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neuro > A3. Differential diagnosis of vertigo and dizziness > Flashcards

A3. Differential diagnosis of vertigo and dizziness Flashcards

1
Q

History taking in vertigo and dizziness

A
  • Distinguish the type of dizziness
  • Duration
  • Exacerbations:
    *Worse with
    -head movement,
    -eye closure (vestibular)
    -no change (nonvestibular)
    *Worse with exercise
    (cardiac, pulmonary cause)
  • Associated symptoms:
    *Neurological (central):
    *Audiological (peripheral): hearing loss, tinnitus, otalgia
    *Nausea/vomiting (peripheral vestibular disorders)
    *SOB, palpitations
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2
Q

types of dizziness

A

○ Vertigo (room-spinning): illusion of rotatory movement due to disturbed orientation of the body in space
○ Lightheadedness (disconnected from environment)
○ Presyncope
○ Dysequilibrium (unstable, off-balance)

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3
Q

Exacerbations of vertigo and dizziness

A

○ Worse with
head movement,
eye closure (vestibular),
no change (nonvestibular)

○ Worse with exercise (cardiac, pulmonary cause)

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4
Q

vertigo and dizziness
Associated symptoms
○ Neurological (central):

A
  • ataxia (TIA, VBI, migraine),
  • changes in consciousness,
  • transient diplopia,
  • dysphagia,
  • dysarthria,
  • headache,
  • sensory/motor deficits (CNS)
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5
Q

classification of vertigo
can be —- or —-
which is more common??

A
  • Central (brainstem or cerebellar), 15%
  • Peripheral (inner ear or vestibular nerve), 85%
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6
Q

causes of Central Vertigo

A

Central (brainstem or cerebellar)
■ Cerebrovascular disorders:
● TIA
● Stroke
● Vertebrobasilar insufficiency

■ Drugs/toxins
■ Tumor (astrocytoma)
■ Trauma
■ Inflammation (meningitis, cerebellar abscess)
■ Migrainous vertigo
■ Multiple sclerosis (demyelination)
■ Syringobulbia

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7
Q

causes of Peripheral Vertigo

A

(inner ear or vestibular nerve)
■ Menière’s
■ BPPV (benign paroxysmal positional vertigo)
■ Trauma
■ Drugs: streptomycin, quinine, salicylates
■ Labyrinthitis
■ Vestibular neuronitis
■ Cerebellopontine angle tumors
*Acoustic neuroma
*Meningioma
*Epidermoid/dermoid

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8
Q

■ Cerebellopontine angle tumors

A

●Acoustic neuroma
●Meningioma
●Epidermoid/dermoid

they can cause peripheral vertigo (inner ear or vestibular nerve)

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9
Q

Differential diagnosis of dizziness

A
  • Vertigo
    *central: brainstem or cerebellar
    *peripheral** (inner ear or vestibular nerve)
  • Nonvertiginous:
    *Psychogenic (diagnosis of exclusion)
    ■ Depression
    ■ Anxiety etc
  • Vascular
    ■ Orthostatic hypotension
    ■ Stokes-Adams syndrome
    ■ Arrhythmia
    ■ CHF
    ■ Aortic stenosis
    ■ Vagovagal episodes
    ■ Metabolic causes
    *Ocular
    ■ Decreased visual acuity
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10
Q

Nonvertiginous
○ Psychogenic (diagnosis of exclusion)

A

■ Depression
■ Anxiety etc

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11
Q

Nonvertiginous vascular causes

A

■ Orthostatic hypotension
■ Stokes-Adams syndrome
■ Arrhythmia
■ CHF
■ Aortic stenosis
■ Vagovagal episodes
■ Metabolic causes

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12
Q

Vertigo what is it

A
  • is an illusion of rotational, linear or tilting of self or environment
    ● Produced by peripheral (inner ear or vestibular nerve) or central (brainstem, cerebellum) stimulation
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13
Q

Imbalance symptom for peripheral VS central vertigo

A
  • Peripheral: moderate-severe imbalance
  • central: mild-moderate
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14
Q

Nausea and vomiting symptom for peripheral VS central vertigo

A
  • Peripheral: Severe
  • central: Variable
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15
Q

Auditory symptoms symptom for peripheral VS central vertigo

A
  • Peripheral: common
  • central: rare
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16
Q

Neurologic symptoms symptom for peripheral VS central vertigo

A
  • Peripheral: rare
  • central: common
17
Q

Compensation symptoms comparison for peripheral VS central vertigo

A
  • Peripheral: rapid
  • central: slow
18
Q

Nystagmus symptoms comparison for peripheral VS central vertigo

A
  • Peripheral:
    *unidirectional
    *horizontal or rotatory
  • central:
    *Bidirectional
    *horizontal or vertical
19
Q

BPPV (benign paroxysmal positional vertigo) onset and duration

A
  • sudden onset
  • duration: seconds
20
Q

Labyrinthitis
onset and duration ,
hearing loss,
tinnitus

A
  • sudden onset
  • duration: days
  • unilateral hearing loss
  • +/-, whistling
21
Q

Menieres
onset
duration
hearing loss
tinnitus

A
  • gradual onset
  • duration: mins-hrs
  • fluctuating unilateral or bilateral hearing loss
    • tinnitus
22
Q

Acoustic neuroma onset, duration
hearing loss
tinnitus
neuro symptom

A
  • insidious/gradual onset
  • duration: chronic
  • hearing loss is progressive
    • tinnitus
    • ataxia, CN7 palsy
23
Q

neuro symptom of Acoustic neuroma

A

ataxia, CN7 palsy

24
Q

drugs causing perpipheral vertigo

A

streptomycin
quinine
salicylates

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