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Neuro 2 Midterm Exam > Lecture 8: Vestibular Dysfunction > Flashcards

Lecture 8: Vestibular Dysfunction Flashcards

1
Q

What is important to rule out before testing for BPPV?

A

VBI

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2
Q

What are sx of VBI?

A

5D 3N 1A

dizziness, diplopia, dysarthria, dysphagia, drop attacks

nausea, nystagmus, numbness of face

ataxic gait

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3
Q

What can be causes of VBI?

A

an occlusion cause by bone spurs, OA instability

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4
Q

What is Unilateral vestibular loss caused by?

A

aka peripheral hypofunction

vestibular neuritis, labrynthitis, viral or bacteria infection, acoustic neuroma, temporal bone fx or trauma, aging

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5
Q

What is PP of UVH?

A

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

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6
Q

What is UVH neuritis?

A

inflammation of superior portion of vestibular nerve- the branch associated with balance resulting in vertigo but NOT hearing loss

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7
Q

What is UVH neuronitis?

A

damage specifically to sensory neurons of vestibular ganglia similar sx to neuritis

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8
Q

What is UVH labyrinthitis?

A

inflammation of labyrinth and affects both branches of CN 8 resulting in vertigo and hearing loss

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9
Q

What are key diagnostic features of a UVH?

A

horizontal nystagmus, postural instability, positive head thrust and reduced caloric response on ENG

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10
Q

What is medical tx for UVH?

A
  1. vestibular suppressant (meclizine)
  2. vestibular rehab to improve sx
  3. treat underlying cause
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11
Q

What is chronic UVH?

A

“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

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12
Q

What is likely cause of chronic UVH?

A

decrease of afferent discharge in the vestibular nerve likely due to a virus

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13
Q

What is the most common cause of bilateral vestibular loss?

A

ototoxicity from antibiotics most likely gentamicin

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14
Q

Why is bilateral loss common in elders?

A

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

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15
Q

Why is knowing elders lose vestibular function important to PT?

A

highlighting need to incorporate vestibular assessment when working with geriatrics

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16
Q

What is PP of bilateral VH?

A

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

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17
Q

What is Meniere’s disease?

A

development of endolymph hydrops in the cochlea creating malabsorption of endolymph and an increase in pressure

18
Q

What is PP of Meniere’s?

A

same as UVH but also with aural fullness and tinnitus (ringing of ears) and reversible hearing loss

19
Q

Is vestibular rehab appropriate for Meziere’s?

A

No bc their sx will resolve in between episodes

use vest suppressants, diuretics, lifestyle mods

20
Q

Where is likely location of a CNS vestibular pathology?

A

involves vestibular nuclear complex of cerebellum

21
Q

What are common diagnosis with CNS vest problem?

A

brainstem strokes, head trauma, migraine related vestibulopathy, MS, cerebellar degradation

22
Q

What is the main problem associated with CNS issues?

A

integration and processing of sensory input from vestibular, visual and somatosensory systems are impaired

23
Q

What is clinical PP of CVD of CNS?

A

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

24
Q

What are 6 Concomitant D’s of CVD?

A

diplopia, dysarthria, dysmetria, dysphagia, dizziness, drop attacks

25
Q

What is different between peripheral vertigo and CNS vertigo?

A

CNS less severe can get through day where UVH vertigo is debilitating

26
Q

What is skew deviation?

A

associated with CVD, downward vertical strabismus

commonly with lesions of brainstem

27
Q

What is HINTS?

A

Head Impulse Nystagmus Test of Skew, used to diagnose acute vestibular syndrome, is it peripheral or Cerebellar?

28
Q

What are 3 things used to differentiate between a neuritis and cerebellar stroke?

A

normal head thrust, direction changing nystagmus and skew deviation

29
Q

What percentage of head traumas result in vestibular dysfunction?

A

30-65%

most common is labyrinthine concussion

30
Q

What are sx to help determine if vestibular dysfunction is from head trauma?

A

vertigo, tinnitus, HA, severe imbalance, mood disorders, sleep disorders, cognitive deficits

31
Q

What are risk factors for delayed outcome of healing?

A

young age, female, migraines, motion sickness, learning disability, mood disorders , dizziness at time of injury or repetitive concussions

32
Q

What is cervicogenic dizziness?

A

type of vestibular condition that is more peripheral and concussion like

non specific sensation of altered orientation in space and disequilibrium

33
Q

What is cause of cervicogenic dizziness?

A

inflammation of cervical roots or facet joints leading to abnormal afferent signals from neck

usually arises with previous neck injury and pain

34
Q

What are sx of cervicogenic dizziness?

A

dizziness (not vertigo), c spine pain, postural imbalance, possible decreased Cervical ROM, HA

35
Q

What are specific exams for cervicogenic dizziness?

A
  1. traction- reduction in sx
  2. smooth pursuit neck torsion
  3. head and neck differentiation test (moving pts body on stable head)
36
Q

What is tx for cervicogenic dizziness?

A

manual therapy techniques for OA, AA

cervicokinesthetic re-ed

37
Q

What is migrainous vertigo?

A

vertigo as a result of migraine aura, secondary to wave of neuronal and glial depolarization

38
Q

What is etiology of migrainous vertigo?

A

genetic or hereditary but pathophysiology is less understood

39
Q

What are sx of migrainous vertigo?

A

vertigo with aura, N/V, photophobia and phonophobia, HA, less severe tinnitus

better with sleep or rest

40
Q

What is important to remember about vestibular rehab with migrainous vertigo?

A

HA must be managed medically for rehab to be effective

41
Q

What are 3 rehab considerations for migrainous vertigo?

A
  1. habituation exercise- to decrease sensitivity to activities that provoke dizziness
  2. postural control exercises- improve equilibrium
  3. activity modification- rest/relaxation, structured lifestyle
42
Q

What are some other reasons why vestibular function decreases in elderly?

A

degenerative changes in otoconia and sludgy endolymph makes displacement of otoconia more problematic

Neuro 2 Midterm Exam (11 decks)

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