Central Vestibular System & Peripheral System Disorders- Lecture 12

Question 1

vestibular nuclei complex

Answer 1

primary processor of vestibular input

connects incoming afferent info and motor output neurons

Question 2

what does the vestibular nuclei complex have

Answer 2

4 major nuclei in the pons

extends into the medulla

Question 3

what does the vestibular nuclei complex process

Answer 3

vestibular sensory input and extra vestibular proprioceptive, visual, tactile and auditory info

Question 4

cerebellum

Answer 4

monitors vestibular performance and readjusts the central processing

major recipient of vestibular info from the nuclei

Question 5

what do both the cerebellum and nuclei process

Answer 5

info in association with somatosensory, proprioceptive and visual input

Question 6

vertebrobasilar arterial system

Answer 6

provides supply for both the peripheral and central vestibular system

Question 7

when might clinical syndromes with vestibular components appear

Answer 7

after occlusions of the basilar artery and its branches

Question 8

VSR

Answer 8

vestibular spinal reflex

Question 9

vestibular spinal reflex

Answer 9

adjusts posture when the head is moved

anticipates a loss of balance and adjusts posture to maintain balance

Question 10

abnormal VSR

Answer 10

difficulty with static or dynamic balance and the feeling of being off balance

Question 11

age related changes with the vestibular system

Answer 11

increased difficulty with eyes closed activities

decreased ability to detect head position and motion

reduced number of receptor cells

Question 12

BPPV

Answer 12

benign paroxysmal positional vertigo

Question 13

what is BPPV

Answer 13

positional vertigo of short duration (up to one minute) which occurs when the pt lie down, sits up, rolls over in bed, looks up or bends over

Question 14

what is BPPV caused by

Answer 14

otoconia from the otolith that have become misplaced within the semicircular canals

Question 15

Hallpike-Dix position

Answer 15

20-30 degrees of cervical extension

45 degrees of rotation

Question 16

what does the Hallpike-Dix position elicit

Answer 16

symptoms of vertigo within 1-40 secs

not lasting more than 60 sec

Question 17

why does BPPV occur

Answer 17

head trauma

degeneration of the vestibular system

following ear surgery

dental work

virus

idiopathic

link to vitamin D deficiency

Question 18

what will be seen in the dix hallpike position with BPPV

Answer 18

torsional nystagmus

pt’s will habituate with repetition

Question 19

what else can BPPV be seen in

Answer 19

roll test position

Question 20

roll test position

Answer 20

pt supine

30 degrees of flexion and 45 degrees of rotation

nystagmus will not be torsional

Question 21

how can BPPV resolve

Answer 21

w/o treatment

usually b/w 6 mo-1 yr

Question 22

how can BPPV be treated

Answer 22

epley/CRt within 1-3 visits

Question 23

labyrinthitis

Answer 23

inflammation of the labyrinth including cochlea

Question 24

what is labyrinthitis d/t

Answer 24

upper respiratory infection

flu

bacterial or viral infection occurring up to 2 weeks prior to onset of symptoms

Question 25

acute symptoms of labyrinthitis

Answer 25

sudden onset of vertigo lasting days w/ nausea and vomiting common pt may be bed ridden or hospitalized secondary to severe symptoms

Question 26

labyrinthitis med

Answer 26

antivert or meclizine may be used initially to surpress the vestibular system decrease vertigo

Question 27

when should meds be stopped --> labyrinthitis

Answer 27

prior to coming to therapy in order for compensation to occur

Question 28

chronic sx --> labyrinthitis

Answer 28

imbalance and dizziness

Question 29

when are symptoms worse --> labyrinthitis

Answer 29

head movement busy visual stimuli stress fatigue weather changes altitude changes illness

Question 30

pts that recover on their own --> labyrinthitis

Answer 30

80%

Question 31

pts that need treatment --> labyrinthitis

Answer 31

prolonged vestibular rehab can speed up compensation

Question 32

vestibular neuritis

Answer 32

inflammation of the vestibular nerve

Question 33

sx of vestibular neuritis

Answer 33

same as labyrinthitis except hearing is spared

Question 34

acoustic neuroma

Answer 34

slow growing benign tumor on CN8 overtime will compress on structures adjacent to it

Question 35

first sx of acoustic neuroma

Answer 35

hearing loss tinnitus decreased vestibular fxn with impaired balance

Question 36

acoustic neuroma has

Answer 36

no dizziness CNS is able to gradually adapt in response to slow onset of sx and slow growing tumor

