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Flashcards in Vertigo Deck (35)
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What is Vertigo?

-describes a sense of movement and rotation of oneself or the surrounding environment

-typically a sensation of spinning, but can also present as linear motion or falling

- may have a peripheral or central origin


What are some characteristics of peripheral vertigo?

-episodic and short duration
-autonomic symptoms present
-precipitating factor
-pallor, sweating
-nausea and vomiting
-auditory fullness (fullness writhing ears)


What are some characteristics of central vertigo?

- autonomic symptoms—less severe
-loss of consciousness can occur
-neurological symptoms present including:
A. diplopia
B. Hemianopsia
C. Weakness
D. Numbness
E. Ataxia
F. dysarthria


What is the etiology of Peripheral vertigo?

1. Benign paroxysmal positional vertigo (BPPV)
2. Ménière’s disease
3. Infection
4. Trauma/tumor
5. Metabolic disorders (diabetes mellitus)
6. Acute alcohol intoxication


What is the etiology of Central Vertigo?

1. Meningitis
2. Migraine headache
3. Complications of neurologic origin post ear infections
4. Trauma/tumor
5. Cerebellar degeneration disorders (i.e. alcoholism)
6. Multiple sclerosis (MS)


What is Benign paroxysmal positional vertigo (BPPV) comprised of?

Comprised of repeated episodes of vertigo that occur subsequent to changes in head position


Describe BBPV

-Only lasts a few seconds and is typically first noted while in a recumbent position since it most commonly affects the posterior semicircular canal

-Nystagmus is present and can be noted using the Dix-Hallpike


What is the etiology of BPPV?

Usually otoconia (carnalith) that loosens and travels into the posterior semicircular canal, causing vertigo.


What is the treatment for BPPV?

Treated with carnality repositions maneuvers which are passive movements used to remove the otoconia from the canals, thus remediating vertigo


What is the Dix-Hallpike test?

Maneuver that is a vertiginous position test used in assessment and treatment


What does the Dix-Hallpike test stimulate?

Stimulates the posterior semicircular canal and attempts to determine if otoconia exist within the canal


What is Dix-hallpike test used for?

If pt experiences nystagmus and vertigo, the test is performed to determine if a pt presents with BPPV or a central lesion


Steps of the Dix-Hallpike

1. Pt in long sitting w/ head rotated 45 degrees to one side

2. Pt is rapidly moved to a supine position w/ the head (still in 45 degrees rotation) extended 30 degrees beyond horizontal off the end of the table

3. PT continues to hold the pt’s head in this position for 20-30 seconds observing the potential nystagmus (direction and appearance can determine inner ear vs CNS lesion)


What is a Nystagmus?

-Abnormal eye movement that entails nonvolitional, rhythmic oscillation of the eyes

-Speed of movement is faster in one direction than the other direction

-Pts with Nystagmus often complain of vertigo, nausea, and oscillopsia


When observing Nystagmus what should the PT be observing?

Eye movement: Horizontal, vertical, rotatory or mixed movements

Type of eye movement: Pendular or jerk

Direction: Bidirectional or unidirectional

Nystagmus movement: Binocular or monocular with symmetrical or dissociated movement. Effects of change of position of the head or posture on Nystagmus


What is congenital Nystagmus?

Typically mild and does not change in severity over the person’s lifetime. It is not usually associated with other pathology


Spontaneous nystagmus

imbalance of vestibular signals to the oculomotor neurons that causes a constant drift in one direction that is countered by a quick moment in the opposite direction.


When does a spontaneous nystagmus typically occur?

Occurs after an acute vestibular lesion and will last approximately 24 hours


Peripheral nystagmus

Occurs with a peripheral vestibular lesion and is inhibited when the pt fixates their vision on an object


Central nystagmus

occurs with a central lesion of the brainstem/cerebellum and is not inhibited by visual fixation on an object


Positional nystagmus

Induced by a change in head position. The semicircular canals stimulate the nystagmus that typically lasts only a few seconds


Gaze-evoked nystagmus

Occurs when the eyes shift from a primary position to an alternate position. The nystagmus is caused by patient’s inability to maintain the stable gaze position

Typically indicative of CNS pathology and is associated w/ brain injury and multiple sclerosis


Compare the direction of a central lesion vs peripheral lesion nystagmus

Central lesion: Bidirectional or unidirectional

Peripheral lesion: Unidirectional w/ the fast segment of movement indicating the opposite direction of lesion


Compare visual fixation of a central lesion vs a peripheral lesion

Central lesion: No inhibition with fixation

Peripheral Lesion: Will inhibit nystagmus and vertigo


Compare Vertigo of a central lesion vs peripheral lesion

Central lesion: Mild

Peripheral lesion: Significant


Compare the length of symptoms of a central lesion vs peripheral lesion

Central lesion: May be chronic

Peripheral lesion: Minutes, days, weeks, but finite period of time; recurrent


Compare the etiology of a central lesion to a peripheral lesion

Central lesion: Demyelination of nerves, vascular lesion, cancer/tumor

Peripheral lesion: Ménière’s disease, vascular disorders, trauma, toxicity, infection of inner ear


Describe the Berg Balance Scale

Purpose: Assess a pt’s risk for falling

Structure: 14 tasks (static activities, transitions movements, and dynamic activities in sitting/standing positions) ; scored on an ordinal scale form 0-4

Maximum score: 56 w/ a score of <45 indicating an increased risk of falling


Describe Fregly-Graybiel Ataxia Test Battery

Purpose: Consists of eight tests conditions used in the batter with each leg measured on two accounts, the time spent in each position and the # of steps that a pt takes w/o falling

Structure: Pass/Fail; Best suited for higher level pts; 5 Trials of:

-stand on beam w/ eyes open
-Stand on beam w/eyes close
-Walk on beam w/EO
-sharpened Romberg (heel-toe static positioning)
-standing w/ EO
-standing w/EC
-standing on one leg w/ EC
-walking on the floor w/ EC


Describe the Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

Purpose: assess balance specifically for pts with hemiplegia

Structure: 7 items; scored form 0-2

Maximum score: 14; even tho 14 is the best score a person can receive, pt may still not have Normal balance