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Neurology > Dizziness, Vertigo, Syncope, and Seizures > Flashcards

Dizziness, Vertigo, Syncope, and Seizures Flashcards

1
Q

What are the three major causes of dizziness

A
  • Presyncope (lightheadedness)
  • Vertigo
  • Multisensory stimuli - Grand canyon or hearing shocking news
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2
Q

What sensation does patient experience in vertigo

A

Room spinning

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3
Q

What is the initial thing you must do when a patient presents with vertigo

A

See if it is peripheral (benign) vs. central (serious)

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4
Q

Difference in onset, intensity, and N/V intensity between central and peripheral vertigo

A

Central vertigo is gradual onset, mild intensity, mild N/V, while peripheral vertigo is sudden onset, severe intensity, severe N/V (3 S’s)

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5
Q

Difference in neurological findings between peripheral and central vertigo

A

Central vertigo has associated neurological findings, while no neurologic findings in peripheral vertigo (except maybe hearing and tinnitus)

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6
Q

Difference in nystagmus and position between central and peripheral vertigo

A

Central vertigo has mild nystagmus and position change has mild effect, while peripheral vertigo has severe effect from position change and severe nystagmus (2 S’s)

Nystagmus: Multidirectional and vertical in central, unilateral vertical in peripheral

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7
Q

Difference in refractoriness in tilt test between central and peripheral vertigo

A

Central vertigo - no refractoriness (tilt test can be repeated)

Peripheral vertigo - rapidly refractory (tilt test cannot be repeated)

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8
Q

Which way will patient fall in both central and peripheral vertigo

A

Towards side of lesion

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9
Q

What are the five types of peripheral vertigo

A
  1. ) Benign positional vertigo
  2. ) Meniere’s disease
  3. ) Acute labyrinthitis
  4. ) Ototoxic drugs - aminoglycosides and diuretics
  5. ) Acoustic neuroma (Shwannoma)
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10
Q

Peripheral Vertigo: What are three characteristics of benign positional vertigo

A
  1. ) Vertigo only experienced in specific positions, lasts for few moments
  2. ) Age > 60
  3. ) Recovery complete within 6 months(Rule of 6’s)
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11
Q

Peripheral Vertigo: What is the treatment for benign positional vertigo

A

Meclizine

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12
Q

Peripheral Vertigo: What is the triad for meniere’s disease

A

Vertigo, tinnitus, and hearing loss

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13
Q

Peripheral Vertigo: Difference between benign positional vertigo spells and meniere’s disease vertigo spells

A

BPV lasts for a few moments, meniere’s lasts for hours to days and recurs several months or years later. BPV heals on own, meniere’s disease hearing loss becomes permanent

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14
Q

Peripheral Vertigo: What is the treatment for meniere’s disease

A

Sodium restriction and diuretics

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15
Q

Peripheral Vertigo: How does acute labyrinthitis occur

A

Viral infection of choclea and labyrinth lasting for several days

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16
Q

Peripheral Vertigo: Symptoms of acoustic neuroma

A

Ataxia, gait unsteadiness, nystagmus, hearing loss, and tinnitus

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17
Q

Three causes of central vertigo

A
  1. ) Multiple sclerosis
  2. ) Vertebrobrasilar insufficiency
  3. ) Migraine-associated vertigo
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18
Q

What is the definition of syncope

A

Transient loss of consciousness/postural tone secondary to acute decrease in cerebral blood flow, with rapid recovery of consciousness without resuscitation

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19
Q

Two major categories to divide syncope into

A

Cardiac and non-cardiac (neurogenic)

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20
Q

Cardiac syncope characteristics

A

Sudden and without prodromal symptoms i.e. patient’s face hits floor, during exercise, may be manifestation of underlying cardiac problem

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21
Q

Three major causes of cardiac syncope

A
  1. ) Arrhythmias
  2. ) Obstruction of blood flow
    3: ) Massive MI
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22
Q

Does vasovagal (neurocardiogenic) syncope have precipitating factors and premonitory symptoms?

A

Precipitating - Pain, fear, stress, extreme fatigue

Premonitory - Pallor, diaphresis, lightheadedness, nausea, dimming vision

23
Q

What physical examination is positive in a vasovagal (neurocardiogenic) syncope

A

Tilt table study - reproduces symptoms

24
Q

What age group does vasovagal (neurocardiogenic) syncope occur in?

A

Before age 40

25
Q

What is the pathophysiology of vasovagal syncope

A

Compensatory sympathetic innervation of standing up doesn’t work and parasympathetic goes into overdrive

26
Q

What symptoms occur in vasovagal syncope?

A

Inappropriate bradycardia, vasodilation, marked decrease in BP, reduced cerebral perfusion (overactive parasympathetic)

27
Q

What is the reversible physical treatment and medical treatment for vasovagal syncope

A

Physical: Supine posture and elevate legs
Medical: B-blockers and disopyramide

28
Q

What are three main reasons for orthostatic hypotension to occur

A
  1. ) Autonomic failure (diabetes, parkinsons)
  2. ) Volume depletion (diuretics, dehydration, etc)
  3. ) Medications
29
Q

What is the definition of orthostatic hypotension

A

Reduction in BP due to postural change

30
Q

How do you treat orthostatic hypotension?

