Flashcards in Vertigo Deck (87):
What are the two types of vertigo?
Central and peripheral
What is the cause of central vertigo?
Brainstem or cerebellar issue
What is the cause of peripheral vertigo?
Labyrinth or vestibular nerve issue
What are the three part of the semicircular canal?
What is the organ that interprets fluid movement in the semicircular canals?
Where in the semicircular canals are the cupulas?
In the ampulla
What are the utricles?
Dilation of the semicircular canals in the horizontal plane
What are the saccules?
Dilation of the semicircular canals in the vertical plane
What are the macula?
Sensory areas in the semicircular canals that house the cupula
What are the hair cells on the cupula called? What is the one big one?
What is the most common cause of peripheral vertigo?
What is the most common central cause of vertigo?
Cerebellopontine angle tumor
What percent of ED visits for vertigo are d/t peripheral causes?
What is the age range that is usually affected with BPPV?
Which gender typically is more affected with BPPV?
True or false: BPPV is rare
What usually exacerbates the vertigo with BPPV?
Turning of the head, or bending over
Which has a latency associated: central or peripheral causes of vertigo?
Which can fatigue: peripheral or central causes of vertigo
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
How do otoconia cause vertigo?
Otoliths keep moving, dragging endolymph and continuing receptor firing
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.
What worsens labyrinthitis symptoms?
In whom does labyrinthitis usually occur in?
Young to middle aged adults
True or false: labyrinthitis is self limiting
What is the recent h/o labyrinthitis / vestibular neuritis?
Usually occurs after an URI
How do you differentiate labyrinthitis /vestibulitis from BPPV?
Labyrinthitis is much more persistent--lasting hours instead of minutes
Which can be suppressed with visual fixation: central or peripheral vertigos?
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)
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
What is the pathophysiology of vestibular neuritis?
Selective inflammation of the vestibular nerve, usually of viral origin
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)
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
What is the classic triad of Meniere's disease?
-Sensorineural hearing loss
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.
What is the treatment for Meniere's disease?
-Low salt diet / diuretics
-Increased sleep, less stress
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.
Is Meniere's disease usually unilateral or bilateral?
What characterizes the tinnitus with Meniere's disease?
Crescendo, usually preceding the vertigo
What is the surgical treatment for Meniere's disease?
What causes a perilymphatic fistula? Where are they located?
Trauma at the round or oval window
What is the prognosis for a traumatic perilymphatic fistula?
What are the s/sx of a perilymphatic fistula?
What are the types of trauma that can lead to a perilymphatic fistula?
-Cough/ forceful sneeze
-Blow to the ear
What is the role of a valsalva maneuver with a perilymphatic fistula?
Will induce s/sx
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
Are vestibular schwannomas benign or malignant?
What is the first symptom of a vestibular schwannoma?
What are the characteristic hearing test findings with acoustic schwannomas?
Ability to discriminate words is out of proportion to the hearing loss
What, besides hearing loss, can occur with vestibular schwannomas? (4)
-Facial nerve palsy
What are the diseases that can mimic vestibular schwannomas?
True or false: for the most part, absence of associated neurological symptoms with vertigo excludes a central infarct as an etiology
True or false: most of the presentations of central causes of vertigo have associated neurologic signs
What is the first CN that comes off below the level of the pons?
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
-Ipsilateral Horner's syndrome
What causes the dysphagia, dysarthria, and dysphonia in lateral medullary syndrome (Wallenberg syndrome)?
Infarct of the nucleus ambiguus
What causes the loss of sensation contralateral to the side of the infarct in lateral medullary syndrome (Wallenberg syndrome)?
Spinothalamic tract is damaged
What causes the vertigo in lateral medullary syndrome (Wallenberg syndrome)?
involvement in vestibular nuclei
What is characteristic of the nystagmus with lateral medullary syndrome?
How is the vertigo with MS different than in peripheral causes of vertigo?
-associated with facial paresis or diplopia
What is the suggested diagnosis for episodes of vertigo that last: a few seconds?
peripheral cause or TIAs
What is the suggested diagnosis for episodes of vertigo that last: several seconds to a few minutes
BPPV or perilymphatic fistula
What is the suggested diagnosis for episodes of vertigo that last: Several minutes to hours
What is the suggested diagnosis for episodes of vertigo that last: days
Early acute vestibular neuritis
What is the suggested diagnosis for episodes of vertigo that last: weeks
What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in head position?
What is the suggested diagnosis for episodes of vertigo that are spontaneous, without consistent provoking factors? (4)
-Acute vestibular neuronitis
What is the suggested diagnosis for episodes of vertigo that comes on after a recent viral illness?
Acute vestibular neuritis
What is the suggested diagnosis for episodes of vertigo that is made worse with: stress
What is the suggested diagnosis for episodes of vertigo that is made worse with: immunosuppression
What is the suggested diagnosis for episodes of vertigo that is made worse with: changes in ear pressure
Aural fullness suggests what vertigo etiology?
Acoustic neuroma or Meniere's disease
What is the characteristic of the hearing loss with acoustic neuromas? (progression, uni/bilateral, type)
Progressive, unilateral, sensorineural
What is the characteristic of the hearing loss with cholesteatomas? (progression, uni/bilateral, type)
Progressive, unilateral, conductive
What is the characteristic of the hearing loss with Ramsay Hunt syndrome? (progression, uni/bilateral, type)
Subacute onset, unilateral
What is the characteristic of the hearing loss with Meniere's disease? (progression, uni/bilateral, type)
What is the characteristic of the hearing loss with otosclerosis? (progression, uni/bilateral, type)
What is the characteristic of the hearing loss with perilymphatic fistulas? (progression, uni/bilateral, type)
What is the characteristic of the hearing loss with TIA or CVA? (progression, uni/bilateral, type)
Sudden onset, unilateral
What is the sensitivity of having vertical nystagmus for a central lesion
What is the general type of nystagmus for peripheral lesions?
Which has hearing loss more commonly: peripheral, or central vertigo
Which has hearing loss more commonly more severe vertigo: peripheral, or central vertigo
Fixation improves symptoms of central or peripheral vertigo?
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
How successful are the Epley maneuvers with BPPV?
80% (A recommendation)