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60 Cards in this Set
- Front
- Back
What are the three types of dizziness and how are they different?
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Lightheadedness - feeling like you may pass out
Dysequilibrium - feeling unsteady in gait, like walking on a boat/dock, "dizzy from the neck down" Vertigo - spinning sensation - like the you or the room is spinning/moving |
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What is presyncope?
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Feeling as though you're about to faint
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What causes presyncope?
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Brain hypoperfusion
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What are the symptoms of presyncope?
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lightheadedness
blurred or tunnel vision graying or blacking out Possibly: pale appearance, diaphoresis, palpitations, nausea, feeling distant |
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What causes syncope?
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Hypoperfusion to both hemispheres or to the brainstem
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What causes hypoperfusion to the brain?
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- Cardiac etiologies: arrythmias, outflow obstruction, valve disease, myocardial infarction
- Hypovolemia: dehydration, blood loss - Medications (BP, prostate) - Vasovagal - excessive vasodilation w/ bradycardia - Orthostatic blood pressure |
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Why does a person drop to the ground during syncope?
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Body becomes level, so the heart doesn't have to pump against gravity and can more quickly perfuse the brain/brainstem
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In what conditions/states may presyncope be observed?
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`Hyperventillation
Hypoglycemia Anxiety |
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What are some general causes of dysequilibrium?
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Cerebellar dysfunction/Ataxia
Proprioception dysfunction (DCML) Extrapyramidal (Ventromedial => Balance/Posture) Visual input abnormalities Rare = mild/resolving vertigo |
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What can cause cerebellar ataxias yielding disequilibrium?
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Acute stroke
Hemorrhage Mass Demyelination Inflammation Infection Alcohol and drugs (e.g. benzo) Alcoholic cerebellar degeneration Paraneoplastic Inherited ataxias Metabolic disorders Postinfectious cerebellitis |
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What can cause proprioceptive abnormalities yielding dysequilibrium?
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B12 deficiency
Tabes dorsalis (syphilis) Cervical spondylosis (myelopathy) Peripheral neuropathy |
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What can cause extrapyramidal lesions, yielding dysequilibrium?
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Parkinsons disease - loss of dopaminergic neurons in substantia nigra --> postural instability
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Why are the elderly prone to feel dizzy?
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Visual loss
Medication effects Decreased position sense Aging vestibular apparatus |
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What are the two types of vertigo?
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Physiologic
Pathologic |
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What causes physiologic vertigo?
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Mismatch between vestibular system, visual system, and somatosensory system
Physically spinning around and suddenly stopping Vestibular system subjected to unfamiliar head movements (seasickness) Unusual head/neck positions (hyperextension at museum, movies) |
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What is the cause of pathologic vertigo?
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Lesion to vestibular system
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How can you distinguish from physiologic and pathologic vertigo?
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Other signs> nystagmus
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What are some signs of central vertigo?
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Presence of brainstem signs, motor and sensory findings, ataxia
Less severe spinning sensation Nystagmus can be bilateral, cannot be suppressed with visual fixation Person can fall in either direction |
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What are some signs of peripheral vertigo?
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Vertigo is brought on solely by movement (acute onset)
More severe spinning sensation No other signs (except perhaps tinnitis or hearing loss) Nystagmus is bilateral & suppressible with fixation Person tends to fall towards the lesioned side Nausea, Vomiting |
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What clinical test can you do to differentiate between central and peripherally caused vertigo?
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Caloric testing - irrigate the external canal with ice water
Central - normal response - nystagmus will beat toward quickly toward opposite ear Peripheral - impaired response - eye will not beat toward opposite ear on the lesioned side |
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Where can lesions causing central vertigo be localized?
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**Cerebellum, brainstem**
Less common: vestibular cortex, thalamus |
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What is the clinical presentation of vestibular neuronitis and Labyrinthitis?
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Both present with acute onset vertigo, nausea, vomiting (within minutes)
Peaks over 24 hours, resolves over days-weeks |
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What is the difference between acute labyrinthitis and vestibular neuronitis?
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Acute labyrinthitis can cause hearing loss
- can be permanent mild-moderate loss of higher frequencies |
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What is the cause and treatment for labyrinthitis?
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Viral or bacterial
Treated with antibiotics or surgical drainage |
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What is Ramsay-Hunt Syndrome?
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A type of labyrinthitis caused by reactivation of latent virus
Presents with deep burning ear pain, vesicular rash in ear canal, unilateral facial weakness (sometimes) |
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What is the clinical presentation of Meniere's Disease?
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recurrent, episodic vertigo attacks that last 30-60min
Nausea/Vomiting Progressive unilateral hearing loss, tinnitus Pressure/Fullness in ear |
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What causes Meniere's Disease?
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Intermittent increase in endolymph production and volume
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How is Meniere's Disease treated?
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Vertigo treated by Low-salt diet, diuretics
Occasionally steroids Rarely surgery No treatment for hearing loss |
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What is the clinical presentation of a Perilymph Fistula?
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At onset: pt hears "pop," sudden increased middle ear pressure, sneezing, blowing nose, coughing, then abrupt onset vertigo
Acute, unilateral Symptoms are often recurrent |
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What is the Valsalva maneuver?
