Vertigo

Question 1

Vertigo relating to dizziness

Answer 1

• false sensation of movement or spinning
• nausea/vomiting/diaphoresis
• swaying, tilting, sense of being “pushed” in all directions

Question 2

Pre-syncope relating to dizziness

Answer 2

• mostly a Cardiovascular/circulating etiology presenting as a neuro symptom
• lightheadedness
• blurry vision
• diaphoresis, heart palpitations, nausea
• occasionally develops into syncope

Question 3

Disequilibrium relating to dizziness

Answer 3

• common in elderly
• more constant and provoked with standing or ambulation
• they “feel” off balance and display an unsteady gait

Question 4

When does vertigo occur?

Answer 4

• occurs when some pathological process disrupts the input from one labyrinth to the brain and the other side tries to compensate and gets confused.
• Its like unplugging an auxiliary cord

Question 5

Syncope relating to dizziness

Answer 5

• sudden loss of consciousness patient has either:
  decreased amount of nutrients to brain (oxygen or glucose)
  OR
• a surge of electrical discharge that wipes out portion of their memory (seizure or arrhythmia)

Question 6

Dysequilibrium related to dizziness

Answer 6

Difficulty sensing where they are in the world

• instability
• elderly with multi sensory deficits
• diabetic with peripheral neuropathy

Question 7

Nonspecific dizziness

Answer 7

• they fit into none of our categories
• normal neuro exam
• chances of being emergent arent likely
• refer to ENT

Question 8

What is vertigo

Answer 8

Dysfunction within the vestibular system

divided into peripheral and central

Question 9

What is peripheral vertigo

Answer 9

-labyrinth and the vestibular portion of the VIII CN (vestibulocochlear nerve)
-CN VIII connects the labyrinth and the brainstem
Labyrinth located in the inner ear
-3 semicircular canals make up the LABYRINTH
-Otoliths (“rocks”) within the fluid filled canals that sense head position in relation to gravity and communicates it to the brain (canals, joints, brain)

Question 10

What is central vertigo

Answer 10

• brain stem, cerebellum, peripheral labyrinths
• Vertebrobasilar artery system supplies the above
• Central and peripheral ischemic vertigo syndromes can overlap

Question 11

What is the onset of peripheral vs. central vertigo?

Answer 11

• peripheral = sudden

- central = slow

Question 12

What is the severity of peripheral vs. central vertigo?

Answer 12

• peripheral = intense spinning

- central = less intense, poorly defined

Question 13

What is the pattern of peripheral vs. central vertigo?

Answer 13

• peripheral = intermittent, resolves with Tx

- central = constant

Question 14

Is peripheral worse on movement or central?

Answer 14

• peripheral = yes

- central = yes and no

Question 15

Match frequency of nausea/diaphoresis with central v. peripheral vertigo

Answer 15

• peripheral = frequently

- central = infrequently

Question 16

What is the direction of peripheral vs. central nystagmus direction?

Answer 16

• peripheral = horizontal lateral, rotary

- central = vertical, pure torsional

Question 17

Does peripheral or central vertigo fatigue?

Answer 17

peripheral

Question 18

Does hearing loss/tinnitus occur with peripheral hearing loss/tinnitus?

Answer 18

• may occur with peripheral

- does not occur with central

Question 19

Will peripheral or central have abnormal TM?

Answer 19

• peripheral may occur

- central no

Question 20

Are there CNS findings in peripheral or central vertigo?

Answer 20

• peripheral = absent (neuro exam is normal)

- central = present

Question 21

Describe the peripheral gait vs central

Answer 21

• peripheral = can walk with assistance

- central = walking with very difficult, often unable to

Question 22

How do you differentiating peripheral nystagmus?

Answer 22

• nystagmus will be in same direction ALWAYS

- it will change direction with gaze changes and visual fixation (fatigues)

Question 23

How do you differentiate central nystagmus?

Answer 23

• vertical nystagmus
• pure torsional nystagmus
• midline gaze nystagmus
• does not fatigue

Question 24

What are the Romberg test result for peripheral and central vertigo?

