Non-BPPV Vestibular Exam Flashcards
what are the oculomotor tests?
gaze evoked nystagmus
vergence
smooth pursuit
saccades
what are the VOR tests?
head shake nystagmus test
head impulse test
dynamic visual acuity
VORx1
VORx2
VORc
what does spontaneous nystagmus test determine?
peripheral (decreased w/ fixation) vs central (unaffected by fixation)
+ spontaneous nystagmus test for central vestibular
no change in intensity
direction changing
not fatiguable
(-) spontaneous nystagmus test for peripheral vestibular
nystagmus increases with Frenzels
unidirectional/fixed
fatiguable
+ central sign for Gaze Evoked Nystagmus test
intensity of nystagmus increases with gaze in any direction
not fatigable
+ peripheral sign (non-BPPV) for Gaze Evoked Nystagmus test
intensity of nystagmus increases when looking in direction of fast phase
fatigable
how does 1st degree nystagmus present (GEN test)?
chronic; 1 wk
nystagmus present with gaze in all 3 directions
most intense when gaze towards healthy ear
how does 2nd degree nystagmus present (GEN test)?
after few days
nystagmus present with gaze center and towards healthy ear
how does 3rd degree nystagmus present (GEN test)?
1st day; acute lesion
nystagmus present in all directions
fastest towards healthy ear
normal test for vergence
target at least 6 cm from nose before pt sees double
abnormal test for vergence
deconjugate eye movement
diplopia before 6 cm
aversion reaction
how far to hold target away for oculomotor testing?
12-18 inches
how far to move target in each direction for smooth pursuit and saccade testing?
30 deg
abnormal finding for smooth pursuit test?
saccadic intrusions
central sign
abnormal test for saccades
over or under shooting
slow scan instead of quick jump
VOR is driven at __ Hz
2 Hz (1 cycle = 120 bpm)
amplitude of movement for VOR
60 deg (30 each direction)
how should head be positioned for head shake test?
flexed 30 deg
procedure for head shake test?
flex head to 30 deg
PASSIVELY shake QUICKLY (2 Hz) for 20 seconds
stop and look straight - observe for nystagmus
abnormal head shake test
direction fixed nystagmus (>2 beats) towards intact side
what is the most sensitive VOR test?
head impulse or head thrust test
which Ewald Law is tested with head impulse/head thrust test?
2nd - vestibular nerve can increase firing with increasing intensities without compensatory saccade
head impulse/head thrust test procedure
hold head 12-18” away
pitch head 30 deg
tell to focus on nose
PASSIVELY, SLOWLY move pt head side
quick, unexpected thrust
which canal is stimulated in head impulse/head thrust test?
horizontal
what is suspected?
pt’s eyes jump back to PT’s nose during head impulse/head thrust test when quickly moved head to the R
right vestibular hypofunction
abnormal DVA test for UNILATERAL vestibular hypofunction
3 or more line difference and dizziness
abnormal DVA test for BILATERAL vestibular hypofunction
3 or more line difference + oscillopsia and postural instability (NO DIZZY)
VOR x1 test procedure
pt actively moves head 20-30 deg at 120/240 bpm while keeping eyes on target held at 12-18 inches away at eye level
abnormal VOR x1 test
target blurry or jumping
unable to move head at 2 Hz
VOR x2 test procedure
active head movement with target moving side to side as fast as can
abnormal VOR x2 test
target blurry
target jumping
dizziness
lesions where will cause inability to cancel VOR?
cerebellum - flocculus or paraflocculus
which test assess visual-vestibular integration in CNS?
VOR cancellation
