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DPT 761 - Neuro Rehab II > Common Peripheral and Central Vestibular Disorders > Flashcards

Common Peripheral and Central Vestibular Disorders Flashcards

1
Q

What are peripheral vestibular disorders, include disorders of = ?

A
  • vestibular apparatus
  • CN VIII
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2
Q

What are general characteristics of peripheral vestibular disorders?

A

Recurring periods of vertigo, nausea, diminished hearing, pressure in the ears, and tinnitus.

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3
Q

What is the direction of nystagmus in peripheral vestibular disorders?

A

Fixed direction, beating toward the more neurally intact ear.

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4
Q

What is Unilateral Vestibular Hypofunction (UVH)?

A

A condition where one side of the vestibular system is not functioning properly.

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5
Q

What is Vestibular Neuritis?

A

Inflammation of the vestibular nerve, usually caused by a virus such as herpes simplex or herpes zoster.

  • Symptoms start as a “vestibularcrisis”
  • Hearing is unaffected
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6
Q

What is the most common cause of peripheral vertigo?

A

Benign Paroxysmal Positional Vertigo (BPPV).

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7
Q

What is Labyrinthitis?

A

Inflammation or infection of the labyrinth that can be viral or bacterial, involving both the cochlea and vestibular apparatus.

  • Cochlea is also involved
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8
Q

What differentiates Labyrinthitis from Vestibular Neuritis?

A
  • Labyrinthitis involves hearing changes and tinnitus
  • Vestibular Neuritis does not affect hearing.
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9
Q

What are common clinical signs of UVH?

A
  • spontaneous nystagmus
  • (+) head impulse test
  • abnormal DVAT
  • abnormal mCTSIB
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10
Q

What does a positive head impulse test indicate in UVH?

A

Ipsilesional vestibular hypofunction.

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11
Q

What is the treatment for Vestibular Neuritis and Labyrinthitis?

Prognosis = ?

A
  • Medical management with anti-dizzy and anti-nausea medications, steroids, and vestibular rehabilitation therapy (VRT).
  • Most patients compensate and can return to full function within 1-8 weeks, though some may have chronic symptoms.
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12
Q

What is Bilateral Vestibular Hypofunction (BVH)?

A

A condition where both sides of the vestibular system are either partially or completely nonfunctional.

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13
Q

What is the most common cause of BVH?

A

Ototoxicity, often due to drugs like aminoglycosides.

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14
Q

What are clinical signs of BVH?

A

Positive head impulse test bilaterally, large decline in DVAT, severe imbalance, and gait ataxia.

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15
Q

What is the treatment for BVH?

A

Vestibular rehabilitation therapy focusing on gaze stability and balance, along with safety education and compensatory strategies.

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16
Q

What is Meniere’s Disease?

A
  • A chronic progressive disorder of the inner ear causing vertigo, tinnitus, and hearing loss.
  • Abnormal amount of endolymph in the inner ear leading to swelling and damage within the labyrinth.
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17
Q

What are the characteristic symptoms of Meniere’s Disease?

A
  • Recurrent vertigo
  • Tinnitus
  • Hearing loss
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18
Q

What is the medical management for Meniere’s Disease?

A

Low sodium diet, diuretics, steroids, and surgery to reduce or prevent fluid buildup.

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19
Q

What is Vestibular Schwannoma?

A

A benign tumor arising from the Schwann cell of CN VIII, often slow-growing.

  • Common symptoms = Unilateral hearing loss, tinnitus, and imbalance.
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20
Q

What is the treatment for Vestibular Schwannoma?

A

Conservative management with watchful waiting, surgical excision, or gamma knife radiation.

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21
Q

What is Cervicogenic Dizziness (CGD)?

A

CGD: Dizziness or imbalance arising from pathology of the cervical spine or surrounding soft tissues.

  • Common symptoms = Dizziness, floating sensation, disorientation, imbalance, neck pain, and occipital headache.
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22
Q

What are central vestibular disorders?

A

Disorders of the central nervous system (CNS) affecting vestibular function.

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23
Q

What are the ‘D’s’ associated with central vestibular disorders?

A
  • Dysarthria
  • Diplopia
  • Dysphagia
  • Dysmetria
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24
Q

What are common causes of central vestibular disorders?

A

Vestibular migraine, Persistent Postural Perceptual Dizziness (PPPD), Arnold-Chiari Malformation, Vertebrobasilar Artery Insufficiency (VBI), stroke, and tumors.

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25
Q

What is Vestibular Migraine?

A

A common neurological cause of vertigo in adults, often associated with migraine headaches.

