Vertigo/Dizziness

Question 1

Lightheadedness

Answer 1

• presyncopal feeling: prodromal symptoms of fainting or near faint

Question 2

Vertigo

Answer 2

• Illusion of movement
• ACUTE
• due to assymmetry of of neural activity between the left and right vestibular nuclei

Question 3

Peripheral Vertigo

Answer 3

• More common
• Inner ear etiology (e.g., semicricular canal debris, veistbular nerve infection, Meniere’s Disease)
• Positional testing: DELAYED HORIZONTAL NYSTAGMUS, away from affected ear
• Falls toward the affected ear

Question 4

Central Vertigo

Answer 4

• Brainstem or cerebellar lesion (e.g., stroke affecting vestibular nuclei or posterior fossa tumor)
• Positional testing: IMMEDIATE NYSTAGMUS in ANY DIRECTION

Symptoms: (usually a combination of symptoms)

• directional change of nystagmus
• skew deviation
• Diplopia
• Dysmetria
• Usually the vertigo itself is less severe than peripheral vertigo

Question 5

Cerebellar ataxia

Answer 5

lack of coordination of movement originating from the cerebellum

Question 6

Sensory ataxia

Answer 6

• due to loss of sensory input into the control of movement (ataxia when eyes are shut)

Question 7

Amitryptyline

Answer 7

• tricyclic antidepressant (TCA)
• well known for having lightheadedness due to large drop in BP, syncope
• avoid in elderly

Question 8

Orthostatic Hypotension

Answer 8

Definition- a drop in Systolic BP of 20 mm Hg, or a drop in Diastolic BP of 10 mm Hg, within 3 mins of standing.

• Common symptoms- lightheadedness, visual gray out, generalized weakness, fatigue and falls
• Systemic OH: will have > 10bpm increase in pulse rate
• Neurogenic OH: will have fixed pulse rate

Question 9

Normal response to standing

Answer 9

Upright posture results in the pooling of 500-1000mLof blood in the lower extremities and splanchnic circulation which initiates the following sequence:

1. A rapid decrease in venous return to the heart
2. diminished cardiac output and BP
3. increases sympathetic outflow
4. peripheral vasoconstriciton

Question 10

Reflex/Vasovagal Syncope

Answer 10

• Neurocardiogenic: Response to a TRIGGER
• occurs acutely and transiently, due to episodic failure of sympathetic efferent vasoconstrictor action, in response to a trigger.
• pts are usually young and have a prodrome of diaphoresis, nausea, fatigue and pallor

Question 11

Cortical Inputs for Balance

Answer 11

• visual confirmation of position,
  2. non-visual confirmation of position (including proprioceptive/dorsal column and vestibular input/inner ear)
  3. a normally functioning cerebellum

Question 12

Romberg Sign

Answer 12

• If close eyes, will fall

- positive sign indicates either inner ear/propioceptive problem

Question 13

Cold Calorics Test

Answer 13

• Used to determine if your brainstem is intact (brainstem is responsible for fast phase of nystagmus)

Remember COWS

• Cold water: Fast phase of nystagmus toward OPPOSITE ear
• Warm water: Slow phase of nystagmus toward SAME ear

Question 14

Hallpike Maneuver Test

Answer 14

• Positive test: nystagmus will be seen going AWAY from affected ear
• Positive test indicates benign positional vertigo (more of inner ear problem then central)

Question 15

Vestibular Neurontis / Acute Labyrinthitis

Answer 15

• Acute onset of severe vertigo that is PERSISTENT
• Peripheral characteristics
• Test: depressed caloric test on affected side

Question 16

Meniere’s Disease

Answer 16

Triad:

1. Vertigo
2. Tinnitus
3. Hearing loss (often bilateral)

• due to distention of endolymphatic sac and increase in endolymphatic volume