wk 10 key Flashcards
4 types of dizziness
- vertigo (illusion of movement of oneself or envo)
- presyncope (feel like going to faint)
- dysequilibrium (impaired walk)
- light headed/ non specific
central vs peripheral causes of vertigo causing a dysfunction in vestibular system
peripheral: BPPV, Menieres, vestibular neuritis
central: vestibular migraine, cerebrovascular disease (stroke, VBI)
TiTrATE dx for dizziness
Timing of sx
Triggers the provoke sx
And a Targeted Exam
flow chart on slide 9
BPPV
episodic vertigo triggered by head motion or change in body position
from migration of ear otoliths in semicircular canal
assess BPPV
dix hallpike
tx for BPPV
vestibular rehab
-epley maneuver to reposition canalith
avoid meds that suppress vestibular ie. benzes or antihistamines
orthostatic hypotension
dizzy when stand up after lying or sitting (decreased cerebral perfusion)
BP drops 20 systolic or 10 diastolic when stand up after sitting
causes: hypovolemia, meds, autonomic insufficiency
Menieres disease
end-lymphatic hydrops; excess fluid pressure in inner ear
unilateral sensorineuronal hearing loss w episodes of vertigo
unidirectional, horizontal torsional nystagmus w vertigo
tx for menieres
salt restrict, caffeine and alcohol restrict, no diuretics, rehab, surgery
vestibular migraines
vertigo plus migraine sx: N/V, photo or phonophobia, visual aura
tx vestibular migraines
avoid triggers, stress, sleep and exercise, vestibular suppressant meds…
psychogenic dizziness
from psychiatric i.e. anxiety, depress
physical findings:
* Moment-to-moment fluctuations in impairment
* Excessive slowness or hesitation
* Exaggerated sway on Romberg, improved by distraction
* Sudden buckling of knee, typically without falling
* A cautious “walking on ice” pattern
DO: SSRI, CBT
barotrauma
vertigo from alterations in pressure (i.e scuba dive, fly)
medication induced dizziness
alcohol, antiparkinsona, antifunal, antihistamines, antihypertensive, narcotics, anticholinergic, hypoglycemics,…..
HINTS
Head Impulse-Nystagmus-Test for Skew
HI
peripheral; saccade
central; normal
nystagmus
peripheral; unidirectional
central; bidirectional
skew
peripheral; normal
central; skew vertical
vestibular neuritis
inflamed vestibular nerve; usually viral
sx: episodic vertigo, no trigger w N/V, oscillopsia, unsteady gait
horizontal or torsional nystagmus
hearing OK
tx: vestibular suppressants
Vertebrobasilar Insufficiency (VBI) or
Vertebrobasilar Ischemia
RED FLAG
inadequate blood flow to brain
can lead to TIA or stroke
neuro sx: diplopia, dysphonia, ataxia, numb or weak
acute labyrinthitis
viral infection i.e. otits media or meningitis
hearing loss, tinnitus, vertigo
tx; antibiotics
Herpes Zoster Oticus (Ramsay Hunt
Syndrome)
inflamed vestibulocochlea nerve
causes dizziness
possible facial paralyssi
cholesteatoma
growth in middle ear; cyst with keratin
otosclerosis
abnormal bone growth in inner ear
conductive hearing loss, tinnitus, vertigo
perilymphatic fistula
seconds of vertigo with sensorineural hearing loss
leak perilymphatic fluid into tympanic or round window
usually from physical trauma
Tumours Arising from the
Cerebellopontine Angle
what are their names
red flag
i.e. schwannoma, meningioma
sensorineural hearing loss and vertigo
Multiple Sclerosis
associated with BPPV or other causes of vertigo
further testing in dizziness
if suspect central lesion and risk for stroke
MRI, MRA
A 55-year-old woman with a history of migraines presents with a 2-day history of severe, continuous dizziness and imbalance. She denies headache, visual changes, or weakness. Her vitals are stable, but the neurological examination reveals nystagmus and difficulty with heel-to-toe walking. She has no other focal neurological deficits.
Given her history and presentation, which of the following is the most appropriate initial diagnostic approach?
Question 2 Answer
a.
Vestibular rehabilitation therapy
b.
Treatment with migraine medication and observation for symptom resolution
c.
Magnetic Resonance Imaging (MRI) of the brain
d.
Dix-Hallpike maneuver to diagnose benign paroxysmal positional vertigo (BPPV)
c.
Magnetic Resonance Imaging (MRI) of the brain
A naturopathic doctor is informing their patient about the prognosis for their vestibular neuronitis.
Which of the following represents the most accurate prognostic information?
Question 3 Answer
a.
A sensation of disequilibrium is likely to persist for years because of bilaterally impaired vestibular function
b.
The prognosis for this condition is good, but BPPV tends to develop afterwards, occurring in approximately 50% of patients
c.
As vestibular compensation occurs, the patient’s vertigo is likely to resolve slowly over a few days
d.
Unfortunately, in 80% of patients, the underlying nerve damage takes three months or longer to resolve
c.
As vestibular compensation occurs, the patient’s vertigo is likely to resolve slowly over a few days
