Hall dizziness lecture

Question 1

Sensation of motion when no motion is occuring

Answer 1

Vertigo

Question 2

Sensation of disturbed spatial orientation

Answer 2

Dizziness

Question 3

you have a patient that is sitting in front of you and you notice that their eyes are moving horizontally seemingly involuntarily, this is called?

Answer 3

Nystagmus

Question 4

The oscillations of ones visual surroundings usually secondary to nystagmus is called

Answer 4

Oscillopsia

Question 5

central vertigo originates in the ______. This can include a lesion of CN______

Answer 5

central vertigo originates in the CNS. This can include a lesion of CNVIII

Question 6

a vertigo that is due to a disease that affects the labyrinth of the inner ear or the vestibular branch of CN VIII can is called _____

Answer 6

Peripheral vertigo

Question 7

in contrast to peripheral vertigo central vertigo comes on ____

Answer 7

Slowly

Question 8

Central vertigo may be ________ where peripheral may be _______ (referring to frequency)

Answer 8

Central: constant and progressive
Peripheral: episodic and recurrent

Question 9

Your patient states that their vertigo is triggered if they turn their to the side and is relieved with motionlessness. From this description it is safe to assume that their veritgo is ______ in nature

Answer 9

Peripheral

Question 10

Shit, your patients eyes are moving up and down vertically. This is bad. and idicative of what kind of vertigo

Answer 10

Central

Question 11

a vertigo that is associated with tinnitus and nausea is _____

Answer 11

Peripheral

Question 12

nystagmus associated with Central vertigo is _______ where peripheral is ______ (fatigable or not?)

Answer 12

Central: not fatigable
Peripheral: fatigable

Question 13

What can cause both central and peripheral vertigo

Answer 13

trauma

Question 14

vertigo associated with migraines is _______(central or periph?)

Answer 14

peripheral

Question 15

Match the pathology with central or peripheral assocaited vertigo:
CNS tumor 
Infection 
Vestibular neuritis 
Menieres disease 
BPPV
acoustice neuroma 
MS

Answer 15

CNS tumor: C
Infection: C
Vestibular neuritis: P (think the vestibular part of the vestibularcochlear nerve)
Menieres disease: P
BPPV: P
Acoustic neuroma: C (think the cochlear part of the vestibularcochlear nerve)
MS: C

Question 16

vertigo is often a benign complaint but these are some dangerous causes:

Answer 16

arrhythmia
vascular pathology 
MI 
Hypoxemia 
Hypoglycemia 
AVM 
CVA

Question 17

You’re at the grocery store and the 65 year old gentleman in front of you starts shouting ahhhhhhhhh! everything is spinning suddenly! instead of pretending to know nothing about medicine, you jump into action knowing that…..

Answer 17

usually sudden onset of sponaneous vertigo is coming from a dangerous cause especially for those over 60, may the odds be ever in his favor

Question 18

though nystagmus is not always present with central vertigo, _______ and _______nystamus is indicative of a central cause

Answer 18

Direction changing, down beat

Question 19

______ is the gold standard of dx for posterior canal BPPV

Answer 19

Dix hallpikes manuever

Question 20

______ is the gold standard of dx for posterior canal BPPV

Answer 20

Dix hallpikes manuever (yes its on here twice, he was really stressing it!)
but do not perform if someone has spontaneus nystagmus

Question 21

This test is 100 percent sensitive for the presence of a central lesion

Answer 21

HINTS:
HI: head impulse
N: nystagmus
TS: test of skew

Question 22

Work up for a vertigo complaint

Answer 22

Labs: CMP CBC ESR
Imaging: CT, CTA (head and neck), MRI/ MRA
Other: EKG, Audiologic eval, ENG, VNG, Caloric testing (COWS)

Question 23

Caloric testing

Answer 23

Cold or warm water into the ear canal. When cold water or cold air enters that ear and changes temp it will cause nystagmus

Question 24

ENG (electronystagmogram)

Answer 24

measures nystagmus nad normal eye movements

Question 25

VNG: Videonystagmography

Answer 25

documents a personal ability to follow visual objects

Question 26

Meds for the treatment of vertigo itself (obviously tx underlying cause)

Answer 26

``` Antihistamines Anticholinergics Benzos Sympathomimetics epley manuever (for BPPV specifically) ```

Question 27

Your patient presents with vertigo that she says lasts 30 minutes to two hours. this happens every couple of days. She also has some hearing loss and ringing in her ears. She states that there is some pressure feeling in her right ear from time to time. What is the most likely dx for this patient and what is the cause?

Answer 27

Menieres disease, | cause is unknown

Question 28

how would you treat menieres dz

Answer 28

Low salt diet diuretics (acetazolamine) Meclizine or valium

Question 29

your patient comes to the urgent care in very apparent discomfort. She has some gait ataxia and says she has been very very dizzy for about a week. This is following a URI the week prior to that. she has some tinnitus but that discomfort is nothing compared to her vertigo, what is the dx?

Answer 29

Viral labrynthitis. Sorry lady we cant do much for you, want some meclizine or diazepam?

Question 30

vertigo lasting for only 1- several seconds, but happens multiple times per day. It is caused by a vasculpression of the vestibular nerve., similar to trigeminal neuralgia and is similarly treated with carbamazepine. Nystagmus is provoked by hyperventilation

Answer 30

Vestibular paroxysmia

Question 31

as many as _____ percent of migraine patients experience dizziness with their migraines.

Answer 31

50

Question 32

The four criteria for a patient to meet for a vestibular migraine

Answer 32

1. meet criteria set forth by the International headache society 2. Episodic or fluctuating symptoms suggestive of a balance disorder 3. no other neuro-otologic diagnosis 4. Experience migraine symptoms during periods of vertigo or imbalace

Question 33

you have a 76 year old patient present with symptoms that SEEM like BPPV. He has no nystagmus with dix-hallpike. Should you get a CT?

Answer 33

YAS! that mofo had an aortic dissection caught on CT of head and neck

Question 34

The mortality of a type 1 debakey aortic dissection increases _____% per hour

Answer 34

6 percent

Question 35

which of the following is a characteristic of central vertigo? A. Symptoms are not triggered by motion/ head postion B. Symptoms are triggered by motion/ head position C. Nystagmus us fatiguable and horizontal symptoms are sudden and episodic

Answer 35

A

Question 36

At what degree of rotation do you hold the patients head during the dix-hallpike's manuever?

Answer 36

45 degrees

Question 37

What is a positive dix-halpike a. patient has relief of symptoms b. patient exhibits torsional fatiguable nystagmus c. patient experiences no change in symptoms d. provider feels audible crack in the patients cervical spine

Answer 37

B.

Question 38

``` Which of the following is most likely to produce central vertigo symptoms over peripheral vertigo symptoms? A. Meniers b. vestibular neuritis c. migrainous vertigo d. acoustic neuroma ```

Answer 38

D