Vertigo

Question 1

What is Vertigo?

Answer 1

• describes a sense of movement and rotation of oneself or the surrounding environment
• typically a sensation of spinning, but can also present as linear motion or falling
• may have a peripheral or central origin

Question 2

What are some characteristics of peripheral vertigo?

Answer 2

• episodic and short duration
• autonomic symptoms present
• precipitating factor
• pallor, sweating
• nausea and vomiting
• auditory fullness (fullness writhing ears)
• TINNITUS

Question 3

What are some characteristics of central vertigo?

Answer 3

• autonomic symptoms—less severe
  -loss of consciousness can occur
  -neurological symptoms present including:
  A. diplopia
  B. Hemianopsia
  C. Weakness
  D. Numbness
  E. Ataxia
  F. dysarthria

Question 4

What is the etiology of Peripheral vertigo?

Answer 4

1. Benign paroxysmal positional vertigo (BPPV)
2. Ménière’s disease
3. Infection
4. Trauma/tumor
5. Metabolic disorders (diabetes mellitus)
6. Acute alcohol intoxication

Question 5

What is the etiology of Central Vertigo?

Answer 5

1. Meningitis
2. Migraine headache
3. Complications of neurologic origin post ear infections
4. Trauma/tumor
5. Cerebellar degeneration disorders (i.e. alcoholism)
6. Multiple sclerosis (MS)

Question 6

What is Benign paroxysmal positional vertigo (BPPV) comprised of?

Answer 6

Comprised of repeated episodes of vertigo that occur subsequent to changes in head position

Question 7

Describe BBPV

Answer 7

• Only lasts a few seconds and is typically first noted while in a recumbent position since it most commonly affects the posterior semicircular canal
• Nystagmus is present and can be noted using the Dix-Hallpike

Question 8

What is the etiology of BPPV?

Answer 8

Usually otoconia (carnalith) that loosens and travels into the posterior semicircular canal, causing vertigo.

Question 9

What is the treatment for BPPV?

Answer 9

Treated with carnality repositions maneuvers which are passive movements used to remove the otoconia from the canals, thus remediating vertigo

Question 10

What is the Dix-Hallpike test?

Answer 10

Maneuver that is a vertiginous position test used in assessment and treatment

Question 11

What does the Dix-Hallpike test stimulate?

Answer 11

Stimulates the posterior semicircular canal and attempts to determine if otoconia exist within the canal

Question 12

What is Dix-hallpike test used for?

Answer 12

If pt experiences nystagmus and vertigo, the test is performed to determine if a pt presents with BPPV or a central lesion

Question 13

Steps of the Dix-Hallpike

Answer 13

1. Pt in long sitting w/ head rotated 45 degrees to one side
2. Pt is rapidly moved to a supine position w/ the head (still in 45 degrees rotation) extended 30 degrees beyond horizontal off the end of the table
3. PT continues to hold the pt’s head in this position for 20-30 seconds observing the potential nystagmus (direction and appearance can determine inner ear vs CNS lesion)

Question 14

What is a Nystagmus?

Answer 14

• Abnormal eye movement that entails nonvolitional, rhythmic oscillation of the eyes
• Speed of movement is faster in one direction than the other direction
• Pts with Nystagmus often complain of vertigo, nausea, and oscillopsia

Question 15

When observing Nystagmus what should the PT be observing?

Answer 15

Eye movement: Horizontal, vertical, rotatory or mixed movements

Type of eye movement: Pendular or jerk

Direction: Bidirectional or unidirectional

Nystagmus movement: Binocular or monocular with symmetrical or dissociated movement. Effects of change of position of the head or posture on Nystagmus

Question 16

What is congenital Nystagmus?

Answer 16

Typically mild and does not change in severity over the person’s lifetime. It is not usually associated with other pathology

Question 17

Spontaneous nystagmus

Answer 17

imbalance of vestibular signals to the oculomotor neurons that causes a constant drift in one direction that is countered by a quick moment in the opposite direction.

Question 18

When does a spontaneous nystagmus typically occur?

