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Neuro II > Exam 2 - Vestibular > Flashcards

Exam 2 - Vestibular Flashcards

1
Q

what health conditions can result in vestibular dysfunction as a secondary complication

A

diabetes
hypertension

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2
Q

list the bony aspects of the labyrinth

A

bony portion of the 3 semicircular canals
cochlea
vestibule
filled with perilymphatic fluid

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3
Q

list the membranous portions of the labyrinth

A

membranous portions of 3 semicircular canals
utricle
saccule
filled with endolymphatic fluid

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4
Q

what are the 3 types of semicircular canals

A

anterior
posterior
horizontal

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5
Q

what are the otolothic organs

A

utricle
saccule

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6
Q

what structures respond to angular acceleration

A

anterior, posterior, and horizontal semicircular canals

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7
Q

what structures are responsible for detecting linear acceleration

A

utricle - horizontal
saccule - vertical

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8
Q

describe the anatomy of the semicircular canals

A

attached to utricle
have an enlarged end (ampulla)
filled with endolymphatic fluid

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9
Q

describe the anatomy of the ampulla

A

on the utricular end of the SCC

contains a cupula

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10
Q

describe the cupula anatomy

A

gelatinous barrier that contains sensory hair cells

hair cells sit on crista ampullaris

cupula will deflect when endolymph moves

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11
Q

describe the different types of hair cells

A

stereocilia - supporting hair cells
kinocilia - main hair cell

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12
Q

describe how excitation occurs in regards to stereocilia and kinocilia

A

movement of stereocilia toward kinocilia = excitation

movement of sterocilia away from kinocilia = inhibition

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13
Q

list the otolithic organs in regards to the utricle and saccule

A

otoconia
gelatinous matrix
hair cells
macula

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14
Q

describe the blood flow of the vestibular system

A

basilar artery
AICA and labyrinthine arteries
AVA, PVA, common cochlear
AC, PC, HC, Utricle, saccule, cochlea

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15
Q

describe how cranial nerve VIII innervates the vestibulocochlear system

A

cochlear: goes to cochlea

superior vestibular: utricle, AC, HC
inferior vestibular: saccule and PC

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16
Q

explain how CN VIII runs in the body

A

CN VIII goes from the inner ear to the vestibular nuclei in the medulla and pons

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17
Q

describe VOR

what is the pathway of VOR

A

gaze stabilization during head movements
eye moves equal and opposite to head

head moves, CN VIII to VN to ON to ocular muscles

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18
Q

describe vestibulo-spinal reflex (VSR)

where is the output

A

big role in postural stability
adjusting limb motion appropriately for the position of the head

output is to the skeletal muscles

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19
Q

describe vestibulo-colic reflex (VCR)

where is the output

A

use of the neck muscles to stabilize the head in space

output is to the cervical musculature

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20
Q

list the 4 vestibular nuclei

A

superior
descending
medial
lateral

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21
Q

what does the superior vestibular nuclei control

A

controls VOR

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22
Q

what is the function of the descending vestibular nuclei

A

connects to the cerebellum and other nuclei

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23
Q

if there is a dysfunction or injury to the connection from the descending vestibular nuclei, what symptoms would you expect

