Podcast
Questions and Answers
What percentage of people aged 85 and over is reported to have some form of vestibular dysfunction?
What percentage of people aged 85 and over is reported to have some form of vestibular dysfunction?
Which type of dizziness is characterized by severe vertigo and positional aggravators?
Which type of dizziness is characterized by severe vertigo and positional aggravators?
Which statement best describes the condition of dizziness in individuals experiencing continuous mild vertigo?
Which statement best describes the condition of dizziness in individuals experiencing continuous mild vertigo?
What key question is essential for differential diagnosis of dizziness?
What key question is essential for differential diagnosis of dizziness?
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By age 75, what is the expected percentage loss in the ability to accurately encode faster head movements due to age-related change?
By age 75, what is the expected percentage loss in the ability to accurately encode faster head movements due to age-related change?
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What should be the first step when screening for the need for imaging post-trauma?
What should be the first step when screening for the need for imaging post-trauma?
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Which of the following is considered a high-risk factor for imaging requirement post-trauma?
Which of the following is considered a high-risk factor for imaging requirement post-trauma?
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What is required to safely assess a patient’s range of motion after a trauma?
What is required to safely assess a patient’s range of motion after a trauma?
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If a patient cannot actively rotate their neck 45° left and right, what should be the next step?
If a patient cannot actively rotate their neck 45° left and right, what should be the next step?
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What symptom progression should be inquired about if the accident occurred some time ago?
What symptom progression should be inquired about if the accident occurred some time ago?
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What describes the condition of vertigo?
What describes the condition of vertigo?
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Which statement is true regarding BPPV?
Which statement is true regarding BPPV?
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What is a common treatment for BPPV?
What is a common treatment for BPPV?
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In the context of Meniere’s disease, what symptom is expected during an episode?
In the context of Meniere’s disease, what symptom is expected during an episode?
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Which group has the highest incidence of Meniere’s disease?
Which group has the highest incidence of Meniere’s disease?
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What is a hallmark principle of vertigo?
What is a hallmark principle of vertigo?
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Which test is specifically used to diagnose BPPV?
Which test is specifically used to diagnose BPPV?
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What characteristic is associated with the later stage of Meniere's disease?
What characteristic is associated with the later stage of Meniere's disease?
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What is a primary symptom associated with labyrinthitis?
What is a primary symptom associated with labyrinthitis?
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Which of the following is NOT a possible cause of labyrinthitis?
Which of the following is NOT a possible cause of labyrinthitis?
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How long does the typical symptomatic period of labyrinthitis last?
How long does the typical symptomatic period of labyrinthitis last?
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Which characteristic distinguishes vestibular neuritis from labyrinthitis?
Which characteristic distinguishes vestibular neuritis from labyrinthitis?
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What is a common trigger for vestibular migraine?
What is a common trigger for vestibular migraine?
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Which condition must be ruled out when diagnosing vestibular migraine?
Which condition must be ruled out when diagnosing vestibular migraine?
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What defines the typical patient demographic for vestibular migraine?
What defines the typical patient demographic for vestibular migraine?
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Which of the following symptoms is characteristic of vestibular migraine but not labyrinthitis?
Which of the following symptoms is characteristic of vestibular migraine but not labyrinthitis?
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What duration of episodes is typically required for diagnosing vestibular migraine?
What duration of episodes is typically required for diagnosing vestibular migraine?
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What is a distinguishing feature of benign paroxysmal vertigo of childhood?
What is a distinguishing feature of benign paroxysmal vertigo of childhood?
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What is considered an excellent outcome for migraine management?
What is considered an excellent outcome for migraine management?
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Which symptom is most characteristic of a PICA TIA?
Which symptom is most characteristic of a PICA TIA?
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What is the first stage symptom of vertebrobasilar arterial insufficiency?
What is the first stage symptom of vertebrobasilar arterial insufficiency?
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Which condition is characterized by a benign tumor encircling the vestibulocochlear nerve?
Which condition is characterized by a benign tumor encircling the vestibulocochlear nerve?
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What does the term 'cross syndrome' refer to in the context of symptoms related to PICA?
What does the term 'cross syndrome' refer to in the context of symptoms related to PICA?
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What is a common risk factor for developing a PICA stroke?
What is a common risk factor for developing a PICA stroke?
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What is a common symptom of cervical vertigo?
What is a common symptom of cervical vertigo?
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Which of the following symptoms is associated with the late stages of atheroma or dissection?
Which of the following symptoms is associated with the late stages of atheroma or dissection?
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What early symptom can indicate a dissection in the cervical arteries?
What early symptom can indicate a dissection in the cervical arteries?
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What kind of testing is often required to confirm issues related to vertebrobasilar arterial insufficiency?
