- reflexive, rhythmic oscillation of eyes (Slow and Fast beat)

Lecture 5: Vestibular Flashcards by Jeremiah Casino

5 disorders of Peripheral Vestibular Dizziness/Disequillibrium

BPPV, Vestibular Neuritis - Labrythitis, Meniere’s Disease, Acoustic Neuroma, Ototoxicity

How well did you know this?

Not at all

Perfectly

Is Dizziness and Disequilibrium CNS or PNS?

Both: CNS –> Cerebellum and Brainstem

PNS –> Sensory: Cranial n. and special

How well did you know this?

Not at all

Perfectly

Most common vestibular disorder in older population?

BPPV

How well did you know this?

Not at all

Perfectly

What is the function of the cupula?

Signals the vestibular n for angular motion, saying which direction the head is moving

How well did you know this?

Not at all

Perfectly

What do the otoliths do?

Horizontal and/or vertical movement

How well did you know this?

Not at all

Perfectly

What is the baseline frequency of CN 8

60-100 hz

How well did you know this?

Not at all

Perfectly

what does VOR stand for?

Vestibular ocular reflex

How well did you know this?

Not at all

Perfectly

What is the input for VOR? and what is the output?

input: head movement
output: eye movement
same amount of degrees but in opposite directions !

How well did you know this?

Not at all

Perfectly

in an intact system: eye mvmd is a result of the _____ in signal sent from _____ nerve on each each side (not the ____ value)

difference, vestibular, absolute

How well did you know this?

Not at all

Perfectly

Dizziness is a result of ___ match between what 3 systems:

mismatch, b/t: visual, somatosensory, vestibular

How well did you know this?

Not at all

Perfectly

define vertigo

sensation of movement in the absence of stimuli: spinning, rocking, lifting

How well did you know this?

Not at all

Perfectly

define disequilibrium

unsteadiness or imbalance, occurring mainly when standing up/ walking
better when sitting or lying down.

How well did you know this?

Not at all

Perfectly

define dizziness HTN

pre syncope, light-headedness, foggy head, spatial disorientation

How well did you know this?

Not at all

Perfectly

name some associated symptoms of dizziness/disequilbrium

tinnitus, nausea/ vomiting, hearing loss, visual changes, aural fullness, headache, 4 Ds: Diplopia, Dysarthria, Dysphagia, Dysmetria

How well did you know this?

Not at all

Perfectly

3 special diagnostic tests for Dizziness/Disequilibrium

MRI, CT, Audiometric Exam

How well did you know this?

Not at all

Perfectly

should you have unilateral hearing loss? as a result of D/D

NO this is a red flag, typically natural hearing loss is bilateral

How well did you know this?

Not at all

Perfectly

use of MRI for D/D

Brain and internal auditory canals, ID stroke or tumor

How well did you know this?

Not at all

Perfectly

use of CT for D/D

temporal bones, brain, internal auditory canals

assist in ID hemorrhage, stroke, tumor

How well did you know this?

Not at all

Perfectly

use of Audiometric exam for D/D

Distinction b/t conductive or sensorineural loss

- word distinction measure of patient’s ability to understand speech

How well did you know this?

Not at all

Perfectly

ENG/VNG: what is this?

assessment of inner ear responses
VEMP: vestibular evoked myogenic potentials
Spontaneous eye movements
positing testing
visual tacking
vestibular testing: Caloric, Rotary Chair testing

How well did you know this?

Not at all

Perfectly

define Nystagmus

reflexive, rhythmic oscillation of eyes (Slow and Fast beat)

How well did you know this?

Not at all

Perfectly

Fast beat goes in what direction in regards to Nystagmus?

To the side of more/increased neural activity !

How well did you know this?

Not at all

Perfectly

What is considered ‘normal’ nystagmus?

Visual end range

- Optokinetic stimulation

How well did you know this?

Not at all

Perfectly

Direction fixed nystagmus is generally driven by: _______, (horizontal)

Peripheral vestibular

How well did you know this?

Not at all

Perfectly

Peripheral Vestibular Nystagmus --> with visual fixation will increase or decrease?

May decrease

Peripheral Vest Nystagmus --> when looking in direction of fast beat will inc or dec?

Increase; will be exaggerated -> Alexander's Law

Direction changing nystagmus with changes in gaze is drive by: _______

Central Vestibular

Regarding Central Vest Nystagmus --> will it fixate it while remaining in 1 position?

No it will change direction still no matter what

Regarding central west nystagmus: with visual fixation --> increase or decrease?

May increase

Is Central vestibular nystagmus mixed pattern like Peripheral?

No, pure vertical and or pure torsional

Name 6 disorders of Central Vestibular dizziness/Disequilibrium

- TBI/Concussion, TIA/Stroke, Cerebellar Disorders, Tumors, MS, Migraines

5 etiologies/Pathogenesis: BPPV can happen?? | BBPV affects women more then men?

- idiopathic - post-traumatic - viral neurolabyrinthitis - Vertebrobasilar Ischemia - Meniere's Female >Male

2 Positional testing for BPPV and their target neuroanatomy:

Dix Hall pike test: anterior and posterior canals | Roll test: Horizontal canals

what are the 2 forms of BPPV

- Canalithiasis | - Cupulolithiasis

How long do canalithiasis symptoms last?