A

ataxic reflexes

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24
Q

what does the medial vestibular nuclei control

A

VOR and VSR

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25
what does the lateral vestibular nuclei control
VSR
26
where are the vestibular nuclei located
pons and medulla
27
what is required to adapt VOR gain
flocculus
28
what is required for VOR duration
nodulus
29
if there is an injury to the anterior-superior vermis, what symptoms would you expect, why
VOR and postural impairments he anterior-superior vermis affects VSR
30
the PICA supplies blood to what structures
medulla and cerebellum
31
AICA supplies blood to what structures
cerebellum
32
where are the ocular nuclei located
in the midbrain
33
the ocular nuclei takes inputs from ______ and sends outputs to _____ via ______
vestibular nuclei ocular muscles via cranial nerves II, IV, VI
34
what muscles are responsible for allowing torsional nystagmus
superior and inferior obliques
35
nystagmus is named after the _____
fast phase
36
what vestibular screening components assess central
saccades smooth pursuit convergence/divergence VOR cancel VOR - can be both HINTS - rules in
37
what vestibular screening components assess peripheral
VOR - can be both HIT position testing
38
list red flags when completing a vestibular screen
direction changing nystagmus postive HINTs sustained nystagmus vertical nystagmus positive vertebral artery screen acute intractable N/V UMN signs unstable vitals not responding to positioning maneuvers S&S of stroke
39
what is BPPV mechanical or electrical problem?
when the otoconia in the utricle gets dislodged into a semicircular canal mechanical problem
40
what is canalithiasis
when the otoconia are free floating in the canal
41
what is cupulolithiasis
theory that the otoconia adhere to the cupula
42
list the symptoms of canalithiasis
latent onset of nystagmus (1-40 seconds) nystagmus goes away within 60 seconds sensation of vertigo lasts the length of the nystagmus most common form of BPPV
43
list the symptoms of cupulolithiasis
immediate onset of nystagmus nystagmus is persistent and may last for the entire time the head is in the affected position sensation of vertigo lasts the length of the nystagmus
44
if the pt presents with up beating and torsional nystagmus toward the affected side, what canal is affected
posterior canal
45
if pt demonstrates horizontal nystagmus with or without torsion (ageotropic or geotropic), what canal is affected
horizontal canal
46
if the pt demonstrates down beating and torsional nystagmus toward the affected side, what canal is affected
anterior (superior) canal
47
what assessments are used to assess anterior and posterior canal
dix hallpike
48
what assessment is used to assess horizontal canal
roll test
49
what BPPV treatment is used to treat posterior canal
epley (canalithiasis) semont liberatory (canalithiasis and cupulithiasis)
50
what BPPV treatment is used to treat anterior canal
semont liberatory
51
what BPPV treatment is use to treat horizontal canal
270 roll (BBQ roll) - treats canalithiasis
52
describe unilateral hypofunction
injury in the peripheral component of the vestibular system that changes the input coming to the CNS from one side ex) vestibular neuritis, labyrinthitis
53
describe bilateral hypofunctions
injury to the peripheral component of the vestibular system that changes the input coming to the CNS from both sides ex) B ototoxicity in the setting of chemotherapy agents
54
what is adaptation
change in the vestibular response to certain stimuli (neuroplastic change where the eris a physiological balance of signaling)
55
what is habituation
decreased response to a stimulus with increased exposure *get used to it*
56
t/f adaptation and habituation are considered electrical problems
true
57
what is the plan of care for BPPV
1-2 visits for single canal, posterior canal, canalithiasis more canals affected, horizontal canal, cupulolithiasis requires more sessions
58
what is the plan of care for unilateral hypofunctions
sub/acute = 2-3 weeks chronic = 4-6 weeks sub/acute = gaze stability exercise 3x/day for 12 mins chronic = 3-5x/day for 20 mins
59
what is the POC for bilateral hypofunctions
5-7 weeks gaze stability exercises 3-5x/day for 20-40 minutes
60
what is the POC for central
depends on what causes the central and if your focus is remediation, compensation, and/or prevention
61
describe the etiology/pt history indicative of vestibular neuritis
inflammation of the balance portion of CN VIII has a precipitation of viral illness most often in winter/spring bc of flu season
62
list the S&S consistent with vestibular neuritis
acute onset vertigo lasting minutes to hours N & V @ all times but increases with head turns no impact to hearing mostly unilateral
63
what diagnosis tests used to assess vestibular neuritis
head impulse test caloric testing vestibular-evoked myogenic potential (VEMP)
64
what medical and physical therapy interventions are used to treat vestibular neuritis
