Term
| patient's description/history |
|
Definition
| most important/sensitive/critical for establishing the eitology of dizziness |
|
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Term
| presyncope, lightheadedness, dysequilibrium |
|
Definition
| what are the 3 types of non-vertiginous dizziness? |
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Term
|
Definition
| the physical exam generally _______ but does not make the diagnosis |
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Term
|
Definition
| are multiple causes for the same symptoms common? |
|
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Term
|
Definition
| how often is the diagnosis uncertain? |
|
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Term
| central vestibular, stroke |
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Definition
| elderly have higher incidence of _____ causes of vertigo most often due to _______ |
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Term
| psychiatric conditions and presyncope |
|
Definition
| what accounts for more dizziness in young people compared to old people? |
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Term
| when 3 or more medications are being used |
|
Definition
| when is dizziness always a risk factor? |
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Term
|
Definition
| in these patients, prescription drug toxicity is an important contributor to diziness |
|
|
Term
cardiovascular/antihypertensive drugs
psychotropic medications |
|
Definition
| what drugs are more frequently known for causing dizziness? |
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Term
|
Definition
| A symptom of illusory movement- rotational sensation or spinning |
|
|
Term
| presyncope or near syncope |
|
Definition
|
|
Term
|
Definition
| Loss of balance without head sensation; sensation of falling |
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Term
|
Definition
| Ill-defined; not otherwise classifiable |
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Term
|
Definition
| faint or loss of consciousness with loss of body tone. |
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Term
|
Definition
| neurologic discharge destabilizing function and causing a change in mental or physical status |
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Term
| peripheral vestibular dysfunction |
|
Definition
-horizontal, universal nystagmus
-absent other neurological symptoms
-unidirectional postural instability
-deafness may be present |
|
|
Term
| central vestibular dysfunction |
|
Definition
-nystagmus in any direction that may reverse direction
-other neurologic signs often present
-postural instability, may fall with walking
-absence of deafness/tinnitus |
|
|
Term
| Peripheral Vestibular disorders |
|
Definition
Acute vestibular neuronitis
Benign positional vertigo
Meniere’s disease
Perilymphatic fistula
Ramsey Hunt Syndrome (herpes zoster)
Acoustic neuroma
Otitis media |
|
|
Term
| Central Vestibular disorders |
|
Definition
Migrainous vertigo
Cerebral, brainstem, or cerebellar ischemia, infarction, or hemorrhage
Brain tumor
Multiple sclerosis
Chiari malformation
Tumor in the fourth ventricle
AIDS encephalitis |
|
|
Term
-Acute vestibular neuronitis
(Labyrinthitis)
-Benign paroxysmal positional vertigo
-Meniere's disease |
|
Definition
| most common of the peripheral vestibular disorders |
|
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Term
|
Definition
| most useful in establishing the cause(clarifying the sensation does not include or exclude or help really) |
|
|
Term
|
Definition
| All vertigo is made worse by ______ |
|
|
Term
time course
provoking factors
aggrevating factors
medications
physical exam |
|
Definition
| 5 things you should check in an office visit |
|
|
Term
|
Definition
| tests for positional nystagmus in the physical exam |
|
|
Term
Further testing may be needed for diagnostic reasons and/or patient reassurance.
Consider psychiatric causes
Especially depressive, anxiety, and somatoform disorders.
May need a referral for formal vestibular testing (eg, electronystagmography). |
|
Definition
| In the minority of patients who have persistent symptoms (>4 to 6 weeks) what should be done (three things) |
|
|
Term
| Benign Paroxysmal Positional Vertigo |
|
Definition
| most common cause of recurrent vertigo |
|
|
Term
|
Definition
A comparison is made between hearing elicited by placing the base of a tuning fork applied to the mastoid area (bone), and then after the sound is no longer appreciated, the vibrating top is placed one inch from the external ear canal (air).
A positive _____ indicate an air-bone gap and, therefore, presumed presence of a conductive hearing loss. |
|
|
Term
|
Definition
A 512 Hz tuning fork is placed on the patient's forehead.
If the sound lateralizes (is louder on one side than the other), the patient may have either an ipsilateral conductive hearing loss or a contralateral sensorineural hearing loss. |
|
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Term
|
Definition
| check ears, eyes, cranial nerves |
|
|
Term
|
Definition
| stand with feet together, eyes closed and see if the patient sways |
|
|
Term
|
Definition
| If psychiatric disorders are suspected this should be done |
|
|
Term
| BPPV (benign paroxysmal positional vertigo) |
|
Definition
changes in position, such as turning, rolling over or getting in and out of bed, or bending over.
severe vertiginous attacks seen with disorders such as labyrinthitis and Meniere's disease. |
|
|
Term
|
Definition
| usually can be treated with simple reassurance |
|
|
Term
|
Definition
| At 30-second intervals, specific head rotations permit the misplaced otolithic material to transit through the posterior semicircular canal and be returned to the utricle, removing the cause of the problem. |
|
|
Term
| epley maneuver, resolves issue in 80% of patients with 1 treatment |
|
Definition
| Symptoms usually taper off gradually with no episode matching the intensity of the original attack after what treatment? |
|
|
Term
Keep head erect for 48 hours.
