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Neurology > Principles of Vestibular and Cerebellar Disease > Flashcards

Principles of Vestibular and Cerebellar Disease Flashcards

1
Q

Define ataxia…

A

A neurological sign of gross incoordination of muscle movements.

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2
Q

What are the three types of ataxia?

A

Sensory
Vestibular
Cerebellar

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3
Q

Define hypometria, hypermetria and dysmetria…

A

Hypometria - Shorter protraction phase of gait
Hypermetria - Longer protraction phase of gait
Dysmetria - Ability to control the distance, power and speed of an action is impaired, combination of hypo- and hypermetria

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4
Q

What parts of the nervous system make up the proprioceptive pathways?

A 
Peripheral never
Dorsal root
Spinal cord
Brainstem 
Forebrain
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5
Q

What are the clinical signs of sensory ataxia?

A

Abnormal postural reactions

Limb paresis

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6
Q

What makes up the vestibular apparatus? What is it’s role in the body?

A

Vestibular nuclei
Vestibular portion of VIII
Vestibular receptors
Controls balance between extensor and flexor muscles

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7
Q

What are the clinical signs of vestibular ataxia?

A 
Head tilt
Leaning, falling or rolling to one side
Abnormal nystagmus
Positional stabismus
Normal/abnormal postural reactions
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8
Q

What are the clinical signs of cerebellar ataxia?

A

Wide-based stance
Intention tremors of the head
Loss of balance and truncal sway
Delayed onset dysmetric hopping
Ipsilateral menace deficits with normal vision
No limb paresis or conscious proprioception deficits
Pendular nystagmus

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9
Q

What is assessed in the observation portion of the neuro exam?

A

Mentation
Posture
Gait
Abnormal involuntary movements

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10
Q

What is assessed in the hands-in portion of the neuro exam?

A

Postural reactions
Cranial nerves
Spinal reflexes, muscle tone and size
Sensory evaluation

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11
Q

Where is the peripheral vestibular system location?

A

In the ear canal

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12
Q

What reflex tests the vestibular system?

A

The occulovestibular reflex - flicking of the eyeline when the head is turned in different directions

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13
Q

What part of the vestibular system assess:
- Head motion and acceleration
- Head position and gravity
Where is the information from these and sensory inputs coordinated?

A
  • Semi circular canals
  • Saccule and urticule
    Vestibular nuclei
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14
Q

How is information from the vestibular system outputted?

A

Forebrain, perceived orientation
SC and cerebellum
Oculomotor system, eye movements

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15
Q

What can input information to the vestibular nuclei?

A 
Semicircular canals
Saccule and utricule
Cerebellum (inhibitory)
Spinal cord
Pontine reticular formation
Contralateral vestibular nuclei
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16
Q

How do head turns and tilts differ?

A

Turn - median plane of the head, nose turned to one side (forebrain)
Tilt - rotation of the median plane of the head, one ear is lower than the other (vestibular)

17
Q

Which breeds suffer from physiological nystagmus? What can cause pendular nystagmus? How does it differ from jerk nystagmus?

A

Siamese, Birman and Himalayan

Congenital abnormality or cerebellar disorders and visual deficits

Has no slow or fast phase

18
Q

What are the clinical signs of Horner’s syndrome?

A 
Enophthalmos (retraction of eyeball into orbit)
3rd eyelid protrusion
Ptosis (drooping of upper eyelid)
Miosis (constriction of pupil)
Congested vessels
19
Q

What is an additional clinical sign of Horner’s in the horse and why?

A

Sweating - have different innervation of the sweat glands

20
Q

Which neural pathway is affected in Horner’s syndrome?

A

The sympathetic trunk of the autonomic system

21
Q

How can regional sweating patterns aid localisation of neural lesions in horses?

A

The lesion will be cranial to innervation of the area that is sweating

22
Q

What clinical signs differentiate central from peripheral disease?

A

Proprioceptive deficits - Central (Possible), Peripheral (No)
Consciousness - Central (Any), Peripheral (Alert)
CN deficits - Central (V-XII may be affected), Peripheral (VII only)
Vertical nystagmus - Central (