Central vestibular disorders Flashcards
1
Q
cerebellum
A
- accepts information form the vestibular nuclei
- an adaptive processor
- provides adjustments for the vestibular reflexes
- provides input to many areas of the central vestibular system
2
Q
vestibule-cerebellum (flocculonodular lobe)
A
- interaction site between peripheral vestibula information and eye movement
- mediates VOR gain
- modulates smooth pursuit
- otoliths input relay
3
Q
spino-cerebellum
A
- accepts lower extremity information
- mediates VSR, coordinates postural control
- lesions include gait ataxia and truncal instability
4
Q
central vestibular disorders
A
- vascular TBI -cerebellar degeneration migraine epilepsy demyelinating diseases tumors degenerative changes
5
Q
vertigo in central disorders are uncommon but can occur in:
A
- root entry zone lesions
- lateral medullary infarcts
- cerebellar infarctions
- migraine
6
Q
common manifestations of central vestibular disorders
A
- lateropulsion
- subjective visual vertical
- ocular tilt reaction
- oculomotor abnormalities
7
Q
oculomotor abnormalities
A
- saccadic abnormalities
- impaired VOR cancellation
- direction changing nystagmus
- down beating nystagmus
- saccadic smooth pursuit
8
Q
cerebellar infarcts
A
- occlusion of the vertebral PICA, AICA
- symptoms: vertigo, nausea with vomiting, ataxia
-clinical findings: oculomotor abnormalities, may mimic peripheral vestibular loss
9
Q
PICA: lateral medullary syndrome
A
- Wallenberg’s or PICA syndrome
- common brainstem CVA
- symptoms: vertigo, dysarthria, altered perception of vertical, ataxia. loss of pain and temp- ipsi on face, contra on body
10
Q
PICA clinical findings
A
- horizontal nystagmus
- ips OTR
- ipsipulsive saccades
- hemiataxia, dysarthria, lateropulsion, dysdiadochokinesia
- ips horner’s syndrome
11
Q
AICA: lateral pontomedullary syndrome
A
- occlusion of dorsolateral pontomedullary region , inferior cerebellum, membranous labyrinth an d8th nerve
- Symptoms: vertigo, imbalance, altered perception of vertical, loss of pain and temp - ipsi on face, contra on body
- hearing loss
12
Q
AICA: clinical findings
A
- similar to PICA
- gaze evoked nystagmus
- ipsilateral facial weakness
- unilateral hearing loss more common in AICA than PICA infarcts
13
Q
Labyrinthine concussion:
A
- most common type of TBI that causes vestibular injury
- BPPV may also be present
- symptoms: dizziness, ataxia, hearing loss, imbalance
14
Q
labyrinthine frcature
A
- temporal bone fracture
- longitudinal- 70-90% of temporal bone frcatures
- oblique - inner ear vestibular compromise complete loss of labyrinthine function
15
Q
head trauma
A
- symptoms
- acute: hearing loss, vertigo, nausea and vomiting
- chronic: persistent hearing loss, hea dmotion intolerance, postural instability when vision is unavailable or distracting
16
Q
clinical findings head trauma
A
- nystagmus
- impaired VOR with saccadic compensation
- head shake induced nystagmus
- decr visual acuity
- pos sharpened Romberg
- rigid head and trunk
17
Q
head truam treatment
A
- habituation for motion intolerance
- habituation for gaze stabilization
- habituation for balance re-training
18
Q
migraine
A
- vertigo with headache
- aura: 2 or more symptoms lasting 4-60 minutes before during or after headache
- vertigo
- decreased hearing ataxia
- dysarthria
- diplopis
- tinnitus
- bilateral visual defect
- decr consciousness
19
Q
clinical sign of migraine
A
- at least 5 HA that last 4-72 hours if untreated
- associated with nausea
- photophobia
- phonophobia
- has at leats 2 of the following- starts unilateral, pulsatile, inhibits daily activities, aggravated by routine physical activity
20
Q
migraine prodrome
A
- mood changes
21
Q
migraine aura
A
- focal neurologic deficit, hypersensistivity to all stimuli
22
Q
migraine Ha
A
hypersensistivity, GI problems
23
Q
migraine postdrome
A
- hypersensitivity, GI, “washed out feeling”
24
Q
panic attack
A
- spells of intense fear that peaks in 10 minutes
- dizziness,
- nausea
- unsteady feeling
- faintness
- nausea
- abdominal distress
- SOB, tachycardia
25
Q
orthstatic hypotension
A
- systolic pressure drops 20mmHg or more in 33 minutes when the patient stands
- tell patient to sit up slowly and wear compression socks. do heel pumps before they move out of it
26
Q
orthostatic intolerance
A
- no drop in blood pressure, but patient is symptomatic
- slaty snakcs
27
Q
symptoms hypotension and intolerance
A
lightheadedness weakness chronic tiredness mental slowing dizziness nausea blurred vision
28
Q
course fro recovery for
Peripheral UVL
-combined peripheral and central lesion
- Peripheral BVL
A
- Peripheral UVL alone: 1-6 mo
- combined peripheral and central lesion: 6-18mo
- peripheral BVL: 6-18 mo for peak response
