Vertigo

Question 1

What is vertigo?

Answer 1

feeling of motion when not moving or exaggerated response to movement

Question 2

What are the peripheral causes of vestibular dysfunction?

Answer 2

labryinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Meniere’s), vestibular neuritis, head injury

Question 3

What are the causes of central vertigo?

Answer 3

brainstem vascular disease, arteriovenous malformations, tumors, MS, vertebrobasilar migrane

Question 4

What is the presentation of peripheral vertigo?

Answer 4

ACUTE, tinnitus, hearing loss, horizontal nystagmus

Question 5

What is the presentation of central vertigo?

Answer 5

gradual, no auditory symptoms, vertical nystagmus

Question 6

What are some drugs that can cause vertigo?

Answer 6

ABX - doxy, metro, aminogly
Anticonvulsants - phenytoin
Hypnotics - diazepam
Analgesics - ASA
Traquilizing drugs & ETOH

Question 7

What is benign paroxysmal positional vertigo?

Answer 7

triggered by head change position, clusters for several days, last few seconds, can treat via habiutation

Question 8

When vertigo last seconds, think?

Answer 8

benign paroxysmal positional vertigo

Question 9

When vertigo last minutes to hours, think?

Answer 9

meniere disease, migrane associated, otic symphilis, cogan syndrome

Question 10

When vertigo last days to weeks, think?

Answer 10

vestibular neuritis

Question 11

When vertigo constant, think?

Answer 11

central cause

Question 12

What is the most common cause of peripheral vertigo?

Answer 12

BPPV

Question 13

What age is the onset of BPPV and who?

Answer 13

40-50 yo, women

Question 14

What manuver is used to dx BPPV?

Answer 14

Dix-Hallpike - pt lies back on exam table and head turned 45 degree one way, if normal do the same thing but turning to the opposite side, if still normal eye response, then repeat but extend the head off the exam table

Question 15

What is the treatment for BPPV?

Answer 15

epley maneuver

Question 16

What causes BPPV?

Answer 16

canalithiasis of posterior semicircular cancal

Question 17

What do you need to observe nystagmus?

Answer 17

Frenzel goggles

Question 18

What presents with sudden severe vertigo + vegetative symptoms?

Answer 18

vestibular neuritis

Question 19

Does vestibular neuritis include hearing loss?

Answer 19

no

Question 20

What are the symptoms of meniere’s disease?

Answer 20

episodic vertigo, SNHL, tinnitus, unilat aural fullness

Question 21

When does meniere’s disease have its onset?

Answer 21

40-50 yo, whites

Question 22

What is the hallmark of meniere’s disease?

Answer 22

endolymphatic hydrops

Question 23

What is the triad of meniere’s disease?

Answer 23

vertigo, hearing loss, tinnitus

Question 24

What is the treatment for meniere disease?

Answer 24

low salt diet and diuretics

Question 25

Contiguous vertigo + hearing loss =

Answer 25

labrinthitis

Question 26

Contiguous vertigo + no hearing loss =

Answer 26

vestibular neuritis

Question 27

What is the treatment for vestibular neuritis and labrynthitis?

Answer 27

steroids first line

Question 28

What is a false sensation of mvmt associated with difficulty in balance or gait?

Answer 28

vertigo

Question 29

What is the perceived motion in vertigo?

Answer 29

rotary

Question 30

What is the first step in dx vertigo?

Answer 30

get info on what it actually feels like - dizziness or vertigo dizziness - light headed vertigo - room is spinning

Question 31

What causes peripheral vertigo?

Answer 31

secondary to disorders of inner ear or 8th CN

Question 32

What causes central vertigo?

Answer 32

CNS disorder, vestibular nuclei and pathway

Question 33

What is the presentation of peripheral vertigo?

Answer 33

sudden, intermittent with severe symptoms, affected by head position and mvmt. N/V, motor function intact

Question 34

What is the presentation of central vertigo?

