L6 - CLINICAL APPROACH TO DIZZINESS + VERTIGO Flashcards
(19 cards)
What is the most important aspect of diagnosing the etiology of dizziness in a PT?
(emphasized)
What is the purpose of the physical exam in diagnosis?
Patient’s description of dizziness (HPI/Hx)
PE is used to CONFIRM the DX (it does NOT make the DX)
40% of dizzy patients have ___ dysfunction
MCC of dizziness
40% of dizzy patients have ___ dysfunction
peripheral vestibular
(inner ear) (peripheral bc
outside of brain)
What are 2 types of positional vertigo?
Which of these types is the MCC of positional vertigo?
- Benign positional vertigo:
MCC
c/b Canalith (Ca2+ stones dislodging) - Vestibular neuritis:
inflammation of vestibular system by meds/INFXs
10% of dizzy patients have a central ___ lesion
central brainstem lesion
or cerebellar
How would you differentiate b/w a central and peripheral cause of dizziness?
(emphasized)
Neurological exam
If dizziness has central etiology = abnormal neuro exam
If dizziness has peripheral etiology = normal neuro exam
Vertigo is caused by displacement of ___ from the ___
Vertigo is caused by displacement of otoconia from the utricle
Vertigo is defined as
Vertigo is defined as an illusion of motion - spinning sensation / sense of swaying or tilting
(some PTs may interpret this
as self-motion others as motion of the environment)
What kind of medications c/c vertigo?
Antibiotics
aminoglycoside toxicity
Clinical features of central vs. peripheral vertigo
- neuro signs?
- deafness or tinnitus?
Neuro signs:
- periph = absent
- central = often present
Deafness or tinnitus:
- periph = m/b present
- central = absent
The Dix-Hallpike maneuver is done to look for __
The Dix-Hallpike maneuver is done to look for rotational nystagmus
must be done on R/L side
head must be behind table
eyes must be open
If rotational nystagmus is seen on the right side (but not on the left) when performing the Dix-Hallpike maneuver, what would you name this dysfunction?
Right benign positional vertigo
If rotational nystagmus is seen when PT is moved either up or down when performing the Dix-Hallpike maneuver, what is this suggestive of?
Peripheral vertigo
Epley’s Maneuver is used to treat ___
Unilateral benign positional vertigo (displaced crystal)
-only TX’s one side
Pre-syncope is defined as __
What are the MCC’s?
Presyncope is the prodromal SX of fainting/near faint
“nearly blacking out or fainting”
lightheadedness, feeling of warmth, diaphoresis, nausea, visual blurring occasionally proceeding to blindness
HX of cardiac dz is relevant
MCC’s include orthostatic HTN, cardiac arrhythmias and vasovagal attacks
A. How do you measure/DX orthostatic HTN?
B. What findings would you expect to see?
A. Have PT sit down and measure baseline BP + HR, then instruct PT to stand up
B. Orthostatic HTN is DX’d if the following is seen within 3 minutes of standing:
1. SBP decrease of @ least
20 mmHg
...or...
2. DBP decrease of @ least
10 mmHg
...and/or...
3. HR increase of > 20 BPM
*(20/10/20)
A. Disequilibrium is defined as a sense of imbalance that occurs primarily when __
B. What is the MCC of disequilibrium? What does it lead to?
A. walking
B. peripheral neuropathy (l/t proprioceptive impairement)
Peripheral neuropathy which leads to proprioceptive impairment c/b caused by
- DM
- B12 deficiency
- Spinal dz (myelopathy)
Patients with dizziness caused by disequilibrium/imbalance tend to walk with a ___ gait + have a positive ____ sign
- wide based gait
- positive Romberg’s sign
required observation of gait + neuro exam to ID disequilibrium/imbalance dx
(emphasized)
What are MCC’s of non-specific dizziness?
1/4 of PTs have major depression (bold)
1/4 of PTs have generalized anxiety or panic disorder (bold)
The remainder have somatization disorder, alcohol dependence and/or personality disorder (bold)
Non-specific dizziness can also be 2ndry to medications (HTN, DM, SSRI’s/SNRI’s)
Hyperventilation