Avoid reaching for objects in high places, looking up suddenly, or bending over.
Change position slowly |
|
Definition
| what instructions should the patient be given after they receive the Eppley maneuver |
|
|
Term
|
Definition
Vertigo
Severe vertigo + progressive sensorineural hearing loss.
Vertigo may improve as hearing impairment worsens.
Tinnitus
Diplopia
Blockage/aural fullness
Episodes preceded by ear fullness/pain
Hearing loss
Bone conduction will exceed air conduction
Hyperacusis also may accompany it. |
|
|
Term
Alcohol use
High salt diet
Sleep deprivation
Stress and fatigue
High altitude
Excess multi-dimensional motion
Medications |
|
Definition
| COMMON PRECIPITANTS OF MENIERE’S EPISODES |
|
|
Term
|
Definition
| in this disease, if attacks are frequent or disabling may benefit from prophylactic treatment with salt restriction or diuretic therapy with Hydrochlorothiazide 12.5mg to 25 mg per day or sometimes both. Occasional patients may require referral to otolaryngology for consideration of surgery |
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|
Term
|
Definition
| Experience hearing loss, fullness, and tinnitus with no rotational vertigo at all. |
|
|
Term
|
Definition
| Experience rotational vertigo, fullness, and tinnitus with no hearing loss at all |
|
|
Term
|
Definition
An acute attack of rotational vertigo causing a sudden drop to the ground.
May or may not have any warning.
Attributed to a sudden loss of tone mediated by vestibulospinal reflexes.
Unlike presyncope and seizures, there is no faintness or loss of consciousness with this.
Often have a sensation of being pushed or pulled to the ground.
Unusual feature of Meniere's disease.
Called Tumarkins' otolithic crises- seen only in advanced cases.
Superior canal dehiscence and aminoglycoside toxicity are also associated with this presentation. |
|
|
Term
| drop attack, occurs in severe meniere's disease |
|
Definition
Totally helpless as the world seems to spin around them
vomit severely from the resulting nausea.
The attacks can last minutes or hours.
After the attacks finally subside, patients may sleep for hours and sometimes for days.
May occur frequently, every year or two, or not at all. |
|
|
Term
|
Definition
Erythrocyte sedimentation rate (ESR), rheumatoid factor, antinuclear antibody (ANA) titer.
Autoimmune disease.
Lipid profile
Possible fat emboli that infrequently affect the 8th cranial nerve.
Rapid plasmin reagin (RPR) test
Undiagnosed syphilis. |
|
|
Term
|
Definition
dizziness presenting symptom < 20% of the time.
more commonly, it is preceded or accompanied by other neurologic deficits in the distribution of the posterior circulation.
Staggering or ataxic gait
Vomiting
Headache
Double vision
Visual loss
Slurred speech
Numbness on one side of the face or body
Weakness, clumsiness, or incoordination. |
|
|
Term
|
Definition
| 1 % of all causes dizziness |
|
|
Term
|
Definition
most common tumor
associated with cochlear symptoms (tinnitus and hearing loss)
unilateral cochlear symptoms |
|
|
Term
|
Definition
Etiologies:
Chronic vestibulopathies
BPPV
Labyrinthitis
Visual problems
Musculoskeletal disorders
Arthritis-cervical spondylosis
weaknesses
Somatosensory or gait deficits
Neuropathies
Dementia-Parkinsonism |
|
|
Term
|
Definition
Occurs more commonly than syncope.
Usually lasts for seconds to minutes.
May report lightheadedness, a feeling of warmth, diaphoresis, nausea, and visual blurring occasionally proceeding to blindness.
An observation of pallor by onlookers usually indicates presyncope.
Usually occurs when the patient is standing or seated upright and not when supine. |
|
|
Term
|
Definition
Most common causes:
Orthostatic hypotension
Cardiac arrhythmias
Vasovagal attacks |
|
|
Term
Presyncope-Sensation of near fainting.
Diminished cerebral perfusion.
P ressure (hypotensive causes)
A rrhythmias
S eizures
S ugar (hypo/hyperglycemia)
O utput (cardiac) /O2 (hypoxia)
U nusual causes
T ransient Ischemic Attacks & Strokes |
|
Definition
| what does pass-out stand for? |
|
|
Term
| Dizziness, pre-syncope, and vertigo |
|
Definition
| do not result in a loss of consciousness or postural tone |
|
|
Term
|
Definition
may be caused by an irregular cardiac rate or rhythm or by changes of blood volume or distribution.
Can occur in otherwise healthy people.
May need 12-lead ECG.
abnormal heart rhythms-prolong Q-T syndrome |
|
|
Term
|
Definition
| the “garbage bag” diagnosis. Often a clinician will have worked their way through history and some physical exam and eliminated the other cause |
|
|
Term
|
Definition
Psychiatric (10% - 25% all causes of dizziness)
Idiopathic causes ( most common) |
|
|
Term
|
Definition
| Here we see a bigger proportion of psychiatric causes and depression, anxiety, somatoform disorders really lead the list. |
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