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Clinical Medicine Dizziness and Vertigo Month 1 Week 3 T3
Clinical Medicine Dizziness and Vertigo Month 1 Week 3 T3
28
Medical
Graduate
09/17/2018

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Term
Balance and Equilibrium organs involved
Definition
• Organs detect motion and aid in maintaining balance
-Organs:
• Utricle: horizontal
• Saccule: vertical
• Semicircular ducts: rotation • Three canals at right angles to each other • Ampulla contain receptors for equilibrium
Term
Static equilibrium
Definition
maintain posture relative to ground
Term
Dynamic equilibrium
Definition
movement of body (head) in response to sudden movements
Term
What is dizzy
Definition
Lightheaded

• Near-syncope
• Implies a non-CNS related problem—many times hypoperfusion of the brain
- Hypovolemic/dehydrated
- Exacerbations with cardiac problems and carotid disease
• Psychological (vasovagal), circulatory (orthostatic BP), arrythmia (SVT), hypoglycemia, unstable vasomotor
• General weakness, palpitations, feeling like you will pass out, blurry or darkening vision, diaphoresis
• The feeling you get your first time scrubbed into a case...
Term
Disequilibrium
Definition
• Due to malfunctioning sensory channels
• Worse with walking or standing, but is relieved when the person sits or is supine
• Feeling of being off balance; worse with crowds, stairs, ramps, escalators
• Distorted proprioception, parkinsonian etiology, alcohol-related, impaired vestibular system, dementia, sedative meds
Term
Vertigo
Definition
hallucination of movement
• It looks like the room is spinning/moving • You feel that you are spinning/moving
Term
Lightheadedness
Definition
presyncope
Term
Clumsiness
Definition
ataxia
Term
“Falling out”
Definition
seizure or aura
Term
Vertigo
Definition
- Hallucination of movement
• Surroundings are spinning
• Feel that you are falling forward/backward/sideways
Term
Central vertigo
Definition
• Damage or dysfunction to the brain: pons or cerebellum
• Usually one constant long episode of vertigo
Term
peripheral vertigo
Definition
• Damage or dysfunction of labyrinth or CN VIII
Term
Peripheral vertigo anatomic location, etiology, clinical presentation
Definition
-anatomic location:
• Labyrinth
• Vestibular nerve
-etiology:
• BPPV (Benign paroxysmal positional vertigo)
• Meniere’s
• Vestibular neuritis
• Labyrinthitis
• Cholesteatoma
-clinical presentation:
• Horizontal nystagmus, away from affected side, fatigable
• More sudden onset usually means peripheral
Term
central vertigo anatomic location, etiology, clinical presentation
Definition
-anatomic location:
• Brainstem • Cerebellum
-etiology:
• Cerebellopontine tumor
• Migraine
• Cerebral vascular
disease
• MS
• Acoustic neuroma
• Seizures
• Meningitis
-clinical presentation:
• Vertical nystagmus, nonfatigable
• Gait problems
• More gradual onset
Term
normal hearing, episodic peripheral vertigo
Definition
BPPV (Benign paroxysmal positional vertigo)
Term
normal hearing, continuous peripheral vertigo
Definition
vestibular neuritis
Term
hearing loss, episodic peripheral vertigo
Definition
Meniere
Term
hearing loss, continuous peripheral vertigo
Definition
Labyrinthitis
Term
Benign Paroxysmal Positional Vertigo is what? cause? worsens w? treatment?
Definition
• MCC of recurrent vertigo: 50– 60 year old female, minutes to hours
• Cause : calcium carbonate otoliths getting stuck in semicircular canal
• Worse with changes in head positioning; lasts seconds to minutes
• Treatment : Epley maneuver • Antihistamines
• Vibration to the back of ear
Term
Dix-Hallpike Test
Definition
• Stand to the side of
the patient
• Pt sitting with head
turned to examiner
• Pt sat so that when
supine, the head will
be beyond the end of
the couch
• Patient lain flat in one
quick, smooth
movement
• Eyes must stay open
• Repeat on other side
• Positive test:
– Rotatory (torsional) nystagmus (& vertigo):
• Diseased ear downmost
– 3 features of BPN:
• Latency – delay of up to 20 seconds before onset
of nystagmus
• Fatigueability – nystagmus fades if head held in
provoking position
• Habituation – Repeating DH test produces less
vigorous response
Term
Epley Maneuver
Definition
[image]
canalith repositioning, treatment for BPPV
Term
Meniere’s Disease cause, symptoms, diagnosis, treatment
Definition
• Idiopathic; distention of endolymph compartment of inner ear
• Each episode lasts minutes/hours/days—many mini attacks
• Tinnitus, ear fullness, hearing loss
• Diagnosis : electrocochleography,
audiometry
• Treatment: symptomatic (meclizine), benzos
- May need to perform decompression if severe
- Avoid salt, chocolate, EtOH
[image]
Term
Vestibular Neuritis is what? caused by? symptoms? treatment?
Definition
• Inflammationof vestibular area of CN VIII
• UsuallyafterURI
• Continuousdizziness, nausea and vomiting, gait changes, horizontal and rotary nystagmus
• Treatment: corticosteroids, meclizine
[image]
Term
Labyrinthitis is what? causes? symptoms? treatment?
Definition
• This is basically vestibular neuritis with hearing loss
• Usually single episode lasting days to weeks, so classified as continuous (viral)
• Associated with hearing loss
• Treatment:
• Lie horizontally, rest
• Antiemetics, diazepam
[image]
Term
Acoustic (Vestibular) Neuroma is what? causes? symptoms? diagnose w? treatment?
Definition
• Schwannoma of CN VIII—benign
• Cause of central vertigo
• Continuous, progressive
vertigo, tinnitus
• Unilateral sensorineural hearing loss is this until proven otherwise
• Diagnosis with MRI
• Treatment: surgery or radiation
[image]
Term
Brainstem Dysfunction
Definition
• Usually caused by vertebrobasilar insufficiency
- Head turning and occluding a vertebral artery (when the other has calcification)
- TIAs
• Discoordination, focal weakness, diplopia, numbness, nystagmus
• Normal hearing
• No tinnitus
[image]
Term
Physiologic Vertigo
Definition
• Seasickness
• Abnormal head movements/positioning
• While painting a ceiling
• Carnival/roller coaster rides
Term
Treatment of Nausea/Vomiting
Definition
• Antihistamines
• Ondansetron (Zofran)
• Metoclopramide (Reglan)
• Prochlorperazine (Compazine)
• Promethazine (Phenergan)
• Scopolamine patch
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