  • Common symptoms = Recurrent vertigo, dizziness, imbalance, fatigue, nausea, motion sickness, light/sound sensitivity, tinnitus.
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26
Q

What is Arnold-Chiari Malformation?

A

A congenital condition where part of the cerebellum descends past the foramen magnum.

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27
Q

What are the symptoms of Arnold-Chiari Malformation?

A

Suboccipital headache, neck pain, unsteady gait, dizziness, oscillopsia, problems with hand coordination, diplopia, dysphagia.

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28
Q

What are the differences between central and peripheral vestibular pathologies in terms of oculomotor testing?

A

Central vestibular pathologies often have abnormal smooth pursuits and saccades, while these are usually normal in peripheral pathologies.

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29
Q

What are the differences between central and peripheral vestibular pathologies in terms of vertigo intensity?

A
  • Central pathologies may have mild vertigo or none at all
  • Peripheral pathologies usually cause intense vertigo
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30
Q

What is Presbyvestibulopathy?

A

Age-related functional decline of the vestibular system, leading to dizziness, imbalance, or gait disturbance.

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31
Q

What are the implications of Presbyvestibulopathy in elderly patients?

A

Increased likelihood and severity of falls, diminished quality of life, and independence.

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32
Q

What is Multifactorial Vestibular Disorder?

A

A condition where multiple factors, including CNS and peripheral vestibular involvement, contribute to vestibular dysfunction.

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33
Q

What role does the vestibular system play in Parkinson’s disease?

A

Patients with Parkinson’s often have chronic vestibular hypofunction and are more prone to BPPV.

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34
Q

How is Multiple Sclerosis (MS) related to vestibular dysfunction?

A

MS can cause central lesions or affect CN VIII, leading to vestibular symptoms.

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35
Q

What conditions might cause light-headedness?

A

Orthostatic hypotension, hypoglycemia, anxiety, panic disorder, cardiac dysfunction, VBI, polypharmacy.

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36
Q

What vestibular conditions might cause dysequilibrium?

A

Bilateral vestibular loss, chronic unilateral vestibular hypofunction, peripheral neuropathy, cerebellar/motor pathway involvement, LE weakness.

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37
Q

What are some key symptoms of vestibular dysfunction?

A

Vertigo, tinnitus, pressure in the ears, difficulty concentrating, feeling disoriented, difficulty watching moving objects, blurred vision with movement.

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38
Q

What is lateropulsion?

A

A tendency to lose balance laterally, often leaning or falling toward the side of vestibular weakness.

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39
Q

What balance tests can be used in a vestibular examination?

A

Modified CTSIB, Romberg, Sharpened Romberg, Single leg stance, 4 Square Step Test, Functional Reach Test, Fukuda Stepping Test.

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40
Q

What is the Modified CTSIB test?

A

A test that evaluates balance by assessing a patient’s ability to maintain stability in different sensory conditions.

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41
Q

What is the Fukuda Stepping Test used for?

A

To assess vestibular weakness by monitoring body rotation while the patient steps in place with eyes closed.

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42
Q

What does a rotation greater than 30 degrees during the Fukuda Stepping Test suggest?

A

Possible vestibular weakness.

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43
Q

What does the Dynamic Gait Index (DGI) assess?

A

The ability to modify gait during various walking tasks.

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44
Q

What does a positive Dix-Hallpike test indicate?

A

Benign Paroxysmal Positional Vertigo (BPPV).

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45
Q

What does the head impulse test (HIT) assess?

A

The function of the vestibulo-ocular reflex (VOR) at high accelerations.

46
Q

What does a positive head impulse test (HIT) indicate?

A

Vestibular hypofunction on the side toward which the head is turned.

47
Q

What does the Dynamic Visual Acuity Test (DVAT) assess?

A

The difference between static visual acuity and visual acuity during passive horizontal head movements.

48
Q

What might a greater than 3-line difference between static and dynamic visual acuity suggest?

A

VOR loss and vestibular hypofunction.

49
Q

What is the role of the cerebellum in vestibular function?

A

It helps with the smoothness of movement by processing vestibular input.

50
Q

What is the significance of a positive Romberg test in a vestibular examination?

A

It indicates a loss of proprioception or vestibular dysfunction.

51
Q

What does the Sharpened Romberg test assess?

A

Balance with feet in a tandem stance, challenging the vestibular system.

52
Q

What does the Single Leg Stance test assess?

A

A patient’s ability to maintain balance on one leg, which can reveal vestibular or proprioceptive deficits.

53
Q

What does a positive Fukuda Stepping Test result indicate?

