B7-098 Dizziness

Question 1

a sensation that the environment or the self is moving/spinning

Answer 1

vertigo

(important to distinguish between vertigo/poor balance/pre-syncope)

Question 2

uncontrolled repetitive movements of the eyes with a fast and slow component

Answer 2

jerk nystagmus

(pendular nystagmus would be even pacing)

Question 3

patient is asked to point at an object with their eyes closed and consistently deviate to one side

Answer 3

past pointing

Question 4

senses linear acceleration (including gravity) and angular motion

Answer 4

vestibular system

Question 5

most medial nuclei of the brainstem

Answer 5

oculomotor (midbrain)
trochlear (midbrain)
abducens (pons)
hypoglossal (medulla)

Question 6

most lateral nuclei of the brainstem

Answer 6

vestibular cochlear (pons/medulla)

Question 7

the inner ear is in the […] bone

Answer 7

temporal

Question 8

cranial nerves that pass through the internal auditory meatus [2]

Answer 8

CN VII
CN VIII

Question 9

the lateral vestibulospinal tract is found in the […] of the spinal cord

Answer 9

anterior funiculus

Question 10

[…] tract controls the extensor muscle to aid in posture and balance

Answer 10

lateral vestibulospinal tract

Question 11

past pointing and + Rombergs indicate an issue with the […] tract

Answer 11

lateral vestibulospinal

Question 12

medial vestibulospinal tract is another name for the

Answer 12

descending MLF

Question 13

[….] tract provides reflex head and eye stabilization

Answer 13

medial vestibulospinal

Question 14

target nuclei of medial vestibulospinal tract

Answer 14

oculomotor nuclei
spinal accessory
cervical motor neurons

Question 15

responsible for the vestibulo-ocular reflex (VOR)

Answer 15

medial vestibulospinal tract

Question 16

tests for the VOR

Answer 16

head impulse test (loose fixation with head turning)
cold calorics

Question 17

contrast focal vs. diffuse vestibulopathy

Answer 17

focal will have unilateral, asymmetric findings

diffuse will have bilateral symmetric findings

Question 18

peripheral vestibulopathy refers to what structures?

Answer 18

CN VIII and inner ear

(extra-axial)

Question 19

the fast phase of nystagmus goes […] the lesion
the slow phase goes […] from the lesion

Answer 19

fast: away
slow: toward

Question 20

unidirectional horizontal nystagmus, fast phase away from lesion

nystagmus less severe when looking toward side of lesion

nystagmus more severe when looking away from side of lesion

VOR abnormal when head is tilted toward the side of the lesion

Answer 20

unilateral peripheral lesion causing issues with medial vestibulospinal tract

Question 21

falling toward side of lesion

past pointing toward side of lesion

Answer 21

unilateral peripheral lesion causing issues with lateral vestibulospinal tract

Question 22

environment rotating toward side of lesion

body leaning away from side of lesion

Answer 22

unilateral peripheral lesion causing issues with perception

Question 23

in a peripheral pattern symptoms of […] and […] would be seen together

Answer 23

medial and lateral vestibulospinal tracts

Question 24

if the symptoms and signs do not follow the expected peripheral pattern, the lesion is

Answer 24

central

Question 25

vertical nystagmus indicates a [...] lesion (up or down beating)

Answer 25

central

Question 26

direction changing nystagmus indicates [...] lesion

Answer 26

central

Question 27

abnormal VOR to the right, but the patient falls to the left

Answer 27

central pattern

Question 28

hearing loss or tinnitus ipsilateral to the vestibular lesion favors a [...] lesion

Answer 28

peripheral

Question 29

long tract findings (weakness, decreased sensation) favors a [...] lesion

Answer 29

central

Question 30

other CN signs favors a [...] lesion

Answer 30

central (diplopia, facial weakness, facial numbness, dysphagia, dysarthia)

Question 31

idiopathic inflammation of CN VIII or cochlea symptoms for days

Answer 31

vestibular neuronitis labyrinthitis

Question 32

free floating debris in the semicircular canal, most commonly otoconia symptoms for seconds after change in head position

Answer 32

benign paroxysmal positional vertigo

Question 33

causes of peripheral focal vestibulopathies [4]

Answer 33

vestibular neuronitis labyrinthitis benign paroxysmal positional vertigo meniere's disease

Question 34

high endolymphatic pressure-acute symptoms with rupture of membranous labyrinth symptoms >20 min to a few hours

Answer 34

meniere's disease

Question 35

causes of central vestibulopathies indicate pathology of the [...] or [...]

Answer 35

brainstem cerebellum

Question 36

medications used as vestibular suppressants to decrease the severity of vertigo [4]

Answer 36

antihistamines (Meclizine) anticholinergics antiemetics benzodiazepines **temporary use**, central compensation will occur eventually

Question 37

how do peripheral vestibulopathies self resolve?

Answer 37

compensation in the cerebellum

Question 38

what symptom will remain even following central compensation for peripheral vestibulopathy?

Answer 38

abnormal VOR will persist

Question 39

failure of stabilization of the eyes with movement objects in visual field tend to bounce when walking

Answer 39

oscillopsia (diffuse)

Question 40

no nystagmus in primary position symmetric-direction changing gaze evoke nystagmus

Answer 40

diffuse vestibulopathy

Question 41

toxic causes of diffuse vestibulopathies [3]

Answer 41

alcohol vestibular suppressants aminoglycosides (gentamycin)

Question 42

acceleration to the left would [...] left CN VIII activity and [...] right CN VIII activity

Answer 42

increase left decrease right

Question 43

a right peripheral neuropathy would cause the eyes to move [...] toward the right and fast corrective saccade to the [...]

Answer 43

slowly left

Question 44

structure that sits on top of the hair cell stereocilia in the semicircular canals that provide information about angular acceleration or head motion

Answer 44

cupula

Question 45

macular organs in which otolith crystals sit on top of stereocilia [2]

Answer 45

utricle saccule

Question 46

static information about your position in space is provided by the [...] in the ear

Answer 46

macular organs (utricle and saccule)

Question 47

output nucleus for the spinocerebellar system dealing with posture

Answer 47

fastigial

Question 48

nucleus of the cerebellum concerned with motor planning

Answer 48

dentate

Question 49

vestibular neuronitis, labrinthitis, and Meniere's cause a [...] pattern of nystagmus

Answer 49

peripheral

Question 50

direction-changing gaze evoked nystagmus

Answer 50

central lesion (stroke)

Question 51

when patients say they are dizzy, what are the 3 most likely meanings?

Answer 51

vertigo poor balance lightheadedness

Question 52

vestibular projections are [bilateral/ipsilateral]

Answer 52

bilateral (diffuse cortical associations)

Question 53

when positive, the Romberg sign indicates (difficultly with balance with eyes closed)

Answer 53

vestibular or proprioceptive problem

Question 54

problems with the spino-cerebellar system cause difficulty with balance when eyes are [...]

Answer 54

opened and closed

Question 55

intense vertigo lasting several hours associated with hearing loss

Answer 55

Menieres

Question 56

brief vertigo precipitated by movements normal examination

Answer 56

benign paroxysmal vertigo

Question 57

vestibular neuronitis would cause vertigo that lasts [...]

Answer 57

several days

Question 58

absence of movement

Answer 58

akinesia

Question 59

difficulty with rapid supination-pronation

Answer 59

dysdiadochokinesis

Question 60

overshooting or undershooting a target

Answer 60

dysmetria