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Vestibular > Foundational Information > Flashcards

Foundational Information Flashcards

1
Q

Vestibular System

A

-Provides CNS info about position of head and motion of the head
-Provide stable vision while head is moving
-Serves as an internal reference
-Postural stability

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2
Q

Vestibular Pathway

A

CN 8 > Vestibular nuceli/ Cerebellum/Vestibulospinal tract/Vestibuloocular/

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3
Q

Central Vestibular System

A

CN 8 > vestib nuclei > cerebellum/vestibulospinal/abducens/oculomotor

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4
Q

Peripheral Vestibular System

A

-Vestibular Apparatus
-Semicircular Canals
-Otolithic Organs

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5
Q

Vestibular Apparatus

A

Semicircular Canals: ant, pos, horizontal
-each with an ampulla

Otolithic Organs: utricle, Saccule

Membranous Labyrinth
-separated by perilymph fluid
-filled with endolymph
-hair receptor cells bend with mmt

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6
Q

Semicircular Canals

A

-Ampulla that contains a crista with a cupula (gelatanous structure containing hair)
-hairs constanly fire AP when the rate of fluid changes when at rest and with head mmts to give information about the body in space
-only actively move during rotation of head in the opposite direction
-Only angular or rotational movement

Horizontal: head rotation (no)
Ant and Post: pitch and roll (yes)

-R and L Posterior and anterior work in same plane

Ex: Turn to the L, L endolymph shifts toward kinocilium (activating), R endolymph shifts away from kinocilium (inhibiting)

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7
Q

Otolith Organs

A

Urtricle and Saccule: membranous sac that responds to linear acceleration/decceleration
-have a macula that contains hair cells embedded in a gelatinous mass with microscopic cristals (otoliths) on top
-displacement of otoliths stimulate neurons
-linear movement of the head

Uricle: Horizontal mmt
Saccule: vertical mmt

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8
Q

Cervical-Ocular Reflex

A

-postural adjustments of head in response to SCC
-substitution for VOR when absent

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9
Q

Vestibulo-Spinal Reflex

A

-postural tone and adjustments of the body for balance while maintaining equilibrium

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10
Q

Medial Longitudinal Fasciculus

A

-Bilateral connections to extraocular eye muscles and superior colliculus

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11
Q

Cerebello-Thalamocortical Pathways

A

-ascending pathway
-lateral and superior vestib colliculi < thalamus < posterior parietal cortex

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12
Q

Vestibular System Function

A

-provides CNS info of head and body
-stable visiono while head is moving
-internal refernce to determine appropriateness of sensory info

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13
Q

Vestibulo Occular Reflex

A

-head and eyes move in diff direction to maintain view
-opp lateral rectus activate to move eyes in same direction

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14
Q

Activation of hair cells

A

-movement that bends hair toward kinocilium causes depolarization and activation
-movement that bends hair away from kinocilium causes hyperpolarization and deactiviation

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15
Q

Otolith Ocular Reflex

A

-input from otoliths
-output to eye muscles
-controls horizontal and vertical eye mmts
-via linear VOR

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16
Q

Vertigo

A

-sensation of the room spinning

BPPV or non-BPPV (anything not canal related)

17
Q

Benign Paroxysmal Positional Vertigo: BPPV

A

-BPPV
-most common; age, trauma
-crystals from utricle or saccule (MC) fall from utricle into SCC (PSCC MC)
-heavy crystals cause change in endolymph viscosity and fire nerve signals
-top shelf vertigo
-brief vertigo and nystagmus

s/s:
-short spells, recurring
-holding still makes it better

18
Q

Nystagmus: PNS

A

Peripheral Vestib:
-Slow phase: VOR
-fast phase: corrective saccade
-usually horizontal
-moves in the same direction

19
Q

Nystagmus

A

-non voluntary rhythmic oscillation of eyes
-named by fast phase
-can be suppressed by fixation
-viewed with frenzel or infared goggles
-increases toward fast phase (Alexander’s law)

