 Today, 15 out of 30 of our Pants Review Challenge, Physician Assistant National Certifying Exam questions. Today's question is going to be, what are some differences between central and peripheral vertigo? Central versus peripheral vertigo. What are some causes of each and what are some differences between the two? Okay, first off, what is vertigo? Vertigo is a room spinning sensation. Usually people come in, they say, I'm dizzy. One of my least favorite things to treat in the world because it's such a complicated workup and in urgent care, unfortunately, there's not a whole lot you can work up. However, you can differentiate by physical exam a lot of the times between peripheral or central vertigo, which can be the difference between sending the person home and sending them to the hospital. So very, very, very important differentiation, central versus peripheral vertigo. So vertigo, again, room spinning sensation, not lightheadedness, not I feel like I'm gonna pass out, especially when I stand up. No, we're talking room spinning sensation. I'm getting dizzy. I mean, it might be even getting luscious. Room spinning sensation is vertigo. It feels like things are moving as opposed to I feel like I'm gonna pass out. So vertigo versus lightheadedness, dizziness versus lightheadedness, this is more dizziness, okay? So that's vertigo. What is central vertigo? Central vertigo is that sensation caused by something inside the central nervous system, brain spinal cord, in this case, usually brain. Peripheral vertigo is something outside of the central nervous system causing the sensation of room spinning, okay? So give me, I'm gonna give you a, this is kind of a two-part question. So the first part, I'm gonna give you a few seconds. Give me at least one, preferably two, possible causes of peripheral vertigo. Okay, two causes of peripheral vertigo are BPPV benign, positional, paroxysmal vertigo, or maybe it's paroxysmal then precisional. BPPV benign, paroxysmal, positional vertigo, and Meniere's disease, okay? So BPPV and Meniere's disease are two causes of peripheral vertigo. Now give me at least one, preferably two causes of central vertigo. Okay, two causes of central vertigo are going to be stroke, cerebrovascular accident, and TIA, the heck does TIA stand for? I should definitely know this, but hey, let's fact check myself. All right, transient ischemic attack, man. I'm a little bit embarrassed that I forgot that one, but life goes on. So two examples, two causes of central vertigo are CVA stroke and TIA, transient ischemic attack. All right, so peripheral vertigo, BPPV, Meniere's disease, central vertigo, stroke, TIA. Okay, now give me at least two differences on physical exam, yeah. Give me two differences on physical exam of peripheral versus central vertigo, what you will find in peripheral versus central. I'll give you a couple seconds to think of an answer of give me two examples of physical exam findings that are different in peripheral versus central vertigo. Okay, in peripheral vertigo, you will have a normal neurologic exam, you will not have any focal neurologic deficits. So I'm not gonna go through the entire neurologic exam, it's extremely extensive, it takes a little while, and it's very, very complicated, which you will learn in PA school and medical school. But in peripheral vertigo, this is a big difference, in peripheral vertigo, you will have a normal neurologic exam, you will not have any focal neural deficits. In central, if there happens to be a stroke or a TIA, particularly a stroke, you will have some neurologic deficits somewhere, you will likely have a focal neural deficit, not always, but usually. So more often than not, peripheral vertigo, negative neurologic exam, totally normal, no focal neural deficits, central vertigo, will have some findings on the neurologic exam. One more physical exam finding that's different is peripheral vertigo, you will have a positive Dix-Halpike maneuver, okay? You'll have a positive Dix-Halpike maneuver, you'll be able to reproduce the peripheral vertigo with a Dix-Halpike maneuver, and you can look up what a Dix-Halpike maneuver is, it's a pretty easy physical exam thing to do. In central vertigo, as if it's a stroke or a TIA, you will have a negative Dix-Halpike, which means you will not be able to reproduce the dizziness with a Dix-Halpike maneuver, okay? One more, or yeah, we'll say one more. One more physical exam finding difference between peripheral and central vertigo is going to be, in peripheral vertigo, the nice stagmus, if there is any, is going to be horizontal, so you have the person look to the left, and you notice the eyes kind of horizontally beating, left to right, left to right. Or you may have, and I've never personally seen this, but you may have some rotational nice stagmus, so you have them move their eyes, and you notice there's some rotational stuff going on. That's important finding, that's unilateral only. So you'll notice if they go sideways, if it's horizontal, it'll go in one direction, okay? So you look the other way, you won't get the nice stagmus, you look that way, the affected side, and you'll get the nice stagmus, okay? So unilateral, horizontal, or rotational vertigo, sorry, unilateral, unilateral, horizontal, or rotational nice stagmus, that is unilateral only, will be peripheral vertigo. For central vertigo, the nice stagmus may change directions, it could be vertical or horizontal, and you might get it going to the left, you might get it going to the right, you might try it several different times, and you'll get, you might try it several different times, and you'll notice that sometimes looking to the left causes vertigo, sometimes looking to the right causes vertigo, sometimes looking up or down, or they might get horizontal, or nice stagmus, the eyes beating kind of horizontally, you might get vertical nice stagmus, not sure if you'll get rotational, it's not on the no card, but either way, it's consistently horizontal or rotational and unilateral in peripheral, and it can be kind of all over the place vertical or horizontal in central vertigo. All right, so I know that was kind of a long one and kind of a complicated one, but I'd be shocked if you didn't get a question on vertigo because it's such a common complaint, oh, I'm dizzy, so I'm not promising you'll see this on the pants, but this is a very, very important concept, central versus peripheral vertigo, sorry, I gaffed a little bit during the presentation of this one, hope you'll forgive me, but yeah, go ahead and watch this video a few different times because this is a very important concept that's kind of complicated, but once you got it, once you understand the physiology and the testing, you kind of got it for life. All right, so central versus peripheral vertigo is day number, I believe that was 15.