Lecture 8: Vestibular Dysfunction Flashcards
What is important to rule out before testing for BPPV?
VBI
What are sx of VBI?
5D 3N 1A
dizziness, diplopia, dysarthria, dysphagia, drop attacks
nausea, nystagmus, numbness of face
ataxic gait
What can be causes of VBI?
an occlusion cause by bone spurs, OA instability
What is Unilateral vestibular loss caused by?
aka peripheral hypofunction
vestibular neuritis, labrynthitis, viral or bacteria infection, acoustic neuroma, temporal bone fx or trauma, aging
What is PP of UVH?
vertigo crisis- sudden onset of vertigo, N/V and imbalance that warrants ER visit
sx lasting 24-72 hours
gradual return to baseline with some vertigo and imbalance
What is UVH neuritis?
inflammation of superior portion of vestibular nerve- the branch associated with balance resulting in vertigo but NOT hearing loss
What is UVH neuronitis?
damage specifically to sensory neurons of vestibular ganglia similar sx to neuritis
What is UVH labyrinthitis?
inflammation of labyrinth and affects both branches of CN 8 resulting in vertigo and hearing loss
What are key diagnostic features of a UVH?
horizontal nystagmus, postural instability, positive head thrust and reduced caloric response on ENG
What is medical tx for UVH?
- vestibular suppressant (meclizine)
- vestibular rehab to improve sx
- treat underlying cause
What is chronic UVH?
“recurrent vestibulopathy”
pp with multiple episodes of vertigo
sx vary from 5 minutes to 24 hours (no hearing loss)
Sx not always brought on by head turns
What is likely cause of chronic UVH?
decrease of afferent discharge in the vestibular nerve likely due to a virus
What is the most common cause of bilateral vestibular loss?
ototoxicity from antibiotics most likely gentamicin
Why is bilateral loss common in elders?
due to a normal decrease in the number of hair cells and vestibular neurons along with drop in the ability of vestibular system to compensate
Why is knowing elders lose vestibular function important to PT?
highlighting need to incorporate vestibular assessment when working with geriatrics
What is PP of bilateral VH?
imbalance especially when eyes closed or in dark, oscillopsia (blurring of eyes)
if complete loss- no vertigo, N/V
if incomplete- sx of vertigo but less severe of UVH
What is Meniere’s disease?
development of endolymph hydrops in the cochlea creating malabsorption of endolymph and an increase in pressure
What is PP of Meniere’s?
same as UVH but also with aural fullness and tinnitus (ringing of ears) and reversible hearing loss
Is vestibular rehab appropriate for Meziere’s?
No bc their sx will resolve in between episodes
use vest suppressants, diuretics, lifestyle mods
Where is likely location of a CNS vestibular pathology?
involves vestibular nuclear complex of cerebellum
What are common diagnosis with CNS vest problem?
brainstem strokes, head trauma, migraine related vestibulopathy, MS, cerebellar degradation
What is the main problem associated with CNS issues?
integration and processing of sensory input from vestibular, visual and somatosensory systems are impaired
What is clinical PP of CVD of CNS?
lateropulsion (while standing), ocular tilt, vertigo, N/V, ataxia, vertical deviation of perceived straight ahead, past pointing, vertical nystagmus, impaired smooth pursuits or saccades, concomitant D’s
What are 6 Concomitant D’s of CVD?
diplopia, dysarthria, dysmetria, dysphagia, dizziness, drop attacks
What is different between peripheral vertigo and CNS vertigo?
CNS less severe can get through day where UVH vertigo is debilitating
What is skew deviation?
associated with CVD, downward vertical strabismus
commonly with lesions of brainstem
What is HINTS?
Head Impulse Nystagmus Test of Skew, used to diagnose acute vestibular syndrome, is it peripheral or Cerebellar?
What are 3 things used to differentiate between a neuritis and cerebellar stroke?
normal head thrust, direction changing nystagmus and skew deviation
What percentage of head traumas result in vestibular dysfunction?
30-65%
most common is labyrinthine concussion
What are sx to help determine if vestibular dysfunction is from head trauma?
vertigo, tinnitus, HA, severe imbalance, mood disorders, sleep disorders, cognitive deficits
What are risk factors for delayed outcome of healing?
young age, female, migraines, motion sickness, learning disability, mood disorders , dizziness at time of injury or repetitive concussions
What is cervicogenic dizziness?
type of vestibular condition that is more peripheral and concussion like
non specific sensation of altered orientation in space and disequilibrium
What is cause of cervicogenic dizziness?
inflammation of cervical roots or facet joints leading to abnormal afferent signals from neck
usually arises with previous neck injury and pain
What are sx of cervicogenic dizziness?
dizziness (not vertigo), c spine pain, postural imbalance, possible decreased Cervical ROM, HA
What are specific exams for cervicogenic dizziness?
- traction- reduction in sx
- smooth pursuit neck torsion
- head and neck differentiation test (moving pts body on stable head)
What is tx for cervicogenic dizziness?
manual therapy techniques for OA, AA
cervicokinesthetic re-ed
What is migrainous vertigo?
vertigo as a result of migraine aura, secondary to wave of neuronal and glial depolarization
What is etiology of migrainous vertigo?
genetic or hereditary but pathophysiology is less understood
What are sx of migrainous vertigo?
vertigo with aura, N/V, photophobia and phonophobia, HA, less severe tinnitus
better with sleep or rest
What is important to remember about vestibular rehab with migrainous vertigo?
HA must be managed medically for rehab to be effective
What are 3 rehab considerations for migrainous vertigo?
- habituation exercise- to decrease sensitivity to activities that provoke dizziness
- postural control exercises- improve equilibrium
- activity modification- rest/relaxation, structured lifestyle
What are some other reasons why vestibular function decreases in elderly?
degenerative changes in otoconia and sludgy endolymph makes displacement of otoconia more problematic
