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Y2 LCRS Neuroscience and Mental Health > auditory function and balance > Flashcards

auditory function and balance Flashcards

clinical vestibular disturbance: define dizziness, vertigo and oscillopsia; recognise how these conditions differ; explain the consequences of uni- and bilateral loss of vestibular function

1
Q

effect of unilateral lesion in vestibular system

A

could be organ or nerve, so no resting discharge from one side of vestibular system, so interprets as movement in direction of no resting discharge, so eyes move to left; vision recorrects -> constant cycle of slow brainstem movement and fast central compensation

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2
Q

8 methods of diagnosing unilateral lesion in vestibular system

A

anamnesis, cranial nerves, balance and gait assessment, cerebellum, gaze assessment (eye movements), vestibular tests, imaging, subjective assessment (questionnaires)

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3
Q

4 vestibular tests in vestibular diagnosis

A

caloric test, vHIT, VEMP, rotational test

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4
Q

2 imaging techniques in vestibular diagnosis

A

CT scan, MRI

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5
Q

symptoms of vestibular lesion

A

vertigo, dizziness and giddiness, unsteadiness, self-motion perception

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6
Q

define vertigo

A

illusion of movement (usually rotational or ‘true vertigo’, whereas dizziness and giddiness are more vague)

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7
Q

define unsteady

A

off balance (bilateral vestibulopathy)

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8
Q

2 locations of peripheral vestibular disorders

A

labyrinth, vestibulocochlear nerve

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9
Q

4 examples of peripheral vestibular disorders

A

vestibular neuritis, BPPV, Meniere’s disease BVF, UVF

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10
Q

location of central vestibular disorders

A

CNS (brainstem/cerebellum)

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11
Q

3 examples of central vestibular disorders

A

stroke, MS, tumours

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12
Q

evolution of vestibular disorders

A

acute -> intermittent -> recurrent -> progressive

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13
Q

2 examples of acute vestibular disorders

A

vestibular neuritis (‘labyrinthitis’), stroke

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14
Q

example of intermittent vestibular disorder

A

benign paroxysmal positional vertigo (BPPV)

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15
Q

2 examples of recurrent vestibular disorders

A

Meniere’s disease (rare), migraine (common)

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16
Q

example of progressive vestibular disorder

A

acoustic neuroma on vestibulocochlear nerve, causing degeneration

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17
Q

7 differential diagnoses to vestibular disorders which present with similar dizzy symptoms

A

heart disorders, presyncopal episodes, orthostatic hypotension, anaemia, hypoglycaemia, psychological, gait disorders

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18
Q

parts of vestibular system (pyramidal)

A

spinal cord -> ponto-medullary junction (where nerve to peripheral vestibular organ) -> vestibular cerebellum -> thalamus -> cerebral cortex

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19
Q

what is vestibular-motion perception

A

sensation of motion (self or environment)

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20
Q

what is oscillopsia

A

defect in seeing environmental motion (indicates nystagmus)

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21
Q

define nystagmus

A

seeing visual world move (slow phase, fast phase repeated)

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22
Q

dizziness or vertigo

A

describe symptoms in words: self or environmental motion (eyes shut), seeing room move; origin may come from ear or brain

23
Q

illusory self-motion: low current

A

feeling of gentle rocking of self

24
Q

illusory self-motion: high current

A

feeling of violent spinning of self and room

25
Q

most common emergency room vertigo diagnoses, which history and examination are aimed at

A

benign paroxysmal positional vertigo (BPPV) - always look for, vestibular neuritis (bipalsy), migrainous vertigo, stroke, mixed (Meniere’s <1% - disorder of inner ear)