Question 37

what is recommended for acoustic neuroma

Answer 37

surgery to remove tumor risk of facial palsy and/or permanent hearing loss

Question 38

gamma knife procedure --> acoustic neuroma

Answer 38

used for smaller tumors

Question 39

stereotactic radiotherapy --> acoustic neuroma

Answer 39

used for small tumors

Question 40

how do pts recover --> acoustic neuroma

Answer 40

without tx vestibular rehab is successful for those who seek treatment

Question 41

meniere's/endolymphatic hydrops is caused by

Answer 41

alteration in production, flow, absorption or reabsorption of the inner ear fluids

Question 42

underlying origin of meniere's/endolymphatic hydrops

Answer 42

unknown may be influenced by infection, abnormal response of the immune system or genetic tendency

Question 43

sx of meniere's/endolymphatic hydrops

Answer 43

vertigo lasting 20 min-12 hrs sensory neural hearing loss nausea vomiting diarrhea

Question 44

sensory neural hearing loss

Answer 44

predominantly low frequency tinnitus or fullness in ears

Question 45

when do pts have episodes --> meniere's/endolymphatic hydrops

Answer 45

one episode every hew years to weekly or daily episodes

Question 46

what occurs after an episode --> meniere's/endolymphatic hydrops

Answer 46

may or may not be residual sx overtime residual sx may worsen --> become symptoms were able to treat

Question 47

when does rehab become ineffective --> meniere's/endolymphatic hydrops

Answer 47

no sx in between episodesq

Question 48

tx for meniere's/endolymphatic hydrops

Answer 48

diet changes various surgeries gentamycin injections endolymphatic shunt

Question 49

endolymphatic shunt

Answer 49

tube inserted into endolymphatic sac to facilitate drainage

Question 50

superior canal dehiscence

Answer 50

thinning or opening in the bone overlying the superior (anterior) semicircular canal

Question 51

symptoms of SCD

Answer 51

vertigo oscillopsia caused by loud noise and activities that increase intracranial pressure sensitivity to sound fatigue fullness in the ear

Question 52

what does SCD create

Answer 52

a third area affected by pressure fluid w/in the canal is moved by stimuli from pressure or sound

Question 53

what is SCD caused by

Answer 53

developmental abnormality of thin, fragile bone over the superior canal

Question 54

when do symptoms present SCD

Answer 54

following trauma or slow erosion of the bone over time

Question 55

how is SCD diagnosed

Answer 55

CT symptoms clinical exam

Question 56

how is SCD treated

Answer 56

surgery to reface the bone or plugging of the canal

Question 57

perilymphatic fistula

Answer 57

rare condition a tear or defect in the oval or round window that separates the inner and middle ear changes in pressure that affect the middle ear will also affect the inner ear

Question 58

when does perilymphatic fistula occur

Answer 58

following trauma or following rapid changes of intracranial or atmospheric pressure

Question 59

sx perilymphatic fistula

Answer 59

vertigo nausea imbalance

Question 60

when do symptoms increase perilymphatic fistula

Answer 60

pressure changes or altitude exertion

Question 61

tx perilymphatic fistula

Answer 61

strict bed rest or surgery do not get better with therapy

Question 62

ototoxicity

Answer 62

damage to hair cells of inner ear

Question 63

what causes ototoxicity

Answer 63

drugs --> primarily gentamicin and other "mycin" drugs esp if meds are delivered by IV for greater than 6 days

Question 64

pt may not have --> ototoxicity

Answer 64

total loss of vestibular fxn

Question 65

sx ototoxicity

Answer 65

imbalance ataxia oscillopsia gaze instability with decreased or absent VOR

Question 66

sx will be worse w/ --> ototoxicity

Answer 66

increased loss of hair cells

Question 67

when will a pt have vertigo --> ototoxicity

Answer 67

damage is asymmetrical

Question 68

vestibular rehab --> ototoxicity

Answer 68

focused on strengthening residual fxn or on substitution if there is total bilateral loss

Question 69

TBI/head trauma can cause

Answer 69

both central and peripheral problems

Question 70

sx -->TBI/head trauma

Answer 70

dependent on the area involved and the severity of central or peripheral injury

Question 71

sx could include --> TBI/head trauma

Answer 71

dizziness, vertigo, imbalance, headache, migraine, short term memory deficit and motion sensitivity

Question 72

vestibular rehab --> TBI/head trauma

Answer 72

prolonged