Flashcards in Vertigo and Syncope Deck (89)
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
What is disequilibrium?
Sense of imbalance (losing balance without sensation of movement)
-Imbalance and gait difficulties
What is presyncope?
Feeling of impending faint of LOC (no true syncope, generally associated with cardiac etiology)
Causes of vertigo
Peripheral (vestibular ex otologic lesion)
Central (central ex brainstem lesion)
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
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
Vague, nonspecific "dizziness"
Can be associated with psych disorders (anxiety, depression, stress rxn) and hyperventilation
What to ask with the dizzy pt?
Duration of sxs and events
Relation to position (standing. head movement etc)
Associated sxs (n/v, hearing loss, ear fullness, tinnitus, HA, vision, seizures, weakness)
What serious causes of vertigo MUST always be ruled out?
Cerebrovascular disease (vertebrobasilar insufficiency/stroke)
Important parts of PE in vertigo
Ear (obstruction, fluid, perf)
Neuro (CNs, motor, cerebellar testing)
What is nystagmus?
Slow drift in one direction followed by fast response in the opposite direction
Categories of nystagmus
(direction of fast component)
Horizontal: peripheral or metabolic cause
Horizontal/torsional: peripheral or positional
Vertical: think CNS!!!
What is Dix-Hallpike maneuver most helpful for?
What is electronystagmography or videonystagmography?
Assessment of vestibular function/ocular motility
-Record eye movements in response to visual, positional or rotational stimuli
What is caloric testing used for?
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
What is vestibular paresis?
Seen in abnormal caloric testing
Impaired or absent thermally induced fast nystagmus (indicates pathology in labyrinth on irrigated side)
Most common cause of vertigo
Benign Paroxysmal Positional Vertigo
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
What is BPPV associated with?
Prolonged bed rest and head trauma
PE for BPPV
Dix-Hallpike can reproduce vertigo and horizontal nystagmus
Sxs fatigue with repetition
Management of BPPV
Reassurance that self-limited
Particle repositioning maneuvers
Vestibular rehab (OT or positional exercises)
Anti vertigo meds might help
First line vestibular suppressants
Anticholinergics (Scopolamine) or antihistamines (Meclizine or dimenhydrinate)
Other vestibular suppressants
Phenothiazines (prochlorperazine, promethazine)
Etiology of vestibular neuritis
(vestibular neruonitis, labyrinthitis etc)
Young to middle age
Presumed viral or postviral inflammatory (affecting vestibular portion of CN VIII)
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
How to diagnose vestibular neuritis
Positive head thrust test
No CNS deficits
Caloric testing shows vestibular paresis on affected side
Management of vestibular neuritis
Symptomatic tx (bed rest, vestibular suppressants, anti-emetics PRN, prednisone taper over 10 days)
Pathogenesis of Meniere's
Secondary to endolympathic hydrops (syphilis and head trauma)-distortion of membranous endolymph containing portions of labyrinthine system