368.2 🩺 國考版

368.2.1 高頻考點

368.2.1.1 Four Dizziness Types

  1. Vertigo (spinning) — vestibular
  2. Presyncope (faint) — cardiovascular
  3. Disequilibrium (off-balance) — neurological
  4. Lightheadedness — psychiatric, metabolic

368.2.1.2 Peripheral vs Central

Feature Peripheral Central
Severity Often severe Often less severe
Nystagmus Unidirectional H Direction-changing or vertical
Fixation Reduces No change
Hearing May affect Usually not (except AICA)
Other neuro None Present
HIT Abnormal Normal
Skew Absent Present

368.2.1.3 BPPV

  • Most common cause of vertigo
  • Posterior canal most common
  • Brief (< 1 min), positional
  • Dix-Hallpike + Epley

368.2.1.4 Vestibular Neuritis

  • Sudden sustained vertigo
  • No hearing loss (vs labyrinthitis)
  • Viral prodrome often
  • Steroids
  • Vestibular rehab

368.2.1.5 Meniere Disease

  • Recurrent attacks (20 min - hours)
  • Tetrad: vertigo + tinnitus + hearing loss + fullness
  • Endolymphatic hydrops
  • Diet + diuretics + intratympanic steroid/gentamicin

368.2.1.6 Vestibular Migraine

  • Recurrent vertigo + migraine features
  • Treatment as migraine

368.2.1.7 HINTS Exam

  • Head Impulse: peripheral abnormal (saccade), central normal
  • Nystagmus: peripheral unidirectional H, central changing/vertical
  • Test of Skew: peripheral absent, central present

368.2.1.8 Cerebellar Stroke

  • EMERGENCY
  • May cause obstructive hydrocephalus
  • Decompression if mass effect
  • 5 Ds: dizziness, diplopia, dysarthria, dysphagia, dystaxia

368.2.1.9 AICA Infarct

  • Lateral pons
  • Vertigo + hearing loss (mimics labyrinthitis!)
  • HINTS exam helps distinguish

368.2.1.10 Wallenberg (PICA)

  • Lateral medullary
  • Ipsilateral face, contralateral body sensory loss
  • Vertigo, dysphagia, hoarse, ataxia
  • Horner

368.2.2 Treatment Quick Reference

Condition Treatment
BPPV Epley maneuver
Vestibular neuritis Steroids + vestibular rehab
Meniere acute Vestibular suppressants
Meniere prevention Salt restriction + diuretics + betahistine
Vestibular migraine Migraine prevention
Central Treat underlying (stroke, etc.)