Central Vestibular Disorders

Question 1

List common central causes of vestibular dysfunctions

Answer 1

1. Migraines
2. TIA
3. Stroke
   
   • PICA
   • AICA
4. Cerebellar degeneration
5. Arnold-Chiari Malformation
6. MS
7. TBI

Question 2

what is the suggested mechanism for migraines?

Answer 2

• thought to be caused by changes in nerve cell electrical and chemical activity in the brain
• changes in cerebral blood flow → vasospasm and vasodilation resulting in inflammation in surrounding tissue
• some evidence points towards gene mutations

Question 3

T/F: Migraines are underdiagnosed?

Answer 3

TRUE

often under-recognized and untreated too

50% of migraines never recieve a dx

Question 4

do pts w/migraines typically have vestibular symptoms?

Answer 4

44% of them have some degree of vestibulopathy

patients w/migraines commonly show vestibular system as an aura

Question 5

can vestibular rehab help w/migraines?

Answer 5

at times

dependent on intensity, cannot push these pts as hard

Question 6

which site of an TIA most commonly have vestibular symptoms?

Answer 6

Vertebrobasilar artery TIA

most common symptom = vertigo (lasts minutes to hours, tend to be very intense)

typically have underlying CVA risk factors

Question 7

what brainstem and cerebellar strokes most commonly have vestibular symptoms?

Answer 7

1. Posterior Inferior Cerebellar Artery (PICA)
   
   • Wallenberg’s Syndrome
2. Anterior Inferior Cerebellar Artery (AICA)
   
   • PICA symptoms + hearing
   • may present with a combination of peripheral and central vestibular damage

Question 8

List some cerebellar degenerative disorders that can have vestibular symptoms

Answer 8

1. Genetic, Congenital
   
   • spino-cerebellar ataxias
2. Alcoholism
3. Paraneoplastic Disorders

Question 9

what type of vestibular symptoms can a Arnold-Chiari Malformation have?

Answer 9

1. HA
2. imbalance
3. aural fullness
4. tinnitus
5. vertigo
6. can present w/spastic quadriplegia over time

Question 10

T/F: Arnold-Chiari Malformations require extensive treatments

Answer 10

FALSE

If symptoms aren’t severe, can monitor and don’t require any intervention

if symptoms progress, requires surgery (decompression)

typically don’t require rehab

Question 11

T/F: Vestibular rehab is helpful for central disorders

Answer 11

TRUE

• once symptoms are stable (but uncompensated) rehab can be effective
• starg by targeting vestibular system to see if it can improve
• with more chronic cases, can shift and try to “beef up” other balance systems and give pts lifestyle modifications to max functional independence

Question 12

what is PPPD (3PD)?

Answer 12

Persistent Postural-Perceptual Dizziness

characterized by dizziness w/o vertigo and fluctuating imbalance provoked by personal, social or environment stimuli, which can not by explained by some other neuro-otologic disorder

Question 13

what types of symptoms are there with 3PD?

Answer 13

1. symptoms are often daily, present for months
2. primary symptoms related to body posture
3. can see coinciding depression and anxiety
4. often preceded by peripheral vestibular dysfunction

Question 14

list the criteria for diagnosing 3PD?

Answer 14

1. >/= 1 symptoms of dizziness or unsteadiness present on most days for 3 months or longer
2. persistent symptoms w/o specific provocation, but are exacerbated by:
   
   • upright position
   • active or passive motion
   • exposure to moving visual stimuli or complex visual patterns
3. precipitated by conditions that cause vertigo, unsteadiness, dizziness or problems w/balance
4. symptoms cause sig distress or functional impairment
5. all other dx ruled out

Question 15

how is 3PD managed?

Answer 15

1. VRT → if residual vestibular symptoms still present
   
   • adaptation
   • habituation
   • substitution
   • pt edu
2. Cognitive Behavioral Therapy
   
   • multidisciplinary is key
   • desensitization/habituation
   • offer validation, empowerment