19. Dizziness and Vertigo
Terms in this set (25)
List 6 characteristics that can help differentiate peripheral from central vertigo.
1. Onset: sudden vs. gradual
2. Intensity: severe vs. mild
3. Duration: seconds or minutes or intermittent for days vs. usually weeks for months, can be seconds or minutes for vascular causes
4. Effect of head position: worsened by change vs. usual or no change
5. Associated neuro findings: none vs. usually present
6. Associated auditory findings: may have intermittent tinnitus vs. none"
List 6 causes of peripheral vertigo.
1. FB in ear canal
2. Cerumen or hair against TM
4. Labyrinthitis (suppurative, serous, toxic, chronic)
6. Meniere's disease
7. Vestibular neuronitis
8. Perilymphatic fistula
9. Trauma (labyrinth concussion)
10. Motion sickness
11. Acoustic neuroma
List 6 causes of central vertigo.
1. Infection (encephalitis, meningitis, brain abscess)
2. Vertebral basilar artery insufficiency
3. Subclavian steal syndrome
4. Cerebellar hemorrhage or infarction
5. Vertebral basilar migraine
6. Post-traumatic injury (temporal bone fracture
7. Postconcussive syndrome
8. Temporal lobe epilepsy
11. Cervical spine muscle and ligamentous injury
List two systemic causes of vertigo.
List the triad of Meniere's disease.
2. Hearing loss
Describe the presentation of BPPV.
Short-lived, positional, fatiguable vertigo; associated N/V
O/E: single head position can precipitate vertigo, horizontal nystagmus
Describe the presentation of serous labyrinthitis.
Mild to severe positional vertigo; coexisting or antecedent ear, nose or throat infection or meningitis; associated mild to severe hearing loss
O/E: non-toxic, minimal fever
Describe the presentation of suppurative labyrinthitis.
Mild to severe positional vertigo; coexisting acute exudative inner ear infection; associated severe hearing loss, N/V
O/E: febrile, toxic, AOM
Describe the presentation of toxic labyrinthitis.
Gradually progressive vertigo; vestibulotoxic medications; associated hearing loss, N/V
O/E: hearing loss and ataxia
Describe the presentation of Meniere's disease.
Recurrent episodes of severe rotational vertigo usually lasting hours, with abrupt onset, clusters, and long symptom free periods; associated N/V, hearing loss, tinnitus
O/E: no positional nystagmus
Describe the presentation of vestibular neuritis.
Sudden onset severe vertigo, with increasing intensity for hours, then gradually subsiding over several days (mild symptoms may persist weeks to months), +/- history of infectious or toxic exposure; 3rd and 4th decades of life; associated N/V, but not auditory symptoms
O/E: +/- spontaneous nystagmus
Describe the presentation of acoustic neuroma.
Gradual onset and increase in vertigo, with later neurologic symptoms; characteristically women 30-60 yrs; associated hearing loss, tinnitus, with later development of ataxia and neurologic symptoms
O/E: unilateral hearing loss, true truncal ataxia, neuro signs (later), decreased corneal reflex
Describe the presentation of vertebrobasilar insufficiency.
Isolated new onset vertigo, in a pt of advanced age, with history of atherosclerosis, associated HA, neuro symptoms (dysarthria, ataxia, weakness, numbness, diplopia, rare hearing loss and tinnitus)
O/E: neurologic deficits
Describe the presentation of cerebellar hemorrhage.
Sudden onset severe vertigo; associated HA, N/V
O/E: toxic, dysmetria, true ataxia, and ipsilateral CN VI palsy
What is Wallenberg's syndrome?
Occlusion of the posterior inferior cerebellar artery
Describe the presentation of Wallenberg's syndrome.
Vertigo and significant neurologic complaints; associated N/V, loss of pain and temp sensation, ataxia, hoarseness
O/E: loss of pain and temp sensation on ipsilateral face and contralateral body, paralysis of palate, pharynx and larynx, ipsilateral Horner's
Describe the presentation of subclavian steal.
Syncopal attacks during exercise, associated arm fatigue, cramps, mild lightheadedness
O/E: diminished or absent radial pulses or BP differential
Describe the presentation of vertebrobasilar migraine.
Vertigo followed by HA, similar episodes in past, FHx of migraine, with onset in adolescence; associated dysarthria, ataxia, visual disturbances, and paresthesias
O/E: no residual neurologic or otologic signs
Describe the presentation of MS.
Onset of attacks of vertigo in 20-40 yrs, other attacks of varying neurologic symptoms, associated N/V
O/E: vertical, horizontal or rotary nystagmus, bilateral internuclear ophthalmoplegia, ataxic eye movements
Describe the presentation of temporal lobe epilepsy.
Vertigo, associated memory impairment, hallucinations, trancelike states, seizures
O/E: aphasia and seizures
Occurs when vestibular information becomes unbalanced.
Slow movement towards stimulus, fast movement away from stimulus
Direction is determined by the fast component
What are risk factors for central causes of vertigo?
Age, male, Afib, CAD, DM
Ataxia + vertigo = bad = likely due to a central cause
What are some meds that worsen vertigo?
Quinine, quindine, caffeine, aminoglycosides, anticonvulsants, nicotine, EtOH
What is internuclear ophthalmoplegia?
Inability to adduct affected eye on lateral gaze (abnormal CNIII); normal CN VI (able to abduct, but with coarse nystagmus)
Indications MLF lesion on the side of the CNIII weakness and is pathognomonic for MS"
Describe the head thrust test.
Facing patient, have pt stare at your nose.
Rapidly turn patient's head 10 degrees to one side
Normally pt's eyes should stay focused on your nose
Vestibular nerve dysfunction: eyes temporarily move along with head, then corrective saccade back to midline
Indicative of neuritis or labyrinthitis