A

Increased sodium intake and fluids. Pharmacologic: Midodrine and fludrocortisone

31
Q

What is the main goal of diagnosing syncope in general

A

To differentiate between cardiac and noncardiac etiologies

32
Q

What are three things you must do for history when someone presents with syncope

A
  1. ) Find out events around syncope event
  2. ) Check medications
  3. ) Ask witnesses
33
Q

What five physical examinations should you do in syncope

A
  1. ) BP supine, sitting, standing
  2. ) Mental status
  3. ) Murmurs (aortic stenosis, hypertrophic cardio)
  4. ) Carotid pulses - check bruits
  5. ) Reflex bradycardia and hypotension via pressure to carotid sinus
34
Q

What labs should you order to help in the diagnosis to the type of syncope

A

ECG for sure, CBC, metabolic panel

35
Q

What additional tests can you do when someone presents with syncope

A
  1. ) 24 hour holtor monitoring for arrhythmia
  2. ) Table tilt - if recurrent episodes and vasovagal (non cardiac)
  3. ) CT/EEG - if seizure
  4. ) Echo - if ECG is abnormal or other evidence of structural heart disease
36
Q

How does a seizure occur?

A

Sudden abnormal discharge of electrical activity in the brain

37
Q

What is the definition of epilepsy?

A

Recurrent, idiopathic seizures

38
Q

Out of the eight causes of seizures, what are the four M’s

A
  1. ) Metabolic disturbances - hyponatremia, hypoglycemia, hypocalcemia, uremia, thyroid storm, etc
  2. ) Mass lesions - cancers, hemorrhage
  3. ) Missing drugs - non-compliant with anticonvulascents or acute withdrawal from alcohol, benzos, barbiturates
  4. ) Miscellaneous - pseudo-seizures (aware of it), enclampsia, hypertensive encephalopathy
39
Q

Out of the eight causes of seizures, what are the four I’s

A
  1. ) Intoxication - cocaine, lithium, lidocaine, theophylline, carbon monoxide, metals
  2. ) Infections - meningitis, abscess in brain
  3. ) Ischemia - stroke, TIA
  4. ) Increased ICP - caused by trauma
40
Q

What are the two major categories of seizures and the two subcategories for each

A
  1. ) Partial seizure - One part of brain with temporal lobe and associated symptoms from any other part involved
    a. ) Simple
    b. ) Complex
  2. ) Generalized seizure - Both parts of brain with loss of consciousness
    a. ) Tonic clonic (grand mal)
    b. ) Absence
41
Q

For partial seizures, What is the major difference between simple and complex partial seizure

A

In simple, consciousness INTACT with unilateral tonic-clonic movements

In complex, consciousness IMPAIRED with 1-3 minute automatisms, postictal confusion, and hallucinations

42
Q

What is the course of the grand mal seizure

A

1.) Sudden loss of consciousness, with tonic phase (may lose breathing) then clonic phase for 30 seconds at least, then flaccid and comatose before regaining symptoms

43
Q

What are additional features of grand mal seizure

A
  1. ) Postictal confusion and drowsiness for 10 to 30 minutes

2. ) Tongue biting, vomiting, apnea, incontinence

44
Q

What is the course of absence seizure and how frequent is it

A

Child disengages from activity, stares into space, returns to activity seconds later and this episode only lasts for seconds

Happens 100 times per day

45
Q

What is one similarity and difference between grand mal and petit mal seizure in terms of symptoms

A

Petit mal has impairment of consciousness similar to grand mal, but does not have loss of postural tone, continence, or postictal confusion

46
Q

What is the only test you usually need to do if someone has known epilepsy and comes presenting with seizure

A

Check anticonvulescent levels

47
Q

If this is the patient’s first seizure with unknown epilepsy, what tests should be ordered

A

Most important: EEG (but not adequate alone for diagnosis) with neurology consult

Other lab tests: CBC, electrolyte, blood glucose, LFT’s, renal function tests, serum calcium, urinalysis

Radiology tests: CT scan of head, MRI (important), LP and blood cultures if patient is febrile

48
Q

What is the first thing you must do if you see a patient in a seizure

A

ABC: Secure airway and roll patient to side to prevent aspiration

49
Q

In what percent of patients is monotherapy the only thing required for seizures

A

70%

50
Q

What is the medication strategy for seizures

A

Increase first convulascent until signs of tocxity appear, then add second drug. If patient symptom free for two years after, then begin to taper but confirm decision with EEG

51
Q

How do you determine risk of recurrence of seizures

A

With EEG - normal = much less recurrence

52
Q

When should you treat patient with seizures

A

Do not treat after first seizure, must also have abnormal EEG or brain MRI normal or patient is in status elepticus

53
Q

What is the treatment of grand mal and partial seizures?

A

Phenytoin and carbamazepine

54
Q

What is the treatment for petit mal seizures

A

Ethosuximide and valproic acid

Neurology (9 decks)

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