Common Peripheral and Central Vestibular Disorders Flashcards
What are peripheral vestibular disorders, include disorders of = ?
- vestibular apparatus
- CN VIII
What are general characteristics of peripheral vestibular disorders?
Recurring periods of vertigo, nausea, diminished hearing, pressure in the ears, and tinnitus.
What is the direction of nystagmus in peripheral vestibular disorders?
Fixed direction, beating toward the more neurally intact ear.
What is Unilateral Vestibular Hypofunction (UVH)?
A condition where one side of the vestibular system is not functioning properly.
What is Vestibular Neuritis?
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
What is the most common cause of peripheral vertigo?
Benign Paroxysmal Positional Vertigo (BPPV).
What is Labyrinthitis?
Inflammation or infection of the labyrinth that can be viral or bacterial, involving both the cochlea and vestibular apparatus.
- Cochlea is also involved
What differentiates Labyrinthitis from Vestibular Neuritis?
- Labyrinthitis involves hearing changes and tinnitus
- Vestibular Neuritis does not affect hearing.
What are common clinical signs of UVH?
- spontaneous nystagmus
- (+) head impulse test
- abnormal DVAT
- abnormal mCTSIB
What does a positive head impulse test indicate in UVH?
Ipsilesional vestibular hypofunction.
What is the treatment for Vestibular Neuritis and Labyrinthitis?
Prognosis = ?
- 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.
What is Bilateral Vestibular Hypofunction (BVH)?
A condition where both sides of the vestibular system are either partially or completely nonfunctional.
What is the most common cause of BVH?
Ototoxicity, often due to drugs like aminoglycosides.
What are clinical signs of BVH?
Positive head impulse test bilaterally, large decline in DVAT, severe imbalance, and gait ataxia.
What is the treatment for BVH?
Vestibular rehabilitation therapy focusing on gaze stability and balance, along with safety education and compensatory strategies.
What is Meniere’s Disease?
- 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.
What are the characteristic symptoms of Meniere’s Disease?
- Recurrent vertigo
- Tinnitus
- Hearing loss
What is the medical management for Meniere’s Disease?
Low sodium diet, diuretics, steroids, and surgery to reduce or prevent fluid buildup.
What is Vestibular Schwannoma?
A benign tumor arising from the Schwann cell of CN VIII, often slow-growing.
- Common symptoms = Unilateral hearing loss, tinnitus, and imbalance.
What is the treatment for Vestibular Schwannoma?
Conservative management with watchful waiting, surgical excision, or gamma knife radiation.
What is Cervicogenic Dizziness (CGD)?
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.
What are central vestibular disorders?
Disorders of the central nervous system (CNS) affecting vestibular function.
What are the ‘D’s’ associated with central vestibular disorders?
- Dysarthria
- Diplopia
- Dysphagia
- Dysmetria
What are common causes of central vestibular disorders?
Vestibular migraine, Persistent Postural Perceptual Dizziness (PPPD), Arnold-Chiari Malformation, Vertebrobasilar Artery Insufficiency (VBI), stroke, and tumors.
What is Vestibular Migraine?
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.
What is Arnold-Chiari Malformation?
A congenital condition where part of the cerebellum descends past the foramen magnum.
What are the symptoms of Arnold-Chiari Malformation?
Suboccipital headache, neck pain, unsteady gait, dizziness, oscillopsia, problems with hand coordination, diplopia, dysphagia.
What are the differences between central and peripheral vestibular pathologies in terms of oculomotor testing?
Central vestibular pathologies often have abnormal smooth pursuits and saccades, while these are usually normal in peripheral pathologies.
What are the differences between central and peripheral vestibular pathologies in terms of vertigo intensity?
- Central pathologies may have mild vertigo or none at all
- Peripheral pathologies usually cause intense vertigo
What is Presbyvestibulopathy?
Age-related functional decline of the vestibular system, leading to dizziness, imbalance, or gait disturbance.
What are the implications of Presbyvestibulopathy in elderly patients?
Increased likelihood and severity of falls, diminished quality of life, and independence.
What is Multifactorial Vestibular Disorder?
A condition where multiple factors, including CNS and peripheral vestibular involvement, contribute to vestibular dysfunction.
What role does the vestibular system play in Parkinson’s disease?
Patients with Parkinson’s often have chronic vestibular hypofunction and are more prone to BPPV.
How is Multiple Sclerosis (MS) related to vestibular dysfunction?
MS can cause central lesions or affect CN VIII, leading to vestibular symptoms.
What conditions might cause light-headedness?
Orthostatic hypotension, hypoglycemia, anxiety, panic disorder, cardiac dysfunction, VBI, polypharmacy.
What vestibular conditions might cause dysequilibrium?
Bilateral vestibular loss, chronic unilateral vestibular hypofunction, peripheral neuropathy, cerebellar/motor pathway involvement, LE weakness.
What are some key symptoms of vestibular dysfunction?
Vertigo, tinnitus, pressure in the ears, difficulty concentrating, feeling disoriented, difficulty watching moving objects, blurred vision with movement.
