exam 2 - peri and central Flashcards
acute unilateral vestibular loss - sym
- Sudden onset
- May have hearing loss
- Spontaneous nys – horizontal, alexander law
acute unilateral vestibular loss - test
- Nys decreases with fixation
- (+) HIT
- (+) head shake test
- (+) vibration induced nys
- (+) DVA
Vestibular neuritis - what is it
a disorder that affects the vestibulocochlear nerve of your inner ear, inflammation
Vestibular neuritis - sym
- Vertigo that can last for days
- No hearing loss, fullness in the ear
- May have flu like sym prior to onset of vertigo
- Nystagmus - Spontaneous nys
Vestibular neuritis - test
none stated
Vestibular neuritis - medical treatment
Medical management: effective within the first month
- Methylprednisolone
- 10-day course of prednisone
Chronic unilateral vestibular loss - sym
- Chronic Dizziness
- Walking - Off balance, Blurring with head movements
- May have hearing loss
- Induced by head movements
Chronic unilateral vestibular loss - test
- (maybe +) HIT
- (+) DVA
- May fall when standing on foam – EC
Subjective BPPV - def
Adults that have BPPV with no nys but the sensation of BPPV with dix hall pike
subjective BPPV intervention
Treat like they have a positive test – do not treat pt forever
Meniere’s disease - what is it
excessive buildup of endolymph causing a higher pressure than normal which can disrupts the sensory system
Meniere’s disease - sym
- Ear pressure (fullness)
- Low frequency hearing loss
- Tinnitus
- Spontaneous attacks – drop attacks
- Vertigo attacks – 20 min - hours
Meniere’s disease - treatment
Endolymphatic surgery
Vestibular ablation
- Chemical
- Surgical
Medical management
Intratympanic steroids
Salt/caffeine restriction
Diuretic
Vasodilator
Immunotherapy
Meniere’s disease - test
- Asymmetric hearing
- Difficulty standing on foam
- Possible autoimmune family history
- Abnormal caloric
Superior canal dehiscence - what is it
sound or pressure induced vertigo of the superior SSC (rare)
Superior canal dehiscence - sym
- Load sound cause object in the VF to move
- Dizziness intros by coughing or sneezing
- conductive hearing loss
- Hear their heart, voice, maybe eye movement in the effected ear, foot steps hitting the ground, 262 Hz tunning fork on malleolus
Superior canal dehiscence - treatment
surgical
Ramsey hunt syndrome - sym
- Ipsilateral facial weakness
- Ear pain
may have hearing loss
Bilateral vestibular disease - def
hypofunction of the vestibular nerves or labyrinths on both sides
Bilateral vestibular disease - sym
- Oscillopsia
- Ataxia – wide base of gait
- Frequent falls
- No vertigo – no spinning
Bilateral vestibular disease - test
- (+) Bilateral HIT
- (+) DVA
- Fall on posturography 5&6 – sometimes 4
- Decrease caloric findings
Bilateral vestibular disease - treatment
VOR – just to see if anything is left
Substitution exercises
Psychiatric dizziness - three categories
- panic disorders
- agoraphobia
- hyperventilation syndrome
Psychiatric dizziness - symptoms
- floating, spinning, swimming of the head
- tension headaches
- palpations
- gastric disorders
- sym constant
o may increase with stress
what is Persistent postural perceptual dizziness (PPPD)
Functional movement disorder – someone can appear to have a spinal cord injury, they cannot stand or walk, but they can actually move all of their bones and muscles
Persistent postural perceptual dizziness (PPPD) - presentation
- These pt brains are built differently – the morphology of their grey matter is different
- There is normally a vestibular trigger – BPPV, neuritis
- These pt do not recover from their vestibular issues – long term problem
o Maladaptive
MS - cause
demylienation of the axons
ms - sym
- Focal neuro signs
- Recurrent attack of vertigo
- Vertical nys – non fatiguing
o See saw nys
MS - age group
20-40
Vestibular migraine - occcurance
most common vestibular issue
Vestibular migraine - sym
- Pain in the head and neck
- Visual changes – photophobia, blurring
- Mood changes
- May be autosomal dominant – trait seen in families
- Sometime positional nys – persistent
what is a Chiari malformations
cere goes through the foramen magnum
Chiari malformations
- Headache
- Neck pain
- Down beating nys with IR goggles
- Balance problems
- Dysphagia
- Weakness
- Vertigo
Perilymphatic fistula (rare) - sym
- Vertigo induced by – coughing, sneezing, Valsalva
- Fluctuating dizziness
- May have hearing loss
Perilymphatic fistula (rare) - cuases
- Barotrauma
- Head injury
- Heavy lifting
Perilymphatic fistula (rare) - tests
- (+) tragal pressure
- (+) Valsalva test
- (+) occasional tullios phenomenon
Perilymphatic fistula (rare) - treatment
refer out
Orthostatic tremor - presentation
- Tremor
o Tremor that cannot be seen
o Position specific – standing
o Disappears or decreases – walking, sitting, supine - CC: I cannot stand for longer than a few minutes
- Fear of falling
Orthostatic tremor - medical management
- Gabapentin
- Primidone
- Pregabalin
Central vestibular - sym
- Inability to walk – gait ataxia
- Dizziness/vertigo
- Head tilt to the side
Central vestibular - tests
- (-) HIT
- Focal neuro signs
- Changing direction of nys
- Sig imbalance
