VERTIGO & DIZZINESS Flashcards
DDx: VERTIGO
ACUTE VESTIBULAR SYNDROME: acute onset dizziness that is continuously present over days
Vestibular Neuritis
Labyrinthitis
Posterior Ischemic Stroke
Trauma
Post-Exposure
SPONTANEOUS EPISODIC VESTIBULAR SYNDROME: episodes that last minutes to hours, NOT triggered by head movement
Vestibular Migraine
Meniere’s
TIA
TRIGGERED EPISODIC VESTIBULAR SYNDROME: episodes last seconds to minutes triggered by head movement or body movement
BPPV
CPPV
Orthostatic Hypotension
MANAGEMENT
SCREEN FOR NEUROLOGICAL DEFECTS
ACTIVATE STROKE ALERT IF CONCERNED
INDICATIONS OF A STROKE IN ACUTE VESTIBULAR SYNDROME
Is there central pattern nystagmus?
Is skew deviation present?
Is the head impulse test negative?
Are there any CNS signs on focused neurological exam?
Is the patient unable to walk unassisted?
If yes to any, treat as stroke
If no to all, treat as vestibular neuritis
DOCUMENTATION
ATTEST:
A - Associated Symtoms
T - Timing
T - Triggers
ES - Exam Signs
T - Testing
ASSOCIATED SYMPTOMS
Neurological Deficits
Vision change
Ataxia
Nausea
Vomiting
Nystagmus
Head Motion Intolerance and unsteadiness
Aura or headaches—-Migraine
Blister—–Ramsay Hunt
Neck pain—–Vertebral artery dissection
Chest pain——Aortic dissection
Deafness / Tinnitis ——Meniere’s
TIMING
Acute and Continuous
Episodic that is not triggered
Episodic that is triggered
TRIGGERS
Turing/movement
Standing
EXAM SIGNS
Orthostatic BP
Gait exam
Focused Neurological: Cerebellar Signs, Cranial Nerves, Visual Fields
HINTS - Acute Vestibular Syndrome
Dix hallpike
TESTING
CT Head (poor test for posterior stroke)
Diffusion Weighted MRI (best test, can be falsely negative within 48 hrs of an ischemic stroke)
CTA Arch to Vertex if concered with vertebral artery dissection
ECG
RED FLAGS
* Dysarthria, Diplopia, Dysphagia, FND, Anesthesia
* Headache, Trauma, whiplash, neck pain
* Gait disturbance
* Palpitations
* Chest Pain
HINTS EXAM
NYSTAGMUS
Unidirectionsl is Peripheral Bidirectional is central
TEST OF SKEW
ANY vertical skew is central
HEAD IMPULSE
Catch up saccade is peripheral Normal is normal or central
BEDSIDE HEARING
AICA stroke will have unilateral hearing loss
PERIPHERAL
ALL:
Unidirectional nystagmus
No vertical skew
Catch up on head impulse
Normal hearing
CENTRAL
ANY:
Bidirectional nystagmus
virtical skew
Normal head impulse (no catch up)
Hearing loss
DIX HALPIKE
INDICATIONS
Triggered Episodic Vestibular Syndrome
EXAM FINDINGS
Torsional nystagmus (top corner of the eye rotating towards the floor)