A

It suggests vestibular weakness if the patient rotates more than 30 degrees while stepping in place.

54
Q

What is the purpose of the 4 Square Step Test?

A

To assess dynamic balance and the ability to step in multiple directions.

55
Q

What is the significance of observing nystagmus during the vestibular examination?

A

Nystagmus is a key diagnostic indicator of vestibular involvement, helping to differentiate between central and peripheral causes.

56
Q

What might vertical nystagmus indicate?

A

Central vestibular system pathology.

57
Q

What does direction-fixed nystagmus suggest?

A

A peripheral vestibular lesion.

58
Q

What does direction-changing nystagmus suggest?

A

A central vestibular pathology.

59
Q

What is the purpose of the oculomotor exam in a vestibular examination?

A

To test the central oculomotor pathways independent of the vestibular system.

60
Q

What are abnormal smooth pursuits a sign of?

A

Central dysfunction such as cerebellar or brainstem involvement.

61
Q

What does the ‘H’ test assess in a vestibular examination?

A

Extraocular range of motion and observation for pathological nystagmus.

62
Q

What does a positive Head Impulse Test indicate?

A

Vestibular hypofunction on the side being tested.

63
Q

What is dynamic visual acuity?

A

The clarity of vision during head movement, testing the VOR function.

64
Q

What is the purpose of the Dix-Hallpike test?

A

To diagnose BPPV by identifying positional nystagmus.

65
Q

What is VOR gain?

A

The ratio of eye velocity to head velocity, ideally 1:1 for normal function.

66
Q

What are corrective saccades during the head impulse test indicative of?

A

Vestibular hypofunction on the side being tested.

67
Q

What is a common symptom of BPPV?

A

Vertigo triggered by specific head positions.

68
Q

What does a decline in dynamic visual acuity indicate?

A

A loss of VOR function and possible vestibular hypofunction.

69
Q

What is the role of the vestibular nuclei?

A

Integration of sensory information from the vestibular system and coordination of motor output.

70
Q

What does spontaneous nystagmus at rest suggest?

A

Acute peripheral unilateral vestibular lesion or hypofunction.

71
Q

What does the Fukuda Stepping Test assess?

A

Spatial orientation and vestibular weakness.

72
Q

What is the purpose of the functional reach test?

A

To assess stability and balance during forward reach, often used in vestibular assessments.

73
Q

What is the difference in nystagmus between peripheral and central vestibular disorders?

A

Peripheral nystagmus is typically unidirectional and horizontal, while central nystagmus can be vertical, direction-changing, or multidirectional.

74
Q

What is Dysmetria, and how is it related to central vestibular disorders?

A

Dysmetria is a lack of coordination of movement, often seen in central vestibular disorders affecting the cerebellum.

75
Q

What are common symptoms of cervicogenic dizziness (CGD)?

A

Dizziness, imbalance, neck pain, and symptoms that worsen with head movements or prolonged neck positions.

76
Q

What is the controversy surrounding the diagnosis of cervicogenic dizziness?

A

The diagnosis is often controversial because neck pain and dizziness frequently co-occur, making it difficult to establish a direct link.

77
Q

What is the role of cervical proprioception training in treating cervicogenic dizziness?

A

Training helps improve joint position sense, which can reduce dizziness and improve balance in CGD patients.

78
Q

What is the typical clinical presentation of a patient with Unilateral Vestibular Hypofunction (UVH)?

A

Spontaneous nystagmus, positive head impulse test, and imbalance, especially on the affected side.

79
Q

What is the pathophysiology behind Vestibular Neuritis?

A

Inflammation of CN VIII, typically due to a viral infection, leading to sudden vertigo and imbalance.

80
Q

How is Vestibular Neuritis typically managed?

A

With anti-nausea medications, corticosteroids, and vestibular rehabilitation to promote central compensation.

81
Q

What distinguishes Labyrinthitis from Vestibular Neuritis?

A

Labyrinthitis involves both hearing loss and vertigo, while Vestibular Neuritis does not affect hearing.

82
Q

What is the primary goal of VRT in patients with UVH?

A

To promote central compensation and improve balance and gaze stability.

83
Q

What are the potential long-term outcomes for patients with UVH?

A

Most patients compensate well, but some may have chronic dizziness or imbalance.

84
Q

What are ‘drop attacks,’ and in which vestibular disorder are they commonly seen?

A

Sudden falls without warning, commonly seen in Meniere’s Disease.

85
Q

What is the significance of ‘aura’ in Meniere’s Disease?

