VBI
?5% OF DIZZY CLINIC VISITS?
MUST ALWAYS THINK OF IT AS A POSSIBLE CAUSE OF ANY VERTIGO!–EVEN ISOLATED VERTIGO
IT HAS BEEN SAID TO IMAGE ANY ONE OVER 45—-AT LEAST CONSIDER IT
MANY DISTINCT ENTITIES BUT FELLOW TRAVELERS OFTEN INCLUDE: DIPLOPIA, DYSPHAGIA, DYSARTHRIA, AND CROSSED FINDINGS (IPSI FACIAL DEFICITS AND ATAXIA WITH CONTRALATERAL BODY FINDINGS)
POST FOSSA MIGRAINE (RARE)
VESTIBULAR MIGRAINE=VASOSPASTIC VERTIGO= 1 VARIANT OF COMPLICATED MIGRAINE
USUALLY MINUTES TO HOURS
NO HEARING LOSS
NL ENT EXAM
NL NEURO EXAM, NL EEG—-DIFF Dx = VERTIGINOUS TEMPORAL LOBE (ASTATIC) SEIZURES—ABNL EEG
AGE RELATED CLASSIFICATION
INFANTS (4 MO — 12-16 MO)
PAROXYSMAL TORTICOLLIS—PREDISPOSED TO MIGRAINE
CHILDREN (12MO—-4-5YRS)
BENIGN PAROXYSMAL VERTIGO OF CHILDHOOD
USUALLY MINUTES TO HOURS
SHORT DURATION—USUALLY NO HL
20% SPONT NYSTAGMUS DURING ATTACKS
MILD UNILATERAL HYPOACTIVITY ON ENG
NO HA
ATTACKS RECUR WITH DIMINISHED FREQ
ADOLESCENCE/ADULTHOOD
BASILAR ARTERY (BICKERSTAFF’S) MIGRAINE/ VESTIBULAR MIGRAINE
70% TRUE VERTIGO/ 30% VAGUE DYSEQUILIBRIUM AND MOTION INTOLERANCE
5% DIRECT ASSOC OF VERTIGO WITH HA
65% VARIABLE ASSOC
30% NO ASSOC OF VERTIGO WITH HA
HIGHLY LINKED WITH PMS (FEMALE PREPONDERANCE)
USUALLY MINUTES TO HOURS
25% HAVE A UNILAT WEAKNESS ON ENG
HIGHLY LINKED WITH FOOD ALLERGY (WATCH FOR PROVOKATIVE FOODS)
SUBCLAVIAN STEAL—VBI EITH U E EXCERSICES
VERTEBRAL ARTERY DISSECTION—-FOLLOWING A VISIT TO THE CHIROPRACTOR
C-SPINE ABNL—VERTEBRALS ENTER THE TRANSVERSE FORAMINA AT C-6
LISTEN FOR A SUPRACLAVICULAR BRUIT—DUPLEX CAN ASSES THE PRESENCE AND DIRECTION OF FLOW
MUST DIFF CERVICAL SPONDYLOSIS FROM CERVICAL VERTIGO
CARDIOGENIC—-VERTEBRAL BASILAR SYSTEM IS VERY SUSCEPTIBLE TO CPP
VASO-OCCLUSIVE DISEASE
RISK FACTORS–HTN, HYPERLIPIDEMIA, AGE, OBESITY, D.M., +FH, SMOKERS, ETC.
ACUTE RAPID ONSET
VASCULAR TIME FRAME—MINUTES
CHRONIC “LACUNAR SYNROME”–MULT SMALL LACUNAR INFARCTS–”PRESBYSTASIS”
20% OF PTS WITH VBI HAVE DIZZINESS AS ISOLATED INITIAL Sx
2/3 OF PTS WITH VBI HAVE DIZZINESS
DIZZINESS IS A COMMON BUT NON-SPECIFIC SYMTOM
LATEROPULSION—IPSI=PICA, CONTRA=SUP CEREBELLAR ARTERY
HIGH INCIDENCE OF FELLOW TRAVELERS–HICCUPS, ATAXIA, VISUAL FIELD DEFICITS, DYSARTHRIA, DYSPHAGIA—”BROWN OUT”, HALLUCINATIONS, SCINTILLATING SCOTOMA, VERTICAL DIPLOPIA, DISTORTION OF VERTICALITY(SKEWED DEVIATION)
DIZZY, DIPLOPIA, DYSARTHRIA, DYSPHAGIA—-HIGH INCIDENCE OF CROSSED FINDINGS!
IPSI FACIAL FINDINGS (DECREASED P/T, HORNERS, PHARYNX AND LARYNX)–LESION BELOW THE DECUSSATION OF THE FACIAL FIBERS
CONTRA BODY FINDINGS (DECREASED P/T)
LESION ABOVE THE PYRAMIDAL DECUSSATION
IPSILAT ATAXIA—FALL TOWARDS THE LESION
IPSI CEREBELLAR STRUCTURES
ASK FOR PROVAKATIVE DYNAMIC VERTEBRAL DUPLEX STUDY
PICA—WALLENBURG’S SYNDROME—LAT. MEDULLARY SYNDROME
LATEROPULSION—SACCADIC IPSIPULSION–SACCADES OVERSHOOT TO THE SIDE OF THE LESION AND UNDERSHOOT CONTRALATERALLY
STEADY STATE DEVIATION OF CLOSED EYES (FRENZELS) TO THE SIDE OF THE LESION
OTOLITH SYNDROME—SKEWED DEVIATION (IPSI EYE LOWER)–DISTORTED PERCEPTION OF VERTICALITY
HOARSENSS–DORSAL MOTOR NUCLEUS—-HORNERS SYNDROME
CAN GET VESTIBULAR MASSETER SYNDROME—MOTOR NUC OF V–WEAKNESS AND DEVIATION OF THE JAW
IPSI CN 8—TINNITUS, SNHL, LOSS OF CALORICS
IPSI CN 7—FACIAL PARESIS
AICA
COMMONLY VERTIGO WITHOUT THE HL IS THE AICA TIA
SUP CEREBELLAR ARTERY SYNDROME
SACCADIC CONTRALATEROPULSION—-SACCADES OVERSHOOT CONTRALATERAL TO THE LESION
PARALYTIC PONTINE EXOTROPIA “THE 1 ½ SYNDROME”–NO EOMI
ANT. VESTIBULAR ARTERY OCCLUSION—VERTIGO WITH NO SNHL
LABYRINTHIAN APOPLEXY—THROMBOSIS OF THE INT AUD ARTERY (LABYRINTHIAN ARTERY)—VERTIGO, N/V, +SNHL