< 60 seconds

How long do cupulolithiasis symptoms last?

> 60 seconds

BPPV treatment?

Repositioning maneuvers: i.e. Dix hall pike, Bbq roll

is BBPV peripheral central, labyrinth or nerve?

PERIPHERAL AND LABRYINTH

Vestibular Neuritis/Labryinthitis aka ______? and age

Unilateral Vestibular Hypofunction; 30-60 years

Pathogenesis of UVH?

Probably Viral: Upper Respiratory or GI tract infection | - Autoimmune, Vascular, Bacterial

What anatomy is affected if Neuritis? how about Labrynthitis

- CN 8 | - Endolymph fluids of the canals

How is UVH symptoms exacerbated?

- Head movements due to inaccurate VOR

how long does UVH last???

- last 1 - 3 days

Diagnostic Studies for Vest. Neuritis/Labryinthitis/ UVH??

VNG/ENG - ID's reduced unilateral response to caloric stimulation

Treatment of Vest Neuritis/Labryinthtis/UVH??

- Vestibular Suppressants: help manage Acute symptoms | - Vestibular rehabilitation

is UVH: central or peripheral? Labryinth or nerve?

PERIPHERAL, AND EITHER BOTH NERVE OR LABRYINTH

Meniere's Disease? is this unilateral or bilateral?

BOTH UNILATERAL AND BILATERAL HYPOFUNCTION

how does Meniere's Disease happen? Pathogenesis

- Trauma, Infection, immune-mediated, genetic pre-disposition

Etiology of Meniere's Disease?

- Malabsorption of Endolymph fluid | - increased pressure and volume --> abnormal firing if hair cells

how long does Meniere's disease last?

- Hours to days

Can PT sufficiently resolve Meniere's? Why or Why not???

NO because its an inflammatory process of the inner ear, you potentially can manage symptoms though

What characteristic can you use to differentiate Meniere's from other Vestibular disorders?

TIMELINE --> IE symptoms are episodic - fluctuating, and progressive nature !!!

Some signs and symptoms of Meniere's disease?

- Episodic flares: Vertigo, fluctuating sensorineural hearing loss (may be permanent over time), ear fullness, tinnitus, disequilibrium, Nausea, Vomitting, Anxiety - Motion Sensitivity - Visual Disturbances

Diagnostic Studies of Meniere's (2):

- Audiogram | - VNG/ENG - Calorics

Treatment of Meniere's Disease

- Manage Diet (low drum, alcohol, nicotine, caffeine) - Diuretics - Suppressive Meds - Surgery (CN 8 section, Labryinthectomy) - Gentamicin perfusion - Psychological support - Vestibular Rehab

Acoustic Neuroma (UVH also): what age range is affected???

30-60 years of age

What is the Neuroanatomy affected in Acoustic Neuroma?

CN nerve 8 and the root

What is the etiology of Acoustic Neuroma?

- Benign tumors from Schwann cells of CN 8

Where are the Tumors of Acoustic Neuroma located?

- Internal auditory canal or cerebellopontine angle

Is acoustic Neuroma insidious or immediate? and what is the primary early sign/symptom?

- insidious onset | - UNILATERAL, progressive Hearing loss

Other associated symptoms of Acoustic Neuroma?

- tinnitus - disequilibrium - dizziness

How is Acoustic Neuroma typically diagnosed? (gold standard)

- Confirmed with MRI w/ gadolinium of internal auditory canals

How do you treat Acoustic Neuroma? in terms of PT

- Vestibular Rehab pre and post op !! | - meaning they need to have surgery lol

what is MEDICAL treatment of Neuroma?

- "wait and watch" - microsurgical resection - Stereotactic Surgery - May experience involvement of CN 8 and permanent hearing loss. after surgery....

Is ototoxicity bilateral of unilateral hypo function?

BILATERAL VESTIBULAR HYPOFUNCTION

Pathogenesis of Ototoxicity??

Pharmacological ! --> TOO MUCH GENTAMICIN: ablates the nerve - tobramycin - vancomycin

What hair cells are affected first for Ototoxicity

Vestibular hair cells first, and then Cochlear hair cells

Signs and Symptoms of Ototoxicity ??

- Severe Disequilibrium - Oscillopsia - Falls - (+) bilateral: Head impulse test

what are the 2 diagnostic tests for Ototoxicity?

- ENG/VNG | - Rotary Chair

What is the prognosis of Ototoxicity ? is it worse than unilateral?

YES, slower and worse prognosis compared to UVH - postural stability will NEVER return to 'normal' - may have difficulty with low light situations/ uneven terrain

What is the neuroanatomy affected with Central Vestibular Hypofunction?

Cerebellum, Brainstem, Vestibular nuclei (S,L,I,M)

important SIGNS for CENTRAL VH

- Impaired Mvmt coordination (heel shin, finger nose) - Ataxia - the loss of full control of bodily movements. - Impaired VOR cancellation - Saccadic Smooth pursuit - Abnormal saccades - 4 D's

What are Non-Vestibular Causes of Dizziness?

- Multi-factorial Faller - Orthostatic HypoTN - Arrhythmias - Diabetes - Hypoglycemia - Infection - Medications - Panic Attacks - Anxiety