Podcast
Questions and Answers
What is the primary reason for the feeling of disequilibrium in vertigo?
What is the primary reason for the feeling of disequilibrium in vertigo?
Which type of vertigo is characterized by severe disequilibrium with less spinning but neurological deficit?
Which type of vertigo is characterized by severe disequilibrium with less spinning but neurological deficit?
What is the term for the classification of vertigo based on the timing of the attacks?
What is the term for the classification of vertigo based on the timing of the attacks?
Which of the following is NOT a cause of peripheral vertigo?
Which of the following is NOT a cause of peripheral vertigo?
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What is the primary difference between central and peripheral vertigo?
What is the primary difference between central and peripheral vertigo?
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What is the primary goal of the Dix-Hallpike and head shake tests?
What is the primary goal of the Dix-Hallpike and head shake tests?
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What is the characteristic of the fast phase of nystagmus?
What is the characteristic of the fast phase of nystagmus?
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What is the primary purpose of the Romberg test?
What is the primary purpose of the Romberg test?
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What is the characteristic of peripheral vestibulopathy in the vestibuloocular reflex test?
What is the characteristic of peripheral vestibulopathy in the vestibuloocular reflex test?
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What is the primary cause of reduced cardiac output (CO) in cardiac pathophysiology?
What is the primary cause of reduced cardiac output (CO) in cardiac pathophysiology?
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What is the primary goal of primary prevention of sudden cardiac death (SCD)?
What is the primary goal of primary prevention of sudden cardiac death (SCD)?
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What is the main purpose of the implantable loop recorder in the diagnosis of SCD?
What is the main purpose of the implantable loop recorder in the diagnosis of SCD?
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What is the characteristic of inherited arrhythmogenic disease in the context of SCD?
What is the characteristic of inherited arrhythmogenic disease in the context of SCD?
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Study Notes
Vertigo
- Normal coordination between vestibular system, vision, and proprioception is essential for maintaining balance and equilibrium.
- Discord in information, abnormal or excessive stimuli, or failure in coordination can lead to vertigo.
- The feeling of disequilibrium in vertigo is an alarm warning from the cortex.
Types of Vertigo
- Central vertigo: affects the brain, characterized by severe disequilibrium with less spinning, neurological deficit, and unprovoked and prolonged attacks.
- Peripheral vertigo: affects the balance apparatus, characterized by mild disease, spinning, and hearing dysfunctions.
Causes of Peripheral Vertigo
- Canalithiasis (BPPV)
- Meniere's disease
- VZV leading to Ramsay Hunt Syndrome
- Labyrinthitis
- Otosclerosis
- Cholastoma
Considerations for Vertigo Classification
- Vestibular or non-vestibular?
- Peripheral or central?
- Timing: paroxysmal, acute, chronic?
- Provoked or spontaneous?
- Other symptoms?
- Specific physical examination: nystagmus, Dix-Hallpike, and head shake
Nystagmus
- Spontaneous nystagmus: patient is asked to focus on the examiner's finger, then moved horizontally, vertically, and rotating.
- Horizontal and rotation nystagmus tend to show peripheral vertigo.
- Pure vertical or pure rotational nystagmus shows central vertigo.
- The slow phase of nystagmus is in the direction of the lesion.
- The fast corrective phase shows the direction of nystagmus.
Other Diagnostic Tests
- Vestibulospinal tests: past pointing, Romberg, and tandem gait.
- Vestibuloocular tests: head thrust, test of skew.
- Cerebellar tests: finger 2 nose, finger 2 finger, dysdiadochokinesia, rebound test.
- Tinnitus or deafness: Rinne, Weber.
Cardiac Pathophysiology
- Reduced cardiac output (CO) due to reduced stroke volume (SV) or heart rate (HR).
- High HR is still bad for CO due to reduced afterload.
- Increased peripheral resistance leads to inadequate blood flow to the cerebral cortex.
- Reduced blood flow to the cerebral cortex for 6-8 seconds → transient loss of consciousness (LOC).
- 50-60 systolic mmHg at heart level → syncope.
- Sudden cardiac death: unpredictable cardiac arrest, often with normal heart beats before the arrest.
Treatment of Cardiac Conditions
- Primary prevention: establish cardiovascular disease and risks, family history of SCD, previous history of SCD, syncope, arrhythmias.
- Goal is to prevent worsening, prevent triggering, and commit improvement.
- Secondary prevention: interventions for survivors of SCD, including implantable cardioverter defibrillation, acute cardiac ischaemia, heart failure, and inherited arrhythmogenic disease.
Diagnosis of Cardiac Conditions
- ECG: main goal is to exclude arrhythmia.
- Holter monitor: to see the EKG during syncope.
- Implantable loop recorder: implanted heart monitoring device that works for 3 years, used for recurrent syncopes.
- Tilt-table testing: for suspect of vasovagal syncope and orthostatic hypertension.
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Description
This quiz covers the diagnosis of nystagmus in a physical examination, including spontaneous nystagmus testing, patient positioning, and interpreting the results. Learn how to identify peripheral and central vertigo and understand the significance of the slow and fast phases of nystagmus.
