Week 14 guided notes: central pathologies

List at least 5 central pathologies that may cause dizziness / vertigo: 

1. cerebrovascular accidents/TIA: AICA PICA or vertebral artery 

2. traumatic brain injury  

3.  demyelinating diseases such as MS 

4. tumor affecting posterior fossa 

5. cerebellar dysfunction/degenerative disorders: multiple system atrophy, spinocerebellar ataxia, chronic alcohol abuse, Chiari malformation 

 

True or False: A person that has a confirmed central diagnosis can have vertigo that is due to a peripheral source (i.e., BPPV or unilateral vestibular hypofunction). 

true

List 7-10 signs that a person is presenting with a central cause of vertigo rather than a peripheral cause (i.e., types of nystagmus or abnormal test findings that may be indicative): 

 

1. ataxia, dysmetria, dysdiadochokiknesia, visual field defects, sensory changes 

2. nystagmus if: direction chaning, pure vertical or torsional, pedular nystagmus, or if it persists in room light for > 7 days 

3. skew deviation (may be combined with head tolt and ocular torsion 

4. abnormalities on oculomotor testing (smooth pursuit, saccades) or VOR cancellation 

5. horizontal or vertical diplopia that lasts > 2 weeks after onset of sx thought to be unilateral vestibular 

6. significant postural instability 

What is the indication for completion of the HINTS+ Test? 

Acute onset of spontaneous and ongoing vertigo 

What findings on the HINTS test would suggest CENTRAL pathology? 

1. negative head impulse 

2. direction changing nystagmus 

3. positive test of skew 

What interventions should PT focus on for central dizziness (no confirmed peripheral source)? 

Rule out secondary peripheral vestibular dysfunction via positional tests for BPPV and gaze stability, habituation and balance activities, long term compensatory strategies for safe mobility 

TRUE or FALSE: Recovery is almost always complete 

false

Which classes of medications are often associated with dizziness as a side-effect? 

• 1. Antihypertensives (beta blockers, diuretics) 

• 2. Sedatives (benzos) 

• 3. Antidepressants/antipsychotics (SSRIs) 

What are the sx of cervicogenic dizziness?

imbalance, unsteadiness, spatial disorientation in conjuction w/ neck pain and or limited cervical ROM

TRUE or FALSE: A person must have “dizziness” AND c-spine dysfunction to have a diagnosis of cervicogenic dizziness 

true

 

What is the underlying pathophysiology associated with cervicogenic dizziness? 

Inaccurate c spine proprioceptive input to cerebellum which affects eye movement to stabilize visual image 

List 4 additional tests and measures that can be performed to help in the diagnosis of cervicogenic dizziness once other conditions are ruled out: 

• 1. Cervical torsion 

• 2. Head neck differentiation 

• 3. Smooth pursuit neck torison 

• 4. Cervical relocation 

List 3 areas/interventions that PT should focus on in the management of cervicogenic dizziness: 

• 1. Cervical strengthening and manual therapy 

• 2. Scapulothoracic strengthening and manual therapy 

• 3. Gaze stabilization w/ cervical retraction 

TRUE or FALSE: A person must meet diagnostic criteria for both MIGRAINE and VESTIBULAR MIGRAINE to be diagnosed with this condition.  

true

TRUE or FALSE: This is relatively common vestibular diagnosis and women are affected more often than men. 

true

TRUE or FALSE: All people that are diagnosed with PPPD must have a diagnosis of anxiety, panic disorder, or depression. 

false

Diagnostic Criteria for PPPD (persistent postural perceptual dizziness)

• Primary dizziness-symptom (rocking/swaying sensation) that is present 50% of the time for more than 3 months. 

 

• Onset following an event that involved acute vestibular sx or impaired postural control 

 

• Symptoms are exacerbated by: upright posture, motion, visual stimuli, complex visual patterns 

 

• Symptoms cause significant distress, functional impairment 

 

• Symptoms can’t be better explained by another disorder 

Treatment for PPPD

• Medical Management: anti-anxiety/depression meds, counseling 

 

• PT Management to focus on what areas? 

 

• Tai chi, relaxation, controlled deep breathing 

• Graded and gradual exposure to provocative environments 

• Task specific exercises 

• Balance stance drills that focus on proprioceptive cues 

 

What are the common triggers for motion sickness? 

Real or perceived motion, Low freq lateral and vertical motions, virtual simulators 

How is motion sickness typically managed? 

• Medication 

• CBT 

• Biofeedback 

• Habituation training 

To be diagnosed with Mal de Debarquement: 

Chronic rocking/swaying dizziness must be associated with recent exposure to prolonged passive motion or exposure to VR 

How long must symptoms persist after this exposure? 

> 1 month