Answer 34

gradual, constant, milder, unaffected by head position, N/V less likely, motor function issues

Question 35

What do you see in cerebellar stroke?

Answer 35

bilat or vertical nystagmus, limb ataxia, gait disturbance, CAN NOT stand w/o support

Question 36

What are some urgent considerations?

Answer 36

cerebellar stroke, CV disease, Vestibular neuritis and labrynthitis

Question 37

What do you get if you suspect urgent causes?

Answer 37

CT or MRI w/ internal auditory canals

Question 38

What are the possible causes of central vertigo?

Answer 38

cerebellar bleeds, infarcts and tumors, lesion of brainstem, MS. cerebellopontain angle tumors

Question 39

When do you admit a vertigo pt?

Answer 39

neuro deficits or cardiac issues, if unable to walk despite max tx, protracted vomiting, significant co morbid, concern of central vertigo

Question 40

What is the motion of nystagmus in central?

Answer 40

vertical

Question 41

What is the motion of nystagmus in peripheral?

Answer 41

horizontal, rotary or absent

Question 42

Can you fatigue a central nystagmus?

Answer 42

NOPE

Question 43

When is an abnormal time you can observe horizontal nystagmus?

Answer 43

cerebellar infarction

Question 44

What are the steps to hallpike maneuver?

Answer 44

lie back and neck extended, sit back up and lay down again, turn head to one side, repeat and have them turn head to other side

Question 45

What is a nystagmus with hallpike that is unidirection, latent and fatigues?

Answer 45

peripheral origin

Question 46

What do you use to alleviate symptoms of vertigo?

Answer 46

Antihistamines Meclizine 12.5-25mg every 8 hours PRN vertigo Benadryl 25-50mg every 4-6 hours PRN Anticholinergics scopolamine – transdermal patch, apply q72 hours

Question 47

What antiemetic/anti nausea do you use?

Answer 47

ondansetron (Zofran) 4 mg q 4-6 hr PRN | Phenothiazines - prochlorperazine, promethazine

Question 48

What are the common causes of peripheral vertigo?

Answer 48

benign paroxysmal persitional vertigo, Meds, Head injury, vestibular neuronitis, labryrinthitis, meniere's disease, pressure on vestibular nerve

Question 49

What are the crystals in BPPV?

Answer 49

otoconia

Question 50

Where do otoconia sit?

Answer 50

basement but can get moved during activities

Question 51

What is the most common cause of peripheral vertigo?

Answer 51

BPPV

Question 52

When are symptoms worse in BPPV?

Answer 52

in the morning

Question 53

How do you dx BPPV?

Answer 53

hallpike

Question 54

How do you tx BPPV?

Answer 54

epley, meds for symptoms, rarely surgery

Question 55

What do you have to do after eply?

Answer 55

sleep sitting up 2 nights, dont bend head a lot for 1 wk

Question 56

When does BPPV pt come back?

Answer 56

2 wks later

Question 57

What is the treatment for labryrinthitis?

Answer 57

diazepam or benzodiazepines - vestiblular suppressant Short course of steroids Antiviral therapy - acyclovir, famciclovir, valacyclovir

Question 58

Is hearing affected in vestibular neuronitis?

Answer 58

no

Question 59

What is vestibular neuronitis due to?

Answer 59

HSV type 1 in vestibular ganglia

Question 60

How do you treat vestibular neuronitis?

Answer 60

steroids, antivirals

Question 61

How do you distinguish labrynrinthisi from vestibular neuronitis?

Answer 61

labrynthrinthis - hearing loss Steroid and antiviral

Question 62

What happens in meniere's diseae?

Answer 62

increase in fluid of endolymphatic system

Question 63

What happens in menieres when endolymph swells?

Answer 63

microruptures - mixing of perilymph and endolymph

Question 64

What is the quadrad of meniere's disease?

Answer 64

vertigo - 2 episodes 20 min w/ nystagmus tinnitus, sensation of aural fullness, hearing loss - lower 20-25 than unaffected side