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Neuro Rehab 2 > vestib - diff dx > Flashcards

vestib - diff dx Flashcards

1
Q

what is the importance of asking good subjective Qs

A

help provide important diff dx info
- 80% chance that your diff dx is correct

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2
Q

what are the main subjective questions to ask

A

primary complaint

h/o of HAs, migraines, GAD
-> can contribute to vertigo sx

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3
Q

what can vertigo be attributed to

A

vestib system dysfunction

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4
Q

what can lightheaded be attributed to

A

hypotension
(ie orthostasis, arrhythmia, syncopal episodes)

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5
Q

what is a good strategy to get pts to clarify their sx

A

tell me what you are feeling w/o using the word dizzy

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6
Q

what can disequilibrium be attributed to

A

imbalance stemming from multiple problems
(ie visual loss, neuropathy)
- all contribute to postural control

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7
Q

what can oscillopia be attributed to

A

spontaneous nystagmus or severe, bilateral hypofunction
- can be uni, more commonly (B)

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8
Q

what is oscillopsia

A

everything is moving as you moving
- everything is bouncing

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9
Q

what can motion sensitivity be attributed to

A

migraine, BPPV

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10
Q

what are diff dx for sx of floating, swimming, rocking, spinning inside of head

A

depression
anxiety
somatoform disorders
mild TBI/concussion
cervical spine dysfunction

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11
Q

what are possible dx for a sx duration of seconds

A

BPPV
perilymphatic fistula

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12
Q

what are possible dx for a sx duration of minutes

A

migraine
TIA
panic attack

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13
Q

what are possible dx for a sx duration of hours

A

migraine
meniere’s
hypotension

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14
Q

what are possible dx for a sx duration of days

A

neuritis
CVA
possibly a migraine

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15
Q

what are possible dx for a sudden onset of sx

A

neuritis/labyrinthitis -> UVH
BPPV
meniere’s
stroke

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16
Q

what are possible dx for a gradual onset of sx

A

acoustic neuroma
stroke (slow bleed)

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17
Q

what are possible dx for an onset of sx preceded by infection

A

labyrinthitis/neuritis
- ear or sinus infections can travel to labyrinth or CN 8

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18
Q

what are possible dx for an onset of sx preceded by trauma

A

cervicogenic dizziness
BPPV (knocked crystal into SCC)
post-concussive syndrome

19
Q

what are possible dx for an onset of sx d/t a change in meds

A

SE of meds
- ototoxicity from aminoglycoside antibiotics (toxic to otoliths -> BVH sx)

20
Q

what are possible dx for a positional dependent trigger

A

BPPV (moving SCCs)
vertebrobasilar insufficiency
UVH (impacts VOR)

21
Q

what is the path behind vertebrobasilar insufficiency vertigo

A

post aspect of circulation
- if tilt head posterior can cause occlusion of vertebrobasilar a.

22
Q

what are possible dx for a change in pressure (associated w sneezing/coughing) trigger

A

perilymphatic fistula
- fistula in peripheral vestib system causing pressure changes

23
Q

what are possible dx for a dark room trigger and why

A

bilateral hypofunction

in dark room take vision away, now don’t have vision or vestib system to help w balance

24
Q

what are examples of activities pts may avoid since sx onset

A

putting head back - VBI
turning head - BPPV

25
Q

what are possible dx for an associated sx such as hearing loss

A

labyrinthitis
- how to diff from neuritis
acoustic neuroma
- tumor growing on CN 8
AICA infarct
meniere’s

26
Q

what are possible dx for an associated sx such as n/v

A

UVH - gaze instability
BPPV
brainstem involvement

27
Q

what are possible dx for an associated sx such as blurriness w head mvmt

A

UVH (VOR)

28
Q

what are possible dx for an associated sx such as HA

A

migraine of CNS

29
Q

what are possible dx for an associated sx such as ear fullness/pain, tinnitis

A

meniere’s

30
Q

what are possible dx for an associated sx such as photo- / phonophobia

A

migraine

31
Q

what are follow up questions to ask to sus out possible dx for an associated sx such as unsteadiness/falls

A

with what activities?
- figure out what position their head is in

32
Q

what are possible dx for an associated sx such as 5 neuro D’s

A

Dizziness
Diplopia
Dysarthria
Dysphagia
Drop attack

CNS dysfunction!

33
Q

what is one of the first things you want to figure out if someone is presenting w s/sx of vestib path

A

r/o stroke
r/o CNS path

34
Q

what is the importance of the “HINTS” exam

A

dx stroke more sensitively than early MRI

35
Q

what are the criteria of HINTS exam (+) for central path

A

HI = Head Impulse is (-) or normal, no corrective saccad
N = nystagmus changes direction or is vertical/torsional
TS = Test of Skew deviation that has vertical saccadic correction

36
Q

what do you do w the info from the criteria of the HINTS exam

A

if any of the 3 are present or (+), indicative of CNS path and need imaging to r/o stroke
- if all present pretty confident that it is a stroke or CNS path

37
Q

what are the criteria of HINTS exam (+) for peripheral path

A

HI = Head Impulse is (+) or abnormal, corrective saccade to midline w rotation
N = nystagmus non-direction changing, horizontal
TS = no skew deviation

38
Q

what is the Test of Skew deviation and what result would indicate central path

A

cover test of one eyeball
- if uncover eye and it is in malaligned and you see vertical realignment as eye jumps back

39
Q

what is the ocular tilt response

A

triad of sx indicating dysfunction:
1. ocular tilt
- head rotated toward affected side

  1. skew deviation
    - vertical misalignment of eyes
  2. ocular torsion
    - eyes will not rotate to stay vertical in orbit in presence of ocular tilt
40
Q

what are sx of vascular pathology involvement

A

vertigo
n/v
imbalance
nystagmus
intolerance to motion

41
Q

what is are 2 considerations with vascular path

A

CNS path can be vascular in nature

infarct or hemorrhage can cause sx similar to those seen w peripheral vestib path

42
Q

what are the 3 main points to help differentiate b/w central and peripheral vestib dysfunction

A

pt hx and sx complaint
oculomotor / vestib exam
postural control and gait

43
Q

how can you differentiate between BPPV and VBI

A

VBI seated test:
- lean upper trunk forward, head turned 45deg to test side and ext
- look for sx as can occlude vessel

(VBI brought on by position of cspine regardless of head position relative to gravity)

44
Q

what is an important consideration with VBI seated testing

A

little efficacy
- perform test anyway bc of serious nature of a (+) VBI test

Neuro Rehab 2 (48 decks)

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