Answer 18

Occurs after an acute vestibular lesion and will last approximately 24 hours

Question 19

Peripheral nystagmus

Answer 19

Occurs with a peripheral vestibular lesion and is inhibited when the pt fixates their vision on an object

Question 20

Central nystagmus

Answer 20

occurs with a central lesion of the brainstem/cerebellum and is not inhibited by visual fixation on an object

Question 21

Positional nystagmus

Answer 21

Induced by a change in head position. The semicircular canals stimulate the nystagmus that typically lasts only a few seconds

Question 22

Gaze-evoked nystagmus

Answer 22

Occurs when the eyes shift from a primary position to an alternate position. The nystagmus is caused by patient’s inability to maintain the stable gaze position

Typically indicative of CNS pathology and is associated w/ brain injury and multiple sclerosis

Question 23

Compare the direction of a central lesion vs peripheral lesion nystagmus

Answer 23

Central lesion: Bidirectional or unidirectional

Peripheral lesion: Unidirectional w/ the fast segment of movement indicating the opposite direction of lesion

Question 24

Compare visual fixation of a central lesion vs a peripheral lesion

Answer 24

Central lesion: No inhibition with fixation

Peripheral Lesion: Will inhibit nystagmus and vertigo

Question 25

Compare Vertigo of a central lesion vs peripheral lesion

Answer 25

Central lesion: Mild Peripheral lesion: Significant

Question 26

Compare the length of symptoms of a central lesion vs peripheral lesion

Answer 26

Central lesion: May be chronic Peripheral lesion: Minutes, days, weeks, but finite period of time; recurrent

Question 27

Compare the etiology of a central lesion to a peripheral lesion

Answer 27

Central lesion: Demyelination of nerves, vascular lesion, cancer/tumor Peripheral lesion: Ménière’s disease, vascular disorders, trauma, toxicity, infection of inner ear

Question 28

Describe the Berg Balance Scale

Answer 28

Purpose: Assess a pt’s risk for falling Structure: 14 tasks (static activities, transitions movements, and dynamic activities in sitting/standing positions) ; scored on an ordinal scale form 0-4 Maximum score: 56 w/ a score of <45 indicating an increased risk of falling

Question 29

Describe Fregly-Graybiel Ataxia Test Battery

Answer 29

Purpose: Consists of eight tests conditions used in the batter with each leg measured on two accounts, the time spent in each position and the # of steps that a pt takes w/o falling Structure: Pass/Fail; Best suited for higher level pts; 5 Trials of: - stand on beam w/ eyes open - Stand on beam w/eyes close - Walk on beam w/EO - sharpened Romberg (heel-toe static positioning) - standing w/ EO - standing w/EC - standing on one leg w/ EC - walking on the floor w/ EC

Question 30

Describe the Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

Answer 30

Purpose: assess balance specifically for pts with hemiplegia Structure: 7 items; scored form 0-2 Maximum score: 14; even tho 14 is the best score a person can receive, pt may still not have Normal balance

Question 31

Describe the functional reach test

Answer 31

Purpose: screening tool used to assess standing balance and risk of fall Structure: Person required to stand upright with a static BOS and the pt reaches without moving the feet (3 trials performed and averaged); Then they close their eyes and balance for 30 seconds.

Question 32

Describe the Romberg Test

Answer 32

Purpose: assessment tool of balance and ataxia that initially positions the pt in unsupported standing, feet together, UE folded, looking at a fixed point straight ahead w/ eyes open (visual, vestibular, somatosensory) *If pt demonstrates ataxia and has (+) Romberg test, this indicates sensory ataxia not cerebellar ataxia

Question 33

Describe the sharpened Romberg

Answer 33

Same as Romberg, but pt’s feet re heel-to-toe (tandem stance) with non-dominant foot in front. EO first; EC second

Question 34

Describe the Timed up and Go (TUG)

Answer 34

Purpose: screening tool that assesses a person’s level of mobility and balance Structure: person sits, transfers to standing, walking 10 feet and turns and walks back to chair; returns to sitting position; 5-point ordinal scale Normal: <10seconds; >20seconds are at the limit for functional independence; >30 seconds are at high risk of fall

Question 35

Describe Tinetti Performance Oriented Mobility Assessment

Answer 35

Purpose: Tool used to screen pts and identify if there is an increased risk for falling Structure: First section: assesses balance; 0-2 scale (16 max) Second section: assess gain; 0-2 scale (12 max) Maximum score: 28 w/risk of falling increasing as the total score decreases (<19 indicates high risk for fall)