What is lateropulsion?
A tendency to lose balance laterally, often leaning or falling toward the side of vestibular weakness.
What balance tests can be used in a vestibular examination?
Modified CTSIB, Romberg, Sharpened Romberg, Single leg stance, 4 Square Step Test, Functional Reach Test, Fukuda Stepping Test.
What is the Modified CTSIB test?
A test that evaluates balance by assessing a patient’s ability to maintain stability in different sensory conditions.
What is the Fukuda Stepping Test used for?
To assess vestibular weakness by monitoring body rotation while the patient steps in place with eyes closed.
What does a rotation greater than 30 degrees during the Fukuda Stepping Test suggest?
Possible vestibular weakness.
What does the Dynamic Gait Index (DGI) assess?
The ability to modify gait during various walking tasks.
What does a positive Dix-Hallpike test indicate?
Benign Paroxysmal Positional Vertigo (BPPV).
What does the head impulse test (HIT) assess?
The function of the vestibulo-ocular reflex (VOR) at high accelerations.
What does a positive head impulse test (HIT) indicate?
Vestibular hypofunction on the side toward which the head is turned.
What does the Dynamic Visual Acuity Test (DVAT) assess?
The difference between static visual acuity and visual acuity during passive horizontal head movements.
What might a greater than 3-line difference between static and dynamic visual acuity suggest?
VOR loss and vestibular hypofunction.
What is the role of the cerebellum in vestibular function?
It helps with the smoothness of movement by processing vestibular input.
What is the significance of a positive Romberg test in a vestibular examination?
It indicates a loss of proprioception or vestibular dysfunction.
What does the Sharpened Romberg test assess?
Balance with feet in a tandem stance, challenging the vestibular system.
What does the Single Leg Stance test assess?
A patient’s ability to maintain balance on one leg, which can reveal vestibular or proprioceptive deficits.
What does a positive Fukuda Stepping Test result indicate?
It suggests vestibular weakness if the patient rotates more than 30 degrees while stepping in place.
What is the purpose of the 4 Square Step Test?
To assess dynamic balance and the ability to step in multiple directions.
What is the significance of observing nystagmus during the vestibular examination?
Nystagmus is a key diagnostic indicator of vestibular involvement, helping to differentiate between central and peripheral causes.
What might vertical nystagmus indicate?
Central vestibular system pathology.
What does direction-fixed nystagmus suggest?
A peripheral vestibular lesion.
What does direction-changing nystagmus suggest?
A central vestibular pathology.
What is the purpose of the oculomotor exam in a vestibular examination?
To test the central oculomotor pathways independent of the vestibular system.
What are abnormal smooth pursuits a sign of?
Central dysfunction such as cerebellar or brainstem involvement.
What does the ‘H’ test assess in a vestibular examination?
Extraocular range of motion and observation for pathological nystagmus.
What does a positive Head Impulse Test indicate?
Vestibular hypofunction on the side being tested.
What is dynamic visual acuity?
The clarity of vision during head movement, testing the VOR function.
What is the purpose of the Dix-Hallpike test?
To diagnose BPPV by identifying positional nystagmus.
What is VOR gain?
The ratio of eye velocity to head velocity, ideally 1:1 for normal function.
What are corrective saccades during the head impulse test indicative of?
Vestibular hypofunction on the side being tested.
What is a common symptom of BPPV?
Vertigo triggered by specific head positions.
What does a decline in dynamic visual acuity indicate?
A loss of VOR function and possible vestibular hypofunction.
What is the role of the vestibular nuclei?
Integration of sensory information from the vestibular system and coordination of motor output.
What does spontaneous nystagmus at rest suggest?
Acute peripheral unilateral vestibular lesion or hypofunction.
What does the Fukuda Stepping Test assess?
Spatial orientation and vestibular weakness.
What is the purpose of the functional reach test?
To assess stability and balance during forward reach, often used in vestibular assessments.
What is the difference in nystagmus between peripheral and central vestibular disorders?
Peripheral nystagmus is typically unidirectional and horizontal, while central nystagmus can be vertical, direction-changing, or multidirectional.
What is Dysmetria, and how is it related to central vestibular disorders?
Dysmetria is a lack of coordination of movement, often seen in central vestibular disorders affecting the cerebellum.
What are common symptoms of cervicogenic dizziness (CGD)?
Dizziness, imbalance, neck pain, and symptoms that worsen with head movements or prolonged neck positions.
What is the controversy surrounding the diagnosis of cervicogenic dizziness?
The diagnosis is often controversial because neck pain and dizziness frequently co-occur, making it difficult to establish a direct link.
What is the role of cervical proprioception training in treating cervicogenic dizziness?
Training helps improve joint position sense, which can reduce dizziness and improve balance in CGD patients.
What is the typical clinical presentation of a patient with Unilateral Vestibular Hypofunction (UVH)?
Spontaneous nystagmus, positive head impulse test, and imbalance, especially on the affected side.
