Cheatography
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Presentation, management , etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Vertigo
- Common complain for >75 years old |
- Central causes include brain stem, cerebellum or other supratentorial structures (vascular supply) |
- Peripheral causes include vestibular, visual and spinal proprioceptive systems |
Cervicogenic Vertigo
- disequilibrium from abnormal proprioceptive activity in the cx |
- Facet joints in C0-C3 highly innervated by cx proprioceptive input |
- Suboccipitals important - supplied with muscle spindles |
- Abnormal stimulation of the articular capsule or muscular spindle mechanism receptors can provide conflicting information with visual and vestibular afferents |
- Causes sensory mismatch between visual, vestibular and cx mechanoreptors - confuses the brain |
- Can be caused by vascular compression and vasomotor changes |
- Can be caused by degeneration, inflammation, joint dysfunction, disc lesion, muscle hypertonicity or trauma |
- Can be whiplash related |
- Stress and anxiety - increases muscle tone and sympathetic firing rate |
Presentation
- Patient complains of dizziness with Cx motion + neck pain |
- Lightheadedness, floating, unsteadiness, imbalance |
- Spinning feeling is not usually present (consider BPPV if present) |
- Symptoms ease with a stable position |
- Consider non-cervicogenic causes (See notes) |
- Diagnosis of exclusion |
- Nystagmus (vertical = central origin, Horizontal = peripheral) |
- Nystagmus is horizontal, abrupt with head movements and diminishes quickly |
- Nystagmus with VBAI has a late onset and intensifies |
- Neck torsion test and head rotation to determine CVG vertigo to BPPV |
- Slower eye tracking movements when head is turned |
- Loss of ROM |
- Upper Cx tenderness + restrictions |
- Hypertonic subocciptals (can reproduce vertigo on palpation), paracervical, traps, scm and pecs |
- Asses for upper crossed or weakness in DNF |
Considerations
- Hx of head trauma
- Loss of consciousness (CV and Resp exam)
- Frequent, unexplained falls
- Hearing loss
- Tinnitus
- Ear Fullness (Otoscope)
- Ear Ache (Otoscope, lymphnodes)
- Ptosis
- Facial/extremity paresthesia (UMNL, Cranial nerve)
- Visual disturbances
- Difficulty/speaking/swallowing/walking (blood pressure for VBAI, cerebellar exam (romberg, finger to nose, heel to knee, gait)
- New medication - anti-hypertensives/antidepressants (blood pressure for orthostatic hypotension |
Imaging
Not usually needed unless VBAI/CNS pathology is suspected |
DDx
- Labryrinthine/vestibular disorders |
- Concussion |
- Intracranial bleed |
- Perilymphatic fistula |
- CNS ischemia/stroke |
- Neoplasm |
- Infections |
- Intracranial swelling |
- Migraine |
- Carotid Sinus syndrome |
- Intoxication |
- Drug toxicity |
Management
- SMT of Cervical and Tx |
- If contraindictaions, mobilisation can be effective |
- Myofascial release/stretching of suboccipital, SCM, upper traps, levator, pecs |
- Postural correction and breathing exercises |
- weakness in DNF |
- Vestibular rehab exercises (canalith repositioning) |
- Ice heat, ultrasouns |
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