26
Q

3 simple measurements to take when acute vertigo suspected

A

postural blood pressure, arterial saturation, ECG

27
Q

what 3 things are ruled out when diagnosing acute vertigo

A

presyncope, pulmonary embolism, cardiac dysrhythmia

28
Q

3 core examination areas for acute vertigo

A

eyes, ears, legs

29
Q

4 investigations of core eye examination for acute vertigo

A

gaze, vestibulo-ocular reflex, hallpike, fundoscopy

30
Q

investigation of core ear examination for acute vertigo

A

otoscopy

31
Q

investigation of core legs examination for acute vertigo

A

gait (and tandem)

32
Q

gaze in patients with peripheral nystagmus

A

nystagmus suppressed with vision, so without visual fixation, nystagmus increases intensity so is peripheral (affecting ear)

33
Q

vestibulo-ochlear reflex in patients with nystagmus

A

doll’s eyes and head impulse test - tell which way nystagmus is as eyes taken off target when head moved - can tell peripheral

34
Q

fundoscopy in patients with acute vertigo

A

retina, spontaneous nystagmus, effect of visual fixation on nystagmus

35
Q

otoscopy in patients with acute vertigo, and impact on antibiotic admission

A

rarely informative except for unilateral peripheral vestibular loss (e.g. Herpes) or suppurative infection in meningitis, so oral antibiotics never indicated

36
Q

gait and tandem walking in patients with acute vertigo

A

narrow gait?, count how many mistakes out of 10 tandem steps, see if eye closure affects balance, and can maintain balance for >20s without vision

37
Q

investigating BPPV (benign paroxysmal positional vertigo): position and duration

A

lying back in bed, with very brief duration (seconds as beware prolonged malaise)

38
Q

investigating BPPV (benign paroxysmal positional vertigo): red flags

A

headache, atypical nystagmus

39
Q

investigating BPPV (benign paroxysmal positional vertigo): typical vs atypical vs complex

A

typical: latency of 10 seconds before see nystagmus when tilt head back due to crystal movement (localise canal), atypical and complex: down-beating nystagmus is central); adaptability, fatiguability

40
Q

treating posterior canal BPPV (benign paroxysmal positional vertigo)

A

epley, semont (right hallpike and semont) to remove crystal debris from semicircular canal

41
Q

define vestibular agnosia in acute traumatic brain injury

A

lack of sensation of dizziness despite a peripheral vestibular activation (evoked nystagmus) indicates a loss of vestibular sensation; nystagmus but don’t see world spin

42
Q

vestibular neuritis: onset

A

subacute (minutes -> hours) continuous vertigo

43
Q

vestibular neuritis: symptoms

A

obvious “vestibular” nystagmus, positive head impulse test, normal gait

44
Q

vestibular neuritis: treatment

A

vestibular sedatives (24-36 hours), mobilise at day 3, treat any BPPV or migraine

45
Q

vestibular neuritis: 5 red flags

A

headache, gait ataxia, hyperacute onset, vertigo and hearing loss, polonged symptoms (>4 days)

46
Q

vestibular neuritis red flags: cause of 40% headaches

A

posterior circulation stroke

47
Q

vestibular neuritis red flags: cause of gait ataxia

A

may be only non-vertiginous manifestation of cerebellar stroke

48
Q

vestibular neuritis red flags: what does hyperacute onset suggest is origin

A

vascular

49
Q

vestibular neuritis red flags: what does vertigo and hearing loss indicate

A

AICA or ugent ENT problem

50
Q

vestibular neuritis red flags: what do prolonged symptoms indicate

A

floor of 4th ventricle problem

51
Q

acute vestibular migraine: history, symptoms and diagnosis

A

history of migraine, acute vertigo with/out headache and recurrent episodes, diagnosis of exclusion

52
Q

acute vestibular migraine: main differential diagnosis

A

cerebellar stroke

53
Q

acute vestibular migraine: 5 red flags (same for cerebellar stroke)

A

headache, gait problems, hyperacute onset, hearing loss, prolonged symptoms (>4 days)

54
Q

cerebellar stroke: symptoms

A

thunderclap onset vertigo, difficulty walking, headache

Y2 LCRS Neuroscience and Mental Health (79 decks)

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