Dizziness And Vertigo

Front 1

What are the three general categories of dizziness?

Back 1

lightheadedness

dysequilibrium - dizzy from neck down

vertigo - sensation of spinning

Front 2

what is syncope?

Back 2

Hypoperfusion to both hemispheres or to brainstem results in syncope

- cardiac, vasovagal, medication, dehydration all causes

Front 3

What are some of the potential causes of dysequilibrium?

in the elderly?

Back 3

Cerebellar dysfunction (ataxia)
Sensory dysfunction (poor proprioception)
Extrapyramidal
Decreased or altered visual input
Rarely: mild or resolving vertigo or vestibular dysfunction

elderly: often multi-factorial

Front 4

is vertigo physiologic or pathologic?

Back 4

it can be both

Front 5

Disturbance of what system causes physiologic vertigo?

Back 5

vestibular system: otolith organs or semicircular canals

* can also be in vestibulospinal tract or medial longitudinal fasiculus

so, vertigo can be caused by either "peripheral" or "central" problems

Front 6

If vertigo is brought on by movement, where does this suggest the cause is?

Back 6

peripheral

Front 7

What type of cause of vertigo is typical of bilateral nystagmus that is irrepressible with visible fixation?

Back 7

central

peripheral tend to be more unilateral and suppressible with fixation

Front 8

in peripheral vertigo, what direction is the fast/quick phase of nystagmus?

Back 8

AWAY from the lesion and rotation, and slow phase is towards

(this differs from normal nystagmus where quick phase is in same direction as rotation [VOR])

Front 9

What does the internal auditory artery branch from? how can this cause "dizziness"?

Back 9

AICA

infarction can cause deafness or vertigo

Front 10

** What is BPPV? what can cause this?

Back 10

Benign paroxysmal positional vertigo: The most common cause of vertigo
Classic presentation: Sudden onset vertigo (severe), triggered by movement, short latency period (seconds) followed by vertigo <1 minute.
Mechanism: otolithic debris (stones) in semicircular canals stimulate hair cells
Spontaneous, head trauma, utricle degeneration in elderly

Front 11

What do Vestibular Neuronitis and Labyrinthitis cause? how do they usually present?

Back 11

acute vertigo, vomiting --> labyrinthitis can also cause hearing loss

usually present after viral syndrome; normally resolve

Front 12

* What is Ramsay-Hunt Syndrome?

Back 12

(Herpes Zoster Oticus) – special case of labyrinthitis

Reactivation of latent virus – spiral and vestibular ganglion

Presents with deep, burning ear pain, vesicular rash in ear canal

Can involve facial weakness (7th nerve)

Front 13

* What is Meniere's Disease?

Back 13

recurrent episodes of vertigo
*intermittent increase in endolymph; increased pressure
occurs in 5th decade of life

Weird thing about Meniere’s – nystagmus can beat toward the affected side (lesion not destructive)

Front 14

What is actually affected in an acoustic neuroma? what is the symptom?

Back 14

actually schwannoma (along the 8th nerve, or at the cerebellopontine angle)

dysequilibrium rather than true vertigo

Front 15

* What maneuver serves to diagnose BPPV? treatment?

Back 15

Dix-Hallpike Maneuver (D = diagnose)

Epley Maneuver ("rolling the rock")

Front 16

Where might you find lesions (central) that cause vertigo?

Back 16

* cerbebellum, * brainstem, thalamus, vestibular cortex

* most common

Front 17

What is often involved in brainstem causes of vertigo?

Back 17

vertebrobasial vascular disease

- infarction, insufficiency, hemmorage; usually accompanies other "brainstem findings": crossed motor/sensory signs, diplopia, dysarthria, dysphagia or cerebellar tract signs (ataxia)

** several other causes: Infection or inflammatory
Multiple Sclerosis (demyelinating plaque in brainstem or cerebellum)
Trauma
Postinfectious, paraneoplastic
Neoplastic
Hereditary/congenital structural
Chiari Malformation
Metabolic

Front 18

what type of lesion would you expect if ataxia is present? (general)

Back 18

central - CNS