glucocorticoids in first 3 days of symptoms onset to decrease inflammation responsive to vestibular rehabilitation treatment (VRT)
65
how long does it take for vestibular neuritis to improve
6 weeks - 3 months
66
what is the etiology of labyrinthitis
bacterial or viral infection of the labyrinth meningitis if bacterial
67
list the S&S of labyrinthitis
hearing and balance affected prolonged vertigo N & V tinnitis often unilateral
68
what diagnostic tests are used to assess labyrinthitis
head impulse test caloric testing vestibular-evoked myogenic potential (VEMP) in subacute or chronic phase CSF, auditory markers, and MRI are tested if bacterial
69
how is labrytinthitis treated
bacterial = antibiotics viral = steriods responsive to vestibular rehabilitation treatment (VRT)
70
what is meniere's disease
also called endolymphatic hydrops often "catch all" for vestibular disorders ischemia of fibrosis around the endolymphatic sac causing abnormalities in the endolymph drainage
71
list the meniere's disease S&S
vertigo lasting for minutes to days possible N&V may have fluctuating hearing loss may have tinnitis that sounds like roaring starts unilateral progresses to bilateral episodic
72
what diagnostic tests are used to assess meniere's disease
audiogram shows low frequency hearing loss
73
how do you treat meniere's disease
not curable 2g/day of sodium to control fluids diuretics to lower extracellular fluid may respond to VRT at first, but need to move to habituation as it progresses
74
describe an acoustic neuroma
also known as a vestibular schwannoma benign tumor of the CN VIII often presents in the internal auditory canal but can present elsewhere
75
what are the S&S of acoustic neuroma
symptoms are dependent on the location of the tumor if in the IAC, pt will have hearing and vestibular impairment and balance impairment tumors grow slowly = onset is slow mostly unilateral
76
how do you treat acoustic neuroma
can be (+) on other CN VIII screens like Renne and Webber MRI or CT needed surgical excision or gamma knife radiation VRT can be useful post-op
77
what is superior canal dehiscence syndrome
thinning or opening on the top of the bone overlying the superior canal often congenital
78
what are the symptoms of superior canal dehiscence syndrome
oscillopsia or vertigo induced by sound
79
how is superior canal dehiscence syndrome diagnosed
observation for eye movements caused by increased pressure or sound in the inner ear of during valsalva
80
how do you treat superior canal dehiscence syndrome
surgery to repair bony deficit not responsive to VRT
81
what is perilymphatic fistula
perforation of the oval or round windows that disrupts biochemistry of the ear
82
describe the symptoms of perilymphatic fistula
perilymph leaks into the middle ear resulting in vertigo and hearing loss that are episodic symptoms increase with activity and decrease with rest
83
how is perilymphatic fistula treated
medically managed with rest, surgery, adn VRT
84
what is labyrinthine concussion
concussion of the inner ear co-occurs with concussion of the brain most often caused by trauma
85
what are the symptoms of labyrinthine concussion
balance difficulty dizziness concussion symptoms (cognitive changes, irritability, sleep disturbances) can have central and peripheral findings possible hearing and vestibular deficits an be unilateral or bilateral
86
how is labyrinthine concussion treated
responds to VRT with a cognitive component
87
describe ototoxicity
can be chemical or environmental typically bilateral
88
what are the symptoms of ototoxicity
balance dysfunction visual dependence (watching where the walk) doesn't have to also have vertigo possible hearing loss
89
what pt history is indicative of ototoxicity
gentamycine (antibiotic) chemotherapy agents solvents
90
describe adaptation in regards to vestibular rehabilitation
change in vestibular response to certain stimuli neuroplastic change where there is a physiological balance of signaling
91
describe habituation in regards to vestibular rehabilitation
decreased response to a stimulus with increased exposure *get used to it*
92
describe substitution in regards to vestibular rehabilitation
training the other systems (somatosensory and visual)
93
what are the high evidence vestibular hypofunction according to the CPG
VRT with acute, subacute, chronic, unilateral vestibular hypofunction VRT with bilateral hypofunction supervised VRT VRT improving quality of life age and gender do not influence outcomes saccades and smooth pursuit do not improve gaze stability
94
what modalities for vestibular hypofunction are considered to be moderate evidence according to the CPG
virtual reality optokinetic stimulation platform perturbations vibrotactile feedback
95
what is considered as weak evidence in the CPG for vestibular hypofunction
balance sodage gaze stability HEP dosage
96
t/f anxiety, vision disturbance, migraine, long term use of vestibular suppressants can impact outcomes
true
97
what interventions are useful for gaze stability
VOR retraining and VOR 1/2
98

Neuro II (4 decks)

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