What is the pathophysiology behind Vestibular Neuritis?
Inflammation of CN VIII, typically due to a viral infection, leading to sudden vertigo and imbalance.
How is Vestibular Neuritis typically managed?
With anti-nausea medications, corticosteroids, and vestibular rehabilitation to promote central compensation.
What distinguishes Labyrinthitis from Vestibular Neuritis?
Labyrinthitis involves both hearing loss and vertigo, while Vestibular Neuritis does not affect hearing.
What is the primary goal of VRT in patients with UVH?
To promote central compensation and improve balance and gaze stability.
What are the potential long-term outcomes for patients with UVH?
Most patients compensate well, but some may have chronic dizziness or imbalance.
What are ‘drop attacks,’ and in which vestibular disorder are they commonly seen?
Sudden falls without warning, commonly seen in Meniere’s Disease.
What is the significance of ‘aura’ in Meniere’s Disease?
An aura often precedes an attack, with symptoms like sound sensitivity, tinnitus, and mild dizziness.
What is the primary difference in the cause of vertigo between Vestibular Migraine and BPPV?
Vestibular Migraine is due to central neurological dysfunction, while BPPV is caused by displaced otoconia in the semicircular canals.
How does Vestibular Migraine differ from Meniere’s Disease in terms of hearing?
Vestibular Migraine does not cause permanent hearing loss, while Meniere’s Disease does.
What is the role of diet and lifestyle modifications in managing Vestibular Migraine?
Avoiding triggers like certain foods, managing stress, and maintaining a regular sleep schedule can help reduce the frequency of attacks.
What is the ‘push-pull’ mechanism in the vestibular system?
A system where paired semicircular canals on opposite sides of the head respond oppositely to head movements, providing balanced signals to the brain.
What is the typical prognosis for patients with Vestibular Neuritis?
Most recover within weeks to months, but some may have residual symptoms like dizziness and imbalance.
How is Vestibular Schwannoma monitored if surgery is not immediately necessary?
Through regular MRI scans and hearing tests to monitor growth and symptom progression.
What are the common symptoms of Multifactorial Vestibular Disorders?
Dizziness, imbalance, and vertigo due to combined central and peripheral vestibular dysfunction.
How does age affect the vestibular system, leading to Presbyvestibulopathy?
Age-related decline in vestibular function due to neuronal and hair cell loss, leading to dizziness and imbalance.
What role does the vestibular system play in patients with Parkinson’s disease?
Patients with Parkinson’s often have chronic vestibular hypofunction, leading to increased fall risk and balance issues.
What is the relationship between Multiple Sclerosis (MS) and vestibular dysfunction?
MS can cause central lesions affecting vestibular pathways, leading to dizziness and imbalance.
How is vestibular rehabilitation therapy (VRT) used in stroke patients?
VRT improves balance and gait, especially within the first six months after a stroke.
What are the common findings in central vestibular disorders?
Severe imbalance, abnormal smooth pursuits and saccades, possible diplopia, and dysmetria.
What is the importance of early diagnosis and treatment of vestibular disorders?
Early diagnosis and treatment can improve recovery outcomes, reduce fall risk, and enhance quality of life.
What are the treatment options for Meniere’s Disease?
Medical management, VRT for balance issues, and in some cases, surgery to reduce fluid buildup in the inner ear.
How does VRT help patients with Bilateral Vestibular Hypofunction (BVH)?
VRT helps improve gaze stability, balance, and reduces fall risk through compensatory strategies.
What is the primary goal of vestibular rehabilitation in central vestibular disorders?
To improve balance, coordination, and reduce dizziness by promoting central compensation.
What are common vestibular symptoms in patients with Alzheimer’s disease?
Dizziness, imbalance, and increased fall risk due to vestibular impairment.
How does anxiety contribute to vestibular dysfunction?
Anxiety can exacerbate dizziness and balance issues, leading to conditions like Persistent Postural Perceptual Dizziness (PPPD).
What are the diagnostic criteria for Vestibular Migraine?
Recurrent episodes of vertigo with a history of migraine, often triggered by typical migraine triggers.
What is the significance of a positive head impulse test?
It indicates vestibular hypofunction, typically seen in conditions like UVH or BVH.
What is the role of the cerebellum in vestibular function?
The cerebellum integrates sensory information to coordinate balance, eye movements, and postural control.
What are the symptoms of Arnold-Chiari Malformation?
Dizziness, imbalance, coordination issues, and suboccipital headaches.
What is the main cause of dizziness in central vestibular disorders?
Disruption of central pathways in the brainstem and cerebellum, leading to persistent dizziness and imbalance.
How is Mal de Debarquement Syndrome (MdDS) typically triggered?
By prolonged exposure to passive motion, such as on a boat or plane, leading to persistent sensations of movement.
What is the recommended treatment approach for Persistent Postural Perceptual Dizziness (PPPD)?
A combination of vestibular rehabilitation, cognitive behavioral therapy, and medication to manage symptoms.
