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26 Cards in this Set

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  • Back
Define vertigo.
Vertigo is a self-limiting hallucination of movement resulting from asymmetrical proprioceptive input to the brain.
Objective vertigo- sensation that surronding objects are moving
Subjective vertigo- person feels he/she is moving
Define dizziness.
Foolish, unsteady and or light headed. Does not imply perception of motion.
True/False. The condition of diziness is a relatively benign condition. It is very rare that something serious is the etiology of diziness.
List the four common etiologies of diziness in order of prevalance according to the findings of the Drachman & Hart study.
1. Peripheral Vestibular Dysfunction
2. Hyperventillation
3. Sensory deficit
4. Psychiatric disorders
Discuss the pathophysiology and prevalence of benign positional vertigo (BPH).
BPH is the most common peripheral vestibular dysfunciton related to pathology of the semi-circular canals (important for head proprioception)
How is Benign positional vertigo diagnosed?
Nylan-Barany Test- Lay patient flat on table with one ear turned to the floor (head over the edge). Check for dizziness and evaluate eye movements for nystagmus. If right ear down exhibits dizineess and nystagmus then right vestibular is to sensitive or left vestibular isnt sensitive enough.
Discuss the pathophysiology of actute vestibular neuronitis.
Bout of spontaneous vertigo complicated by nausea and vomitting typically associated with viral infection/deficiti of one peripheral vestibular system.
What is the etiology/symptomatic presentation of chronic vestibular imbalance?
Momentary vertigo on sudden change of head position. Patients typically suffering from overly sensitive vestibular system since childhood (Hx of carsickness, etc.)
What is Menieres Dz?
Endolymphatic hydrops associated with an overabundance of fluid in the cochlea producing tinnitus and progressive hearing loss.
What is the most common etiology of syncope?
Due to cardiac causes such as episodic bradycardia. Check for cardiac arrhythmia in older patients.
What is the most common cause of vertigo/diziness secondary to psychogenic disorder?
Anxiety hyperventilation.
What is the significance of doing an MRI in patients presenting with unilateral hearing loss?
To rule out acoustic neuroma (schwannoma) neoplasm in the periphery of the 8th nerve.
What is a common cause of multiple sensory deficit in older patients? Discuss its symptomology.
MSD presents as a 'lightheadedness" observed only when patient is walking and particularly when turning. Commonly associated with diabetic neuropathy, cervical spondylosis and vestibular dysfunction.
Discuss the pathophysiology of Meniere's Syndrome.
Dilation of the membranous labyrinth resulting in a feeling of fullness in the affected ear, tinnitus and fluctuating hearing loss that becomes permanent.
What symptoms are associated with Meniere's Syndrome?
Violent episodic vertigo, nausea, vomitting, nystagmus
Who usually presents with Meniere's Syndrome?
Middle age adult with no preference for sex
What is the supposed etiology of vestibular neuronitis?
Viral upper respiratory tract infection.
Describe the text book presentation of Vestibular Neuronitis?
Acute onset vertigo, with severe vomitting with no auditory neuropathy (no hearing loss), self-limiting (2weeks) with labyrinth un/hypo responsive to caloric stimulation.
What is commonly the etiology of Benigng Positional Vertigo (BPV)?
Trauma "whiplash," senescence (loose otoconia)
Discuss the typical presentation of a patient with Benign Positional Vertigo.
Violent vertigo in duration of less then thirty seconds usually induced by lying down in bed. Characterized by nystagmus, absence of tinnitus and hearing loss and spontaneous remission.
What exams can be utilized to reproduce benign positional vertigo?
Nylen-Barany or Hallpike Dix maneuver. Tip patient head back while laying down side to side after rest.
Characterize Perilymph Fistula.
A condition usually due to head trauma or barotrauma (scuba) in which patient describes loss of balance/unsteadiness falling to the side of affected ear. +/- hearing loss
What are three structural causes of vertigo?
Pathologies affecting the end organ, the vestibular nerve and the posterior fossa
If hearing loss is associated with episodes of vertigo, what diagnosis should strongly be considered?
Meniere's Dz
If persistent "unsteadiness" is associated with unilateral hearing loss what diagnosis should be considered?
acoustic neuroma, the most valuable test to order would be an MRI
What is the treatment for Peripheral Vestibular Disorder?
Supression of the labyrinthe system with:
1. Meclizine (Antevert)
2. Diazepam (Valium)