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Moderately forceful expiration with mouth shut and nose pinched
Used normally to equalize pressure between ears and sinuses |
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What occurs in a pt with Perilymph Fistula when he/she performs the Valsalva maneuver?
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Feels increased dizziness
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What causes Perilymph Fistula?
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Hole between the fluid-filled inner ear and air-filled middle ear, disrupts endolymphatic system
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What is the treatment for Perilymph Fistula?
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Usually nothing - heals on its own in 90% cases
Some will require surgery |
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What is an Acoustic Neuroma?
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Schwannoma along the 8th nerve or at the cerebellopontine angle (CPA)
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What is the clinical presentation of an Acoustic Neuroma?
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Dysequilibrium, slow progression, tinnitus, hearing loss
Dx with MRI |
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Treatment for Acoustic Neuroma?
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Surgical - radiosurgery or conventional
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How does Benign Paroxysmal Positional Vertigo (BVVP) clinically present?
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*Most common cause of vertigo*
Sudden onset severe vertigo, triggered by movement, short latency period (seconds) followed by less than one min of vertigo Pt feels worse when lying on affected side, better when still |
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What causes Benign Paroxysmal Positional Vertigo?
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Otolithic debris in semicircular canals stimulate hair cells
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What causes Perilymph Fistula?
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Barotrauma, head injury, surgical effect, spontaneous onset
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What can an Acoustic Neuroma be mistaken for at Dx?
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Meningioma located at CP angle
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How is Benign Paroxysmal Positional Vertigo diagnosed?
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Dix-Hallpike Maneuver - performed at bedside
Latency of symptoms should last for ~1 min when pt is lying down, but recur when pt sits up again with fatiguable vertigo Generally elicited when offending ear is down May observe torsional nystagmus *aka Nyelin-Barany positional testing |
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How is Benign Paroxysmal Positional Vertigo treated?
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Epley Maneuver
*does not work in every case and only works in treating vertigo caused by BPPV |
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What treatment works for all peripheral vertigo?
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Brandt-Daroff exercises: pt sits, lies down on one side with ear to ground, alternates to other side, other ear pointed to ground
10x on each side Desensitizes the central nervous system |
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What medications provide acute relief for adverse symptoms of peripheral vertigo (eg. vomiting)?
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Meclizine (Antivert) - antihistamine
Scopolamine - anticholinergic Diazepam (Valium) - benzodiazepine |
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What is Meclizine (Antivert)?
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Antihistamine
Given to treat acute symptoms of peripheral vertigo |
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What is Scopolamine?
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Anticholinergic
Given to treat acute symptoms of peripheral vertigo |
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What is Diazepam (Valium)?
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Benzodiazepine
Given to treat acute symptoms of peripheral vertigo |
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What affect do aminoglycoside antibiotics have on the vestibular system?
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Cause permanent vestibular dysfunction & damage hair cells, leading to gait ataxia (more so than vertigo)
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What is Streptomycin?
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Very effective aminoglycoside antibiotic
damages hair cells, vestibular dysfunction |
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What is gentamicin?
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Aminoglycoside antibiotic
damages hair cells, vestibular dysfunction |
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What can cause bilateral nerve or labyrinth dysfunction?
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Aminoglycoside antibiotics (streptomycin, gentamicin)
Alcohol or drug intoxication Chronic meningitis (lyme, cryptococcus) Autoimmune vestibulopathy |
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What pt observation will help you localize the side of a cerebellar lesion?
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Pt falls or sways toward the lesion
Nystagmus direction can vary, but is most prominent to the side of the lesion |
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What cerebellar lesions can cause central vertigo?
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Cerebellar stroke - presents with headache (911)
PICA distribution infarct - presents w/ vertigo & ataxia (911) |
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When would you suspect Vertebrobasilar Vascular Disease?
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Sudden onset vertigo/nausea w/ brainstem findings:
crossed motor/sensory signs diplopia dysarthria dysphagia ataxia |
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What is an ominous sign for a patient who presents with sudden onset vertigo with brainstem signs?
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Somnolence (sleepy/drowsiness)
Likely brainstem infarct |
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How could you tell if a pt has vertebrobasilar insufficiency?
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Pt will present with transient brainstem symptoms, because under-perfusion to brainstem causes recurrent, selective ischemia
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What is Chiari Malformation Type I?
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Hereditary condition
Cerebellar tonsils hang below foramen magnum Generally asymptomatic When symptomatic: Headache Vertigo Ataxia Dysphagia dysarthria, hoarseness Long tract signs |
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What is the clinical presentation for Basilar Migraine?
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Vertigo with nausea & vomiting lasting minutes to hours
May or may not occur with photo/phonophobia Attacks can be recurrent *No Dx tests |
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What is psychogenic vertigo?
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Similar to panic attacks and often associated with agoraphobia
Nystagmus absent during vertiginous episode Tx = Cognitive-Behavioral Therapy |
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What is true of vertigo in epilepsy?
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Vestibular sense is an "aura" that usually accompanies other symptoms
*Purely vestibular epilepsy is rare* |