A

An aura often precedes an attack, with symptoms like sound sensitivity, tinnitus, and mild dizziness.

86
Q

What is the primary difference in the cause of vertigo between Vestibular Migraine and BPPV?

A

Vestibular Migraine is due to central neurological dysfunction, while BPPV is caused by displaced otoconia in the semicircular canals.

87
Q

How does Vestibular Migraine differ from Meniere’s Disease in terms of hearing?

A

Vestibular Migraine does not cause permanent hearing loss, while Meniere’s Disease does.

88
Q

What is the role of diet and lifestyle modifications in managing Vestibular Migraine?

A

Avoiding triggers like certain foods, managing stress, and maintaining a regular sleep schedule can help reduce the frequency of attacks.

89
Q

What is the ‘push-pull’ mechanism in the vestibular system?

A

A system where paired semicircular canals on opposite sides of the head respond oppositely to head movements, providing balanced signals to the brain.

90
Q

What is the typical prognosis for patients with Vestibular Neuritis?

A

Most recover within weeks to months, but some may have residual symptoms like dizziness and imbalance.

91
Q

How is Vestibular Schwannoma monitored if surgery is not immediately necessary?

A

Through regular MRI scans and hearing tests to monitor growth and symptom progression.

92
Q

What are the common symptoms of Multifactorial Vestibular Disorders?

A

Dizziness, imbalance, and vertigo due to combined central and peripheral vestibular dysfunction.

93
Q

How does age affect the vestibular system, leading to Presbyvestibulopathy?

A

Age-related decline in vestibular function due to neuronal and hair cell loss, leading to dizziness and imbalance.

94
Q

What role does the vestibular system play in patients with Parkinson’s disease?

A

Patients with Parkinson’s often have chronic vestibular hypofunction, leading to increased fall risk and balance issues.

95
Q

What is the relationship between Multiple Sclerosis (MS) and vestibular dysfunction?

A

MS can cause central lesions affecting vestibular pathways, leading to dizziness and imbalance.

96
Q

How is vestibular rehabilitation therapy (VRT) used in stroke patients?

A

VRT improves balance and gait, especially within the first six months after a stroke.

97
Q

What are the common findings in central vestibular disorders?

A

Severe imbalance, abnormal smooth pursuits and saccades, possible diplopia, and dysmetria.

98
Q

What is the importance of early diagnosis and treatment of vestibular disorders?

A

Early diagnosis and treatment can improve recovery outcomes, reduce fall risk, and enhance quality of life.

99
Q

What are the treatment options for Meniere’s Disease?

A

Medical management, VRT for balance issues, and in some cases, surgery to reduce fluid buildup in the inner ear.

100
Q

How does VRT help patients with Bilateral Vestibular Hypofunction (BVH)?

A

VRT helps improve gaze stability, balance, and reduces fall risk through compensatory strategies.

101
Q

What is the primary goal of vestibular rehabilitation in central vestibular disorders?

A

To improve balance, coordination, and reduce dizziness by promoting central compensation.

102
Q

What are common vestibular symptoms in patients with Alzheimer’s disease?

A

Dizziness, imbalance, and increased fall risk due to vestibular impairment.

103
Q

How does anxiety contribute to vestibular dysfunction?

A

Anxiety can exacerbate dizziness and balance issues, leading to conditions like Persistent Postural Perceptual Dizziness (PPPD).

104
Q

What are the diagnostic criteria for Vestibular Migraine?

A

Recurrent episodes of vertigo with a history of migraine, often triggered by typical migraine triggers.

105
Q

What is the significance of a positive head impulse test?

A

It indicates vestibular hypofunction, typically seen in conditions like UVH or BVH.

106
Q

What is the role of the cerebellum in vestibular function?

A

The cerebellum integrates sensory information to coordinate balance, eye movements, and postural control.

107
Q

What are the symptoms of Arnold-Chiari Malformation?

A

Dizziness, imbalance, coordination issues, and suboccipital headaches.

108
Q

What is the main cause of dizziness in central vestibular disorders?

A

Disruption of central pathways in the brainstem and cerebellum, leading to persistent dizziness and imbalance.

109
Q

How is Mal de Debarquement Syndrome (MdDS) typically triggered?

A

By prolonged exposure to passive motion, such as on a boat or plane, leading to persistent sensations of movement.

110
Q

What is the recommended treatment approach for Persistent Postural Perceptual Dizziness (PPPD)?

A

A combination of vestibular rehabilitation, cognitive behavioral therapy, and medication to manage symptoms.

DPT 761 - Neuro Rehab II (16 decks)

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