Central Vestibular Pathology

Question 1

How are migraines diagnosed?

Answer 1

Diagnosis of exclusion

Question 2

What is thought to be the mechanism behind migraines?

Answer 2

• changes in nerve cell electrical and chemical activity in the brain (change in cerebral blood flow - vasospasms and vasodilation)
• Gene mutations

Question 3

How do migraines differ from headaches?

Answer 3

Migraine
- 4-72 hours
- Unilateral, pulsating sensation
- Moderate or severe pain intensity
- Aggravated by routine physical activity
- Accompanied by nausea +/- vomiting
- Sensitivity to light +/- sound
Headache
- 30 minutes to 7 days
- Bilateral, pressing or tightening sensation
- Mild or moderate pain
- Not aggravated by routine physical activity
- No nausea or vomiting
- No sensitivity

Question 4

Why are migraines so relevant to vestibular pathology?

Answer 4

44% of migraniers have some degree of vestibulopathy; vestibular symptoms are often the migrain aura

Question 5

What is the most common area with vestibular involvement seen with TIAs?

Answer 5

Vertebrobasilar artery

Question 6

What is the most common symptom with a vertebrobasilar artery TIA?

Answer 6

VERTIGO

Question 7

What strokes can cause vestibular dysfunction?

Answer 7

Brainstem and Cerebellar
- Posterior Inferior Cerebellar Artery (PICA)
- Anterior Inferior Cerebellar Artery (AICA)

Question 8

A Posterior Inferior Cerebellar Artery (PICA) stroke will present with what signs and symptoms?

Answer 8

• Vertigo
• Headache
• Facial pain (ipsilateral)
• Disequilibrium
• Nausea and vomiting
• Ataxia (ipsilateral)
• Hiccups
• Contralateral limb burning pain/altered sensation of temperature

Question 9

An Anterior Inferior Cerebellar Artery (PICA) stroke will present with what signs and symptoms?

Answer 9

• PICA symptoms + HEARING LOSS
• Potential a combo of peripheral and central vestibular damage

Question 10

Cerebellar Degenerative Disorders include

Answer 10

• Genetic, congential
• Alcoholism
• Paraneoplastic Disorders

Question 11

What is paraneoplastic disorder?

Answer 11

Breast, lung, ovary, uterine cancer causing immune system to kill anything that looks like cancer cells = Perkinje fibers!!

Question 11

Why should psychological considerations always be on the forefront of your mind when
you treat a patient with vestibular dysfunction?

Answer 11

Undiagnosed or undertreated vestibulopathy can lead to the development of anxiety disorders, PPD, and agoraphobia.

Vestibular system is heavily connected to the autonomic nervous system

Question 12

What is Persistent Postural-Perceptual Dizziness (3PD)?

Answer 12

chronic dizzines with or without vertigo and fluctuating imbalance provoked by personal, social or environmental stimuli which can not be explained by some other neuro-otologic disorder.

Question 13

How does 3 PD present?

Answer 13

• Symptoms occur daily, present for months
• Related to body posture
• Coinciding depression/anxiety

Question 14

3PD is often preceeded by

Answer 14

peripheral vestibular dysfunction

Question 15

What would increase the likelihood of development of PPPD after an acute vestibular event?

Answer 15

Prior diagnosis of anxiety/depression

Question 16

What are the criteria for a 3PD diagnosis?

Answer 16

1. 1 or more symptoms of dizziness or unsteadiness present on most days for 3 months or longer
2. Persistent symptoms without specific provocation, but are exacerbated by upright position, active or passive motion, and exposure to moving visual stimuli or complex visual patterns.
3. Precipitated by conditions that cause vertigo, unsteadiness, dizziness, or problems with balance. (Vestibular syndromes, other neurologic or medical illness, or psychological distress).
4. Symptoms cause significant distress or functional impairment
5. All other diagnoses ruled out.