Answer 24

• peripheral = falls towards same side

- central = variable, changes direction with repeat testing

Question 25

Peripheral causes of vertigo

Answer 25

Vertigo occurs as a result of pathology that involves the middle, inner ear, and acoustic portion of the 8th CN

Question 26

The worse the vertigo the more _______ the process

Answer 26

benign

Question 27

The less severe the motion and longer duration of vertigo the more ______ the cause is such as central or cerebellar lesion

Answer 27

severe

Question 28

What is ataxia

Answer 28

inability to coordinate muscle movements (limb, truncal, and gait)

Question 29

What is nystagmus

Answer 29

rhythmic oscillating movements of eyes and may be vertical or horizontal

Question 30

What does BPPV stand for?

Answer 30

Benign paroxysmal positional vertigo

Question 31

Patient population of BPPV

Answer 31

mid 50's, females 2: 1 males

Question 32

Symptoms/signs of BPPV

Answer 32

- N/V - nystagmus - needs help walking

Question 33

What triggers BPPV

Answer 33

Precipitated by movement (head turning, bending over, position changes)

Question 34

How long does BPPV occur for

Answer 34

EPISODIC Patients are plagued with short episodes NO HEARING LOSS OR TINNITUS

Question 35

Sensitive diagnostic test for BPPV

Answer 35

Dix-hallpike maneuver

Question 36

Lateral canalolithiasis for BPPV test

Answer 36

Lempert's maneuver

Question 37

Superior canalolithiasis for BPPV test

Answer 37

Deep Head Hanging Maneuver

Question 38

Treatment for BPPV

Answer 38

- Epley maneuver (particle repositioning) - PT - Benzodiazepines

Question 39

Onset of Labyrinthitis

Answer 39

mostly acute onset

Question 40

associated illness of Labyrinthitis

Answer 40

* URI*: infection usually viral, but can be bacterial - look for OM - mastoiditis

Question 41

How long does Labyrinthitis last?

Answer 41

lasts days to weeks, gradually settling down

Question 42

Symptoms/signs of Labyrinthitis

Answer 42

``` Nausea/vomiting Hearing loss (infection/inflammation) ```

Question 43

Positioning patient with Labyrinthitis

Answer 43

Position makes it worse

Question 44

patient with Labyrinthitis has issues with

Answer 44

vestibular and hearing issues

Question 45

Onset of Meniere's Disease

Answer 45

gradual and paroxysmal (episodic)

Question 46

What is the cause of Meniere's Dz?

Answer 46

- overproduction of endolymph | - can be lateral or bilateral

Question 47

How long does Meniere's Disease last?

Answer 47

Spells last hours, weeks, months, years

Question 48

Symptoms/signs of Meniere's Disease

Answer 48

N/V | Triad: vertigo, tinnitu, hearing loss

Question 49

Positioning patient with Meniere's Disease

Answer 49

doesn't make it worse, feel fine apart from "spells"

Question 50

patient with Meniere's Disease has issues with

Answer 50

hearing loss and tinnitus

Question 51

Treatment for peripheral vertigo

Answer 51

``` Bed rest NO DRIVING -IV fluids PRN -phernothiazines to reduce nausea -antihistamines to reduce dizziness -vestibular exercises/maneuvers (PT) ```

Question 52

Miscellaneous causes of vertigo

Answer 52

- 8th cranial nerve lesions - tumors of the cerebellopontine angle - herpes zoster oticus

Question 53

Central causes of vertigo

Answer 53

Vertigo that occurs as a result of pathology or a lesion that involves the brainstem, the cerebellum, or the peripheral labyrinths.

Question 54

Central vertigo most common causes

Answer 54

- cerebellar or brainstem hemorrhages and infarctions (STROKE) - vertebrobasilar insufficiency in brain stem - MS - Migranes - Heavy metals - ETOH

Question 55

The 5 Ds in a Neuro Exam with CC: Dizziness

Answer 55

-Diplopia -Dysphagia -Dysarthria -Dysphonia -Dysmetria (ataxia) DO NOT SEND HOME

Question 56

Central vertigo treatment

Answer 56

- MRI/Neuro Consult - Hospital or ER admission - Supportive care