx of carotid sinus syncope
What is an abnormal result of the Carotid Sinus Massage test (__ AND __OR__)?
Abnormal = sxs reproduced and period of asystole for 3-5 seconds OR drop in BP (50+ mmHg)
What are two major CIs associated with the Carotid Sinus Massage test?
- Prior TIA/CVA WITHIN 3 months
- Carotid bruits present
What are four RF associated with Cardiac Syncope?
- Abnormal EKG
- Hx of ventricular arrhythmias
- Hx of CHF
- Age 45+ years
How does Cardiac Syncope differ from other types of syncope?
Cardiac = NO prodrome
What is the most common cause of OBSTRUCTIVE Cardiac Syncope?
Aortic stenosis
What are the three types of Reflex Syncope? Which is most common?
- Vasovagal = most common
- Carotid Sinus
- Situational
What type of Syncope involves prodrome of pallor, diaphoresis and nausea?
Vasovagal Syncope
What type of Syncope is neurally-mediated, and what does this mean?
Reflex Syncope
- Loss of SNS tone → vasodilation, bradycardia → hypotension, syncope
What is the recommended tx for Carotid Sinus Syncope?
Cardiac pacemaker
What population most often presents with Carotid Sinus Syncope?
Male with atherosclerosis
What are the two types of Situational Syncope? Describe each
- Micturition Syncope = after emptying distended bladder
- Tussive Syncope = with severe coughing
What two populations most often present with Tussive Syncope?
- COPD
- Children with asthma
What often presents with Orthostatic (Postural) Hypotension (2)?
- Autonomic Neuropathies
- Peripheral Neuropathies
What are three txs for Orthostatic (Postural) Hypotension?
- Avoid volume depletion
- Med adjustment
- Behavior modification
What two sxs present with Subclavian Steal Syndrome?
What makes these sxs worse?
- Vertigo
- Syncope
Worse with arm exertion
What sign often presents with Subclavian Steal Syndrome?
Difference in pulses of BUE
What definition involves sense of imbalance (losing balance without sensation of movement)?
Disequilibrium
What definition involves vague and nonspecific dizziness?
Lightheadedness
What definition involves feeling impending faint or LOC? What is often the etiology of this?
Presyncope
- Often cardiac etiology
With Cardiac Syncope, what are two examples of bradycarrhythmias? What are three tachycarrhythmias?
Brady
- 2nd Degree AV Block, Type II
- 3rd Degree AV Block (Complete Heart Block)
Tachy
- WPW
- SVT
- VT
What are two common findings seen with Syncope that are NOT seen with seizures?
- Relation to posture
- Cardiac signs
