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13 ENT > Dizziness > Flashcards

Dizziness Flashcards

1
Q

a distinct immediate and sometime incapacitating alteration of sensory experience characterized by a feeling of movement of oneself or environment

A

vertigo

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2
Q

unsteadiness or current tendency to stumble or fall, lacks a clear disturbance of sensorium of vertigo and related to ambulation

A

imbalance/disequilibrium

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3
Q

a floating feeling, mild unsteadiness or depersonalization

A

lightheadedness, can be replicated by hyperventilation

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4
Q

feeling faint or losing consciousness

A

presyncope

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5
Q

mechanics of the balance system

A

input from vestibular (angular and linear), proprioceptive, and visual -> cns -> eye and joints -> vestibulooccular reflex and vestibularspinal reflex

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6
Q

t/f dizziness occurs when there is any dysfunction in the visual, vestibular, or somatic (proprioceptive) system

A

true

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7
Q

non-vestibular causes of dizziness

A

cardiovascular, endocrine, neurologic, drugs

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8
Q

vestibular causes of dizziness

A

disruption in the afferent vestibular pathway or in the equilibrium reflexes mentioned earlier

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9
Q

how to diagnose dizziness

A
  1. ascertain if it’s truly vertigo
  2. elicit triggers, timing, duration, and intensity (detailed hx)
  3. detect associated symptoms (neuro pe)
  4. determine if vestibular or not
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10
Q

the first thing to do with a dizzy patient is __

A

determine if this is a neuro event (sudden onset headache and neurologic signs = urgent refer)

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11
Q

peripheral vs central vertigo

A

peripheral: membranous labyrinth/vestibular apparatus and vestibular nerve
central: nuclei and fiber tracts in cns

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12
Q

nystagmus in peripheral vertigo

A
  • horizontal and torsional
  • inhibited by fixating eyes
  • fades after few days
  • does not change direction with gaze
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13
Q

nystagmus in central vertigo

A
  • purely vertical, horizontal or torsional
  • not inhibited by fixation
  • may last weeks to months
  • may change direction with gaze towards fast phase
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14
Q

imbalance in peripheral and central vertigo

A

p: mild to moderate, can walk
c: severe, cannot walk or stand still

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15
Q

nausea/vomiting in p and c vertigo

A

p: severe
c: varies

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16
Q

hearing loss and tinnitus in p and c vertigo

A

p: common
c: rare

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17
Q

non-auditory neuro symptoms in p and c vertigo

A

p: rare
c: common

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18
Q

latency following provocation in p and c vertigo

A

p: longer (20 s)
c: shorter (5 s)

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19
Q

a conjugated, coordinated eye movement about a certain axis which can be divided into rhythmically alternating slow and fast phases

A

nystagmus

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20
Q

pathology in nystagmus

A

when only one vestibular system is sending inputs to the cns

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21
Q

kinds of movement in nystagmus

A
  • horizontal
  • vertical
  • rotary
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22
Q

slow vs fast phase

A

slow: tonic eye movement induced physiologically or pathologically by vestibular stimulus
fast: saccade like re-fixation movement induced by oculomotor system

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23
Q

direction of the nystagmus is defined by the ____

A

fast component

24
Q

pure tone audiometry

A
  • confirms peripheral vertigo

- abnormal = mri

25
Q

gold standard for diagnosis of retrocochlear pathology

A

mri

26
Q

t/f the use of audiometric brainstem response is recommended for retrocochlear pathology

A

false, hx and pe enough

27
Q

inflammation of the vestibular nerve

A

vestibular neuronitis/neuritis

28
Q

pathophysio of vestibular neuritis

A
  • sudden impairment of peripheral vestibular system of one side
  • usually superior vestibular nerve
29
Q

manifestation of vestibular neuritis

A
  • 2 wks after urti
  • sudden severe attack of rotary vertigo with no apparent cause
  • horizontal symtpoms
30
Q

vestibular neuritis pertinent negatives

A

no ear pain, hearing loss, or tinnitus
no other neuro impairments
no headache

31
Q

in vestibular neuritis, nystagmus is heightened when ___ and decreased when ___

A

heightened when looking toward fast phase

decreased when looking toward slow phase (injured side)

