28. Characteristics of 4 vascular disorders that cause vertigo

September 30th, 2007
by reuben in .vertigo

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wallenberg’s subclavian steal

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Responses to “28. Characteristics of 4 vascular disorders that cause vertigo”

  1. More on Wallenberg’s Syndrome:

    The syndrome is due to infarction of the lateral medulla (lateral medullary syndrome) where there are a bunch of tighly packed structures. Depending on what is infacted the symptoms and signs can vary. The most distressing symptom to the patient and the reason it is important on your diff dx in the ED is vertigo. Some or one of the others may be present:

    Symptoms:
    1. Hyperacute onset vertigo without sudden head position change.
    2. Have you tried to eat or drink? If yes, any dyphagia (usually they haven’t yet tried to eat anytihng because they are too vertiginous)
    3. Hiccups
    4. Unsteady/gait disturbance (will be hard to identify in the setting of vertigo.
    5. The cause is usally verebral dissection (because the PICA comes off the vert) or a.fib. So, neck pain could be another clue.

    Signs:
    1. Horner’s (miosis, ptosis) — (don’t ever mention the clinically useless anhydosis again)
    2. Diminished pain and temperature on the ipsilateral face and contralateral body (test with ice chips/cold soft drink/pin)…look for an asymmetry
    3. Gaze evoked sustained nysagmus. (they’ve infarcted there one vestibular nuclei–say the right side–so the left is pushing the eyes to the right unopposed—so when they look to the right you’ll see nystamgus.)
    4. Skew deviation — the eyes are verically misaligned. if you do a cover uncover test on their eyes one at a time you’ll see them shift up and down as the eye refixates

    [credit: Roy Baskind]

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