Physiologic: normal stimuli
Pathologic: abnormal; 4 types

Caused by vestib:
-slow phase caused by VOR
-fast corrective by cerebellum

Caused by CNS:
-smooth pursuit and saccades

20
Q

Benign Paroxysmal Positional Vertigo: Canalithiasis

A

Canalithiasis (MC):
-otoconia fall off and free float in PSCC
-latent onset of vertico and nystagmus after provoking
-disappears in 1 min

s/s:
-short spells, recurring
-holding still makes it better

21
Q

Benign Paroxysmal Positional Vertigo: Cupulolithiasis

A

Cupulolithiasis:
-otoconia fall off and adhere to cupula of PSCC making cupula denser around endolymph
-immediate vertigo is persistent until head moved
-nystagmus

s/s:
-short spells, recurring
-holding still makes it better

22
Q

Nystagmus: CNS

A

CNS:
-smooth pursuit and saccades (cerebellum and brainstem)
-often follows gaze
-typically vertical, constant (not changed by fixation)
-changes direction when looking changes

23
Q

Nystagmus: BPPV

A

BPPV:
-named by torsion (canal) and rotary component toward the lesion
-Upbeat and rotary for PSCC
-direction fixed

Cause:
-canal stimulation and mixed matched

24
Q

Neuritis/Labyrinthitis

A

Neuritis: no hearing loss
Labryrinthitis: hearing loss and tinitis

-infection/inflammation causing hyperexcitation
-damage causes hypofunction
-fireing rate affected
-long lasting 3-7d
-nystagmus fixed on good side in all 3 degrees of gaze

s/s:
-sudden, lasting days, single event
-spontaneous, exacerbating by movement

25
Q

Acoustic Neuroma

A

-benign tumor on cochlear n that places pressure
-can cause dizziness and balance issues
-no true vertigo s/s

26
Q

Endolymphatic Hydrops/Meniere’s Disease

A

-chronic condition of inner ear
-fluid accumulation building up pressure in inner ear, leads to hyperstimulation
-causes vertigo/hearing loss/hypofunction

Causes:
-Meniere’s Disease (idiopathic)
-Sodium/potassium imbalance

s/s:
-sudden, recurring
-exacerbated by head movements

27
Q

Fistula/Dehiscence

A

-structural hole from trauma
-makes it hard to manage endolymph and pressure
-causes vertigo

28
Q

Vesibular Hypofunction

A

-damage to inner ear or vestib n
-affects VOR and VSR

-unilateral: dizzy
-bilateral: moving images (oscillopsia); gradual onset; no dizziness

29
Q

Spontaneous Nystagmus

A

-cns or pns vestib problem

30
Q

Positional Nystagmus

A

-paroxysmal or static
-Torsional: BPPV or brainstem
-Down/upbeat: cerebellar dysfunction

31
Q

Gaze evoked Nystagmus

A

-eyes drift toward center, contantly corrective

32
Q

Congenital Nystagmus

A

-birth

33
Q

Vestibular Migraine

A

-sensory-perceptual disorder in vestibular
-can cause vertigo/tinnitus

34
Q

Persistent Postural Positional Dizziness (PPPD)

A

-chronic functional dizziness
-autonomic and emotion hyperresponsiveness to vestib stimuli
-after vestibular trauma, s/s becomes persistent after brain fails to adapt

35
Q

Mal de Debarquement (MDDS)

A

-mal adaptation following getting off a moving vehicle
-s/s persistent of rocking or swaying that

36
Q

Non-Vestibular Pathology

A

Cardiovascular/Metabolic

37
Q

Subjective Assessment

A

-quality of s/s
-longevity of s/s
-frequency
-aggravating factors
-easing factors
-associated s/s

38
Q

Symptom Quality

A

Vertigo: illusion of self movement or room spinning
Disequilibrium: sense of being off balance
Gaze-instability: foggy headed, blurry vision (decreased of VOR)
Oscillopia: illusion of excessive motion of object (no dizziness; Bilateral non-BPPV)

39
Q

Diagnostic Questions

A

Vestib or not?
Peripheral or not?

Vestibular (4 decks)

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