32
Q

ddx for vestibular neuritis

A

central infarction of cerebellum
vascular lesions
cns space occupying lesion

33
Q

treatment for vestibular neuritis

A

supportive: bed rest, iv fluids, anti-vertigo meds, corticosteroids, vestibular rehabilitation after acute phase

34
Q

prognosis of vestibular neuritis

A

good with complete recovery but elderly can have residual disequilibrium

35
Q

most common cause of dizziness

A

benign paroxysmal positional vertigo

36
Q

pathophysio of bppv

A
  • caused by particles floating in endolymph of semicircular canal
  • particles cause an unphysiologic deflection of cupula in scc (usually posterior scc)
37
Q

manifestations of bppv

A
  • brief episodic transient vertigo induced by rapid change in head movement
  • vertigo and nystagmus <30 s
  • bppv temporarily becomes less intense and disappears with repeated positioning
38
Q

pertinent negatives in bppv

A

no ear pain, hearing loss or tinnitus

no other neuro impairments

39
Q

diagnostics of bppv

A

dix haplike test: rotatory nystagmus after latent period of 10 s and lasts for a minute

pta-st and calorics normal

40
Q

treatment for bppv

A

canalith repositioning maneuvers (epley’s maneuver and semont’s maneuver)

41
Q

pathophysio of meniere’s disease

A
  • hx: narrow vestibular aqueduct or previous hx of ear trauma
  • oversecretion of endolymph = distention of cochlear duct and displacement of reissner’s membrane towards scala vestibuli
  • rupture of reissner’s membrane = mixing of perilymph and endolymph = inc potassium in perilymph
42
Q

clinical triad of meniere’s disease

A

fluctuating hearing loss, tinnitus, and vertigo

  • tinnitus becomes louder, hearing becomes poorer
  • vertigo ~20 mins
43
Q

manifestation of meniere’s disease

A
  • ear fullness
  • hearing improves after attack but dysequilibrium persists
  • pta: low tone sensorineural hearing loss
  • vestibular testing: hypo- or hyperfunction and eventually hypofunction
44
Q

treatment for meniere’s disease

A
  • symptom control and decreasing fluid
  • diuretics, ccb, histamine analogs
  • anti-emetics
  • salt restriction
  • sedatives
  • intratympanic injection of gentamicin or dexamethasone in serve cases
45
Q

prognosis for meniere’s diesease

A

good but recurrent, hearing loss may become permanent

46
Q

manifestation of migraine associated vertigo

A
  • hx of migraine
  • mimics bppv, meniere’s, or TIA
  • diagnosis by exclusion
47
Q

manifestations of cervicogenic vertigo

A
  • headache
  • syncope, tinnitus, nausea and vomiting, hearing loss, flashing lights
  • elicited by cervical range of motion maneuvers
48
Q

pathophysio of cervicogenic vertigo

A
  • trigger: head/neck assumes a certain position or change in position
  • misalignment causes abnormal information on orientation of head and neck
  • brain mis-corrects based on wrong info = dizziness
49
Q

diagnostics of cervicogenic vertigo

A

pta-st and caloric tests normal

neck ap-l: cervical spondylosis, degenerative change, straightening of normal cervical lordosis

50
Q

treatment for cervicogenic vertigo

A

symptom control, rehab for cervical neck spine problem

51
Q

examples for vestibular neuritis drugs

A

steroids: prednisone

52
Q

examples of meniere’s drugs

A

diruetics: hydrochlorthiazide
histamine: betahistine
ccb: flunarizine, cinnarizine

53
Q

examples of bppv drugs

A

histamine: betahistine
ccb: cinnarizine

54
Q

examples of vestibular sedatives

A

benzodiazepines: diazepam, lorazepam
antihistamines, anticholinergic: meclizine, dimenhydrinate
anticholinergics: scopolamine

55
Q

examples of antiemetics

A

metoclopramide: prochlorperazine
others: gingko biloba

13 ENT (18 decks)

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