What kind of testing is often required to confirm issues related to vertebrobasilar arterial insufficiency?
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Which defining symptom could help identify acoustic neuroma in later stages?
Which defining symptom could help identify acoustic neuroma in later stages?
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Which approach is recommended for managing a stable atheroma?
Which approach is recommended for managing a stable atheroma?
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What does the acronym '3 N's' refer to in the context of issues related to cervical vertigo?
What does the acronym '3 N's' refer to in the context of issues related to cervical vertigo?
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Study Notes
Dizziness: Impact and Causes
- Dizziness affects a significant portion of the population, especially those aged 65+.
- 80% of people aged 65+ and 85% of people aged 85+ experience vestibular dysfunction.
- Age-related changes reduce the ability to encode fast head movements by 35% by age 75.
- Dizziness can be triggered by head movement or visual stimuli.
- Systemic causes (endocrine/cardiovascular) produce lightheadedness. Proprioceptive causes lead to unsteadiness.
- Central nervous system dizziness is continuous, mild, and unaffected by movement, while peripheral nervous system dizziness is severe, positional-dependent, and episodic.
- “Dizzy” is a layman’s term with no clinical meaning. The key diagnostic question is: What does your dizziness feel like?
Major Types of Dizziness
- Wobbly (Disequilibrium): Feeling unsteady.
- Whirling (Vertigo): Illusion of rotatory movement (self or surroundings).
- Weak (Pre-syncope/Lightheadedness): Feeling faint or lightheaded.
Vertigo: Causes and Characteristics
- Vertigo (illusion of rotatory motion) is always accompanied by nausea and vomiting if present.
- Vertigo affects vision like being on a carousel but does not cause blurring or vision loss.
- Head movement typically aggravates vertigo if the vestibulocochlear nerve is affected.
Specific Vertigo Causes
- Benign Paroxysmal Positional Vertigo (BPPV): Otoliths (calcium crystals) stimulate vestibular nerve inappropriately. Symptoms are aggravated by head movement; vertigo resolves quickly (30 seconds to 2 minutes max).
- Meniere's Disease: Autoimmune condition causing overproduction of endolymph in one ear. Initially episodic with vertigo, aural fullness, tinnitus, and balance problems. Later stages progressively affect hearing, balance, and include fluctuating hearing loss and tinnitus.
- Labyrinthitis: Inner ear inflammation usually from infection (viral). Symptoms include ear pain, headache, severe constant vertigo, possible discharge, hearing loss, and tinnitus (typically a week-long symptomatic period).
- Vestibular Neuritis: Inflammation of the vestibular portion of the nerve (not cochlea or cochlear branch). Symptoms are similar to labyrinthitis, but without hearing loss or ear pain. Onset is typically over 40.
- Vestibular Migraine: A type of migraine with vertigo as a prolonged aura; often associated with headache. A common cause of spontaneous vertigo and most often in women. Diagnosis is by exclusion; patient must have 5 episodes of vestibular symptoms.
- PICA TIA/Stroke: Posterior circulatory occlusion. Symptoms include sudden vertigo, nausea, vomiting, hemi-ataxia, and possible Horner's syndrome.
- Vertebrobasilar Arterial Insufficiency (VBAI): Atheroma (plaque) progressing to severe insufficiency, potentially causing dizziness or vertigo upon head turning or in neutral positions. Dissection presents similar early symptoms but also neck pain, tearing or ripping pain, headache. Potential for late symptoms such as ataxia, nausea, numbness, nystagmus, dysarthria, dysphagia, diplopia, and drop attacks.
- Acoustic Neuroma: Benign tumor on the vestibulocochlear nerve; slow-growing and typically diagnosed in those aged 50+. Symptoms include progressive hearing loss, tinnitus, and disequilibrium, potentially leading to cerebellar signs.
Disequilibrium: Cervicogenic Disequilibrium
- Cervicogenic disequilibrium is unsteadiness due to cervical spine movements or positions.
- Stiff or painful neck, reduced ROM, and positional dizziness.
- May result from injuries, vestibular insults, osteoarthritis, inflammatory processes, or cervical instability.
- Diagnosis is by exclusion - need to rule out other pathologies.
- Testing includes checking for motor/sensory, cranial nerve function, balance, and using physical examination screens like Fitzritson's test, Canadian C-spine Rule.
Additional Considerations
- Accurate diagnosis requires understanding the specific symptom characteristics and context.
- Referral to a medical professional is crucial, especially in case of new or severe dizziness and when other symptoms overlap or worsen.
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Description
Explore the various impact and causes of dizziness, particularly in older adults. This quiz delves into vestibular dysfunction, types of dizziness, and their underlying mechanisms. Understand the significant prevalence and implications of dizziness in individuals aged 65 and older.
