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Flashcards in Vertigo and Syncope Deck (89)
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1

What is vertigo?

Sensation of movement when there is none or just abnormal movement, often spinning (tumbling, falling forward/back)
It is a symptom!
Associated with nystagmus and postural instability

2

What is disequilibrium?

Sense of imbalance (losing balance without sensation of movement)
-Imbalance and gait difficulties

3

What is presyncope?

Feeling of impending faint of LOC (no true syncope, generally associated with cardiac etiology)

4

Causes of vertigo

Peripheral (vestibular ex otologic lesion)
Central (central ex brainstem lesion)

5

Presentation of peripheral vertigo

Sudden, acute onset (may be severe)
Associated ear sxs (hearing loss, tinnitus)
Nystagmus can be horizontal and/or torsional (rotary)
Neuro sxs ABSENT

6

Presentation of central vertigo

May be gradual and progressive
Rare to have ear sxs
Nystagmus can occur in any direction, can be dissociated in 2 eyes (often vertical and nonfatigable)
Neuro sxs PRESENT (diplopia, ataxia, dysrthria)
May see HA or n/v

7

Lightheadedness

Vague, nonspecific "dizziness"
Can be associated with psych disorders (anxiety, depression, stress rxn) and hyperventilation

8

What to ask with the dizzy pt?

Duration of sxs and events
Relation to position (standing. head movement etc)
Possible triggers
Associated sxs (n/v, hearing loss, ear fullness, tinnitus, HA, vision, seizures, weakness)

9

What serious causes of vertigo MUST always be ruled out?

Cerebrovascular disease (vertebrobasilar insufficiency/stroke)
MS
Acoustic neuroma

10

Important parts of PE in vertigo

VS (orthostasis)
Ear (obstruction, fluid, perf)
Cardiac
Neuro (CNs, motor, cerebellar testing)

11

What is nystagmus?

Slow drift in one direction followed by fast response in the opposite direction

12

Categories of nystagmus

(direction of fast component)
Horizontal: peripheral or metabolic cause
Horizontal/torsional: peripheral or positional
Vertical: think CNS!!!

13

What is Dix-Hallpike maneuver most helpful for?

BPPV

14

What is electronystagmography or videonystagmography?

Assessment of vestibular function/ocular motility
-Record eye movements in response to visual, positional or rotational stimuli

15

What is caloric testing used for?

Vestibulo-ocular reflex

16

Normal response in caloric testing

COWS (Cold Opposite Warm Same)-direction of fast bearing nystagmus response
Cold water: eyes deviate ipsilateral and nystagmus beats away to opposite side
Warm water: eyes deviate contralateral and nystagmus beats to same side

17

What is vestibular paresis?

Seen in abnormal caloric testing
Impaired or absent thermally induced fast nystagmus (indicates pathology in labyrinth on irrigated side)

18

Most common cause of vertigo

Benign Paroxysmal Positional Vertigo

19

Presentation of BPPV

Transient (<1 min) episodes of vertigo associated with changes in head position
No hearing changes
Self limited but may last weeks or months

20

What is BPPV associated with?

Prolonged bed rest and head trauma

21

PE for BPPV

Normal
Dix-Hallpike can reproduce vertigo and horizontal nystagmus
Sxs fatigue with repetition

22

Management of BPPV

Reassurance that self-limited
Particle repositioning maneuvers
Vestibular rehab (OT or positional exercises)
Anti vertigo meds might help

23

First line vestibular suppressants

Anticholinergics (Scopolamine) or antihistamines (Meclizine or dimenhydrinate)

24

Other vestibular suppressants

Phenothiazines (prochlorperazine, promethazine)
Benzos

25

Etiology of vestibular neuritis

(vestibular neruonitis, labyrinthitis etc)
Young to middle age
Presumed viral or postviral inflammatory (affecting vestibular portion of CN VIII)

26

Presentation of vestibular neuritis

Single attack of severe vertigo (several days to a week)
Associated with viral URI
N/v and gait instability
No tinnitus or hearing loss (if hearing loss then labyrinthitis)
Fall to affected side

27

How to diagnose vestibular neuritis

Positive head thrust test
No CNS deficits
Audiograms normal
Caloric testing shows vestibular paresis on affected side

28

Management of vestibular neuritis

Self-limited
Symptomatic tx (bed rest, vestibular suppressants, anti-emetics PRN, prednisone taper over 10 days)

29

Pathogenesis of Meniere's

Secondary to endolympathic hydrops (syphilis and head trauma)-distortion of membranous endolymph containing portions of labyrinthine system

30

Rupture theory of Meniere's

Swelling then rupture of membranous labyrinth causes paralysis of vestibular nerve fibers and degeneration of cochlear hair cells