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Clinical Medicine 1 > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

1
Q

This a sensation of motion without movement or exaggerated motion with movement.

A

Vertigo

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2
Q

This is often described as a vague dizziness and presyncope

A

Light headedness

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3
Q

If you suspect vertigo, what questions should you obtain in the history?

A
  1. Quality of the vertigo
  2. Frequency/Duration
  3. Associated Sx
  4. Exacerbating Sx
  5. Medications, Illicit drugs, alcohol
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4
Q

What distinct physical exam finding would you see in a patient with vertigo?

What additional physical exam findings could you see?

A

Nystagmus

Romberg (Imbalance)
Pronator Drift
Poor Finger-to-nose

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5
Q

Distinguish between peripheral vertigo and central vertigo through evaluation of nystagmus

A

Peripheral vertigo….

Latent Horizontal/torsional nystagmus that does not change direction with gaze, displays response fatigue and is supressed with fixation. LESS Imbalance

Central Vertigo….

Non-latent vertical/horizontal/torsional nystagmus that changes with direction but does not respond to fatigue or fixation. MORE imblance

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6
Q

What are the FOUR most common causes of vertigo?

A

BPPV
Vestibular neuronitis/labyrinthitis
Vestibular migraine
Meniere’s Syndrome

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7
Q

This form of vertigo presents typically in short duration intervals, head positions exacerbate the Sx, and w/o hearing change/tinnitus.

A

BPPV

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8
Q

What maneuver can you preform to confirm BPPV?

A

Dix Hallpike Maneuver

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9
Q

What are FOUR different etiologies of BPPV?

A
  1. Trauma
  2. Prolonged Head Position
  3. Labyrinthitis
    Meniere’s Disease
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10
Q

What maneuver is often used to treat BPPV?

What else can be used to treat BPPV?

A

Epleys Maneuver

Vestibular suppressants

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11
Q

If a patient presented with the complaint of vertigo lasting for a few hours to days, +/- hearing loss/tinnitus, and no specific trigger to the vertigo.

A

Vestibular Neuronitis

Labyrinthitis

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12
Q

What TWO Sx of vestibular neuronitis may be present after vertigo resolves?

A
  1. Facial weakness

2. Dizziness/Imbalance

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13
Q

What is the presumed etiology of vestibular neuronitis?

A

Viral

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14
Q

How is vestibular neuronitis treated pharmacologically?

What non-pharmacological management options are used to treat vestibular neuronitis?

A
  1. Vestibular suppressants/antiemetics in the acute phase ONLY
  2. Steroids
  3. Possibly antivirals
  4. Sodium restriction
  5. Vestibular rehabilitation therapy
  6. Driving restrictions
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15
Q

When would ABx be warranted in vestibular neuronitis?

A

Only if it were associated with acute otitis media

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16
Q

How would Meniere’s Syndrome present?

A
  1. vertiginous attacks lasting for hours
  2. Aural of fullness
  3. Roaring tinnitus
  4. Decreased hearing
17
Q

Menieres Disease often results from a _______ of the endolymphatic system which can result in the degeneration of vestibular and cochlear _____ cells.

A

Distension

Hair

18
Q

How might the audiogram look in a patient with Menieres Disease

A

The effected ear will show low frequency hearing loss and will normalize as the frequency of sounds increase

19
Q

What is the first line treatment for Meniere’s Disease?

A

Sodium reduction (1500 mg a day)

20
Q

How does diuretic therapy work in theory with Meniere’s Disease?

A

It reduces the fluid in the ear to prevent attacks

21
Q

If Meniere’s becomes a chronic problem what treatment options are available?

A

Gentamicin Ablation

22
Q

What is unique to the presentation of migranous vertigo?

A
  1. unilateral throbbing headache
  2. Visual Aura
  3. N/V, photophobia
  4. FHx of migraines
  5. History of motion sicknes
23
Q

T/F: In a patient with migranous vertigo, dizziness may last a few minutes to a few hours

A

True

24
Q

Vertigo is often an associated symptoms in a migraine _____.

A

Aura

25
Q

T/F: Hearing changes and tinnitus are not associated with Migrainous vertigo

A

False, they are

26
Q

How is hearing lose in Migrainous vertigo different from Meniere’s Disease?

A

In migrainous vertigo hearing loss will typically stabilize, where as in Menieres disease it is a steady decline.

27
Q

What is the primary treatment for migrainous vertigo?

What additional non-pharmacologic treatment options are available?

A

Eliminate migraine triggers

Vestibular rehabilitation therapy

28
Q

What are the pharmacological treatments of migrainous vertigo?

A
  1. Migraine Prophylaxis (Propanolol, Amitriptyline, Verapamil)
  2. Benzodiazepines (Clonazepam)
29
Q

What are common causes of central vertigo?

A
  1. MS
  2. Tumors
  3. Cerebrovascular disease
  4. Sz
  5. Neurodegenerative
30
Q

What are the Sx of central vertigo?

A

Slow progressing dizziness
central nystagmus
neurological deficits

31
Q

What imaging study is warranted in a patient with central vertigo?

A

MRI

Clinical Medicine 1 (6 decks)

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