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Flashcards in Evaluation of the Dizzy Patient Deck (22)
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1
Q

Define vertigo.

A

Vertigo is the illusion of movement. - It may be subjective (the patient feels like they are moving) or objective (the patient feels that the environment is moving).

2
Q

Define presyncope.

A

Presyncope is a feeling of faintness or lightheadedness. It occurs with a global decrease in perfusion of the brain.

3
Q

Define desequilibrium.

A

Disequilibrium is the feeling of being unsteady on ones feet.

4
Q

What is Meniere Syndrome?

A

Meniere syndrome is a condition in which there is increased pressure in the endolymph of the inner ear (probably due to diminished resorption of endolymph). -This may result in “blowouts” of the membranes of the inner ear, with sudden attacks of vertigo lasting hours. - It usually also results in gradually progressive, low-pitch hearing loss, often with a humming or buzzing type of tinnitus.

5
Q

What is Benign Paroxysmal Positional Vertigo?

A
  • Benign paroxysmal postional vertigo is a condition in which some otoliths are free to move around the inner ear.
  • They provoke sudden attacks of vertigo beginning after several seconds of delay and lasting less than a minute.
  • Looking up at the ceiling, down at the floor or turning over in bed often provoke the symptom
  • (Dix)Hall Pike (Nylan-Barany) maneuver often reproduces symptoms of vertigo and provokes rotatory nystagmus that also lasts less than a minute.
6
Q

What is the canilith repositioning maneuver?

A

The canilith repositioning (Epley) maneuver is used to treat benign paroxysmal postional vertigo by moving the patient through a series of postions that move otoliths from the semicircular ducts into the utricles

7
Q

What is a perilymph fistula?

A

Perilymph fistula is a condition in which there is a small tear in the wall separating the perilymph of the inner ear from the middle ear cavity.

- This is often near the round window.    - Changes in pressure in the middle ear or in the fluids of the inner ear can provoke movement of fluid and symptoms of vertigo.
8
Q

What is the Hennebert sign?

A

Hennebert sign is the provocation of vertigo by pressure introduced to the external ear canal via insufflation.

  • This can be seen in perilymph fistula or Meniere syndrome.
  • This is similar to a “fistula test.”
9
Q

What is the fistula test?

A

A “fistula test” is the reproduction of vertigo by changing pressure (either increasing or decreasing) in the external ear canal through an otoscope. -This can provoke symptoms in perilymph fistula, but also in Meniere syndrome. -This is similar to Hennebert sign.

10
Q

What is a chiari malformation?

A

Chiari malformation is the congenital herniation of the cerebellum through the foramen magnum.

  • Results in vertigo and occipital headaches.
  • There may be vertical nystagmus and, when severe, dysfunction of long tracts of the spinal cord.
11
Q

What is an acoustic neuroma?

A

Acoustic neuroma is a relatively common, benign tumor that is comprised of Schwann cells of the vestibular nerve. - It is characterized by progressive hearing loss and some (usually mild) vertigo.

12
Q

What types of dizziness are there?

A
  • Vertigo (the illusion of movement) - Presyncope (light-headedness or faintness) - Disequilibrium (unsteadiness on the feet) - “other” (usually a floating type of sensation).
13
Q

What questions would lead you to suspect that the patients “dizziness” is vertigo? presyncope? disequilibrium?

A
  • Vertigo would be suggested by affirmative answer to the question: - “Does this feel like you are on an amusement ride?” - Significant nausea with the event. - Presyncope - Feel “faint, light-headed or “like passing out.” - Disequilibrium - “feeling unsteady on the feet” - Markedly improving when touching a stationary object.
14
Q

What are the possible causes of vertigo?

A

There are peripheral causes and central causes.

  • Peripheral causes => pathology of the inner ear or the vestibulocochlear nerve.
  • Central => conditions affecting the caudal brain stem or vestibulocerebellum.
  • Conditions that irritate the cerebral cortex, such as migraine or very rare seizures, can produce vertigo if they involve cortical locations that are involved in perception of motion.
15
Q

How can you distinguish peripheral vertigo from that caused by damage to the central nervous system?

A
  • Peripheral vertigo (damage to the inner ear or vestibulocochlear nerve):
    • Nystagmus appears rotational and horizontal but is almost never in a vertical (up or down) direction.
    • Imbalance is mild-moderate
  • Central vertigo (cerebellum, vestibular nuclei and brain stem):
    • Nystagmus is purely vertical, horizontal, or torsional.
    • Imbalance is severe
16
Q

What conditions can cause vertigo provoked by movement?

A
  • Benign paroxysmal positional vertigo
  • Cervicogenic vertigo
  • Vertebral artery insufficiency
17
Q

What conditions can cause vertigo provoked by loud noise or by pressure changes?

A
  • Perilymph fistula
  • Meniere syndrome.
18
Q

What conditions that are associated with vertigo can be provoked by head or neck trauma?

A
  • Benign paroxysmal positional vertigo
  • Perilymph fistula
  • Cervicogenic vertigo
  • Vetebral artery dissection
  • Labyrinthian concussion
  • Post-traumatic migraine
  • Postconcussion syndrome.
19
Q

What conditions that are associated with vertigo also usually produce hearing loss?

A
  • Meniere syndrome and perilymph fistula produce at least some hearing loss (worse as the condition progresses).
    • Meniere syndrome => the hearing loss tends to be a loss of ability to hear lower tones.
    • Acoustic neuroma is characterized by significant hearing loss, although the vertigo is typically relatively mild.
20
Q

What are some central causes of vertigo?

A
  • Stroke
  • Multiple sclerosis
  • Chiari malformation
  • Tumors around the craniocervical junction and cerebellum can produce vertigo.
  • Migraine often produces light-headedness and occasionally can produce actual vertigo as part of an aura.
21
Q

What are some potential causes of presyncope?

A
  • Presyncope is the result of global decrease in cerebral perfusion. This can be caused by:
    • Decreased cardiac output (arrhythmia, outflow obstruction)
    • Autonomic instability (due to drugs, conditions that damage autonomic components of the nervous system or vasovagal/vasodepressor events).
    • Vascular instability can accompany migraine or follow head trauma
    • Patients with anxiety (probably through a mechanism of hyperventilation) have cerebral vasoconstriction.
22
Q

What are some potential causes of disequilibrium?

A

This results from deficits in the sensory or motor systems that maintain the upright posture.

1) The most common cause is loss of proprioception in the feet
- Patient has a “sensory ataxia” with a broad-based gait.
- They are much worse when walking in the dark (or with their eyes closed) or when the ground is rough or irregular.
2) Vestibular disorders can also produce disequilibrium
- Extrapyramidal disease (such as Parkinson disease) can produce diseqilibrium
- Postural corrections are slowed
3) Cerebellar disease