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Specialty Medicine > Vertigo > Flashcards

Flashcards in Vertigo Deck (87):
1

What are the two types of vertigo?

Central and peripheral

2

What is the cause of central vertigo?

Brainstem or cerebellar issue

3

What is the cause of peripheral vertigo?

Labyrinth or vestibular nerve issue

4

What are the three part of the semicircular canal?

-Horizontal
-Anterior
-Posterior

5

What is the organ that interprets fluid movement in the semicircular canals?

Cupula

6

Where in the semicircular canals are the cupulas?

In the ampulla

7

What are the utricles?

Dilation of the semicircular canals in the horizontal plane

8

What are the saccules?

Dilation of the semicircular canals in the vertical plane

9

What are the macula?

Sensory areas in the semicircular canals that house the cupula

10

What are the hair cells on the cupula called? What is the one big one?

Stereocilia
Kinocilia

11

What is the most common cause of peripheral vertigo?

BPPV

12

What is the most common central cause of vertigo?

Cerebellopontine angle tumor

13

What percent of ED visits for vertigo are d/t peripheral causes?

85%

14

What is the age range that is usually affected with BPPV?

60-70

15

Which gender typically is more affected with BPPV?

Females

16

True or false: BPPV is rare

false--extremely common

17

What usually exacerbates the vertigo with BPPV?

Turning of the head, or bending over

18

Which has a latency associated: central or peripheral causes of vertigo?

Peripheral

19

Which can fatigue: peripheral or central causes of vertigo

Peripheral

20

What is different about the h/o BPPV compared to a central lesion?

-BPPV is episodic, whereas central is persistent
-BPPV is positional, whereas central is not

21

How do otoconia cause vertigo?

Otoliths keep moving, dragging endolymph and continuing receptor firing

22

How do you tell which ear is affected in the dix-hallpike maneuver?

During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closer to the ground.

23

What worsens labyrinthitis symptoms?

head movement

24

In whom does labyrinthitis usually occur in?

Young to middle aged adults

25

True or false: labyrinthitis is self limiting

True

26

What is the recent h/o labyrinthitis / vestibular neuritis?

Usually occurs after an URI

27

How do you differentiate labyrinthitis /vestibulitis from BPPV?

Labyrinthitis is much more persistent--lasting hours instead of minutes

28

Which can be suppressed with visual fixation: central or peripheral vertigos?

Peripheral

29

What is the natural h/o vestibular neuritis?

-Develops over hours (sudden)
-Severe for a few days, then subsides over the course of 2 weeks (usually)

30

What are the long term sequelae of vestibular neuritis?

Some patient scan have residual symptoms and imbalance for months, or longer
-Some develop abnormal caloric testing at 1 year

31

What is the pathophysiology of vestibular neuritis?

Selective inflammation of the vestibular nerve, usually of viral origin

32

Which way is the fast phase of the nystagmus in vestibular neuritis: toward or away from the healthy ear?

Toward the healthy ear (away from affected)

33

What alters the intensity of the nystagmus in vestibular neuritis, in terms of gaze?

Intensity increases with gaze toward healthy ear, and decreases with gaze towas affected ear

34

What is the classic triad of Meniere's disease?

-Episodic vertigo
-Tinnitus
-Sensorineural hearing loss

35

What is the pathophysiology of Meniere's disease?

Excess endolymph in the semicircular canals causes hydrops, bursting, and ionic mismatch. The canals heal, but are susceptible to it recurring.

36

What is the treatment for Meniere's disease?

-Low salt diet / diuretics
-Increased sleep, less stress
-Vestibular suppressants

37

What is the natural h/o Meniere's disease?

Recurrent, acute attacks that usually last for about a day. Results in progressive sensorineural hearing loss.

38

Is Meniere's disease usually unilateral or bilateral?

Unilateral

39

What characterizes the tinnitus with Meniere's disease?

Crescendo, usually preceding the vertigo

40

What is the surgical treatment for Meniere's disease?

Labyrinthectomy

41

What causes a perilymphatic fistula? Where are they located?

Trauma at the round or oval window

42

What is the prognosis for a traumatic perilymphatic fistula?

Self-limiting

43

What are the s/sx of a perilymphatic fistula?

Vertigo

44

What are the types of trauma that can lead to a perilymphatic fistula?

-Cough/ forceful sneeze
-Scuba diving
-Blow to the ear

45

What is the role of a valsalva maneuver with a perilymphatic fistula?

Will induce s/sx

46

Where do vestibular schwannomas usually grow? What is the significance?

Within the internal acoustic meatus
-Not much room to grow before compressing the nerve or facial nerve

47

Are vestibular schwannomas benign or malignant?

Benign

48

What is the first symptom of a vestibular schwannoma?

Hearing loss

49

What are the characteristic hearing test findings with acoustic schwannomas?

Ability to discriminate words is out of proportion to the hearing loss

50

What, besides hearing loss, can occur with vestibular schwannomas? (4)

-Tinnitus
-Vertigo
-Otalgia
-Facial nerve palsy

51

What are the diseases that can mimic vestibular schwannomas?

-Migraine HAs
-MS
-Stroke

52

True or false: for the most part, absence of associated neurological symptoms with vertigo excludes a central infarct as an etiology

False

53

True or false: most of the presentations of central causes of vertigo have associated neurologic signs

True

54

What is the first CN that comes off below the level of the pons?

CN 6

55

What is lateral medullary syndrome (Wallenberg syndrome)? S/sx?

PICA infarct, leading to an infarct in the lateral medulla
-Sensory deficits of the trunk and contralateral, and CN sensory deficits ipsilateral
-vertigo
-Ipsilateral Horner's syndrome
-ataxia

56

What causes the dysphagia, dysarthria, and dysphonia in lateral medullary syndrome (Wallenberg syndrome)?

Infarct of the nucleus ambiguus

57

What causes the loss of sensation contralateral to the side of the infarct in lateral medullary syndrome (Wallenberg syndrome)?

Spinothalamic tract is damaged

58

What causes the vertigo in lateral medullary syndrome (Wallenberg syndrome)?

involvement in vestibular nuclei

59

What is characteristic of the nystagmus with lateral medullary syndrome?

Vertical nystagmus

60

How is the vertigo with MS different than in peripheral causes of vertigo?

-Variable
-Occurs randomly
-associated with facial paresis or diplopia

61

What is the suggested diagnosis for episodes of vertigo that last: a few seconds?

peripheral cause or TIAs

62

What is the suggested diagnosis for episodes of vertigo that last: several seconds to a few minutes

BPPV or perilymphatic fistula

63

What is the suggested diagnosis for episodes of vertigo that last: Several minutes to hours

-Meniere's disease
-Perilymphatic fistula
-Acoustic neuroma

64

What is the suggested diagnosis for episodes of vertigo that last: days

Early acute vestibular neuritis
Stroke

65

What is the suggested diagnosis for episodes of vertigo that last: weeks

Psychogenic

66

What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in head position?

BPPV

67

What is the suggested diagnosis for episodes of vertigo that are spontaneous, without consistent provoking factors? (4)

-Acute vestibular neuronitis
-Meniere's disease
-migraine
-MS

68

What is the suggested diagnosis for episodes of vertigo that comes on after a recent viral illness?

Acute vestibular neuritis

69

What is the suggested diagnosis for episodes of vertigo that is made worse with: stress

Psychogenic

70

What is the suggested diagnosis for episodes of vertigo that is made worse with: immunosuppression

HSV

71

What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in ear pressure

Perilymphatic fistula

72

Aural fullness suggests what vertigo etiology?

Acoustic neuroma or Meniere's disease

73

What is the characteristic of the hearing loss with acoustic neuromas? (progression, uni/bilateral, type)

Progressive, unilateral, sensorineural

74

What is the characteristic of the hearing loss with cholesteatomas? (progression, uni/bilateral, type)

Progressive, unilateral, conductive

75

What is the characteristic of the hearing loss with Ramsay Hunt syndrome? (progression, uni/bilateral, type)

Subacute onset, unilateral

76

What is the characteristic of the hearing loss with Meniere's disease? (progression, uni/bilateral, type)

Sensorineural
Initially fluctuating

77

What is the characteristic of the hearing loss with otosclerosis? (progression, uni/bilateral, type)

Progressive, conductive

78

What is the characteristic of the hearing loss with perilymphatic fistulas? (progression, uni/bilateral, type)

Progressive, unilateral

79

What is the characteristic of the hearing loss with TIA or CVA? (progression, uni/bilateral, type)

Sudden onset, unilateral

80

What is the sensitivity of having vertical nystagmus for a central lesion

80%

81

What is the general type of nystagmus for peripheral lesions?

Horizontal

82

Which has hearing loss more commonly: peripheral, or central vertigo

Peripheral

83

Which has hearing loss more commonly more severe vertigo: peripheral, or central vertigo

Central

84

Fixation improves symptoms of central or peripheral vertigo?

Peripheral

85

What type of medication should be used for vertigo? Why should these be used sparingly?

Benzos and meclizine (antihistamine)
-Suppresses the brain's ability to adapt

86

How successful are the Epley maneuvers with BPPV?

80% (A recommendation)

87

What is the role of vestibular rehab exercises?

Trains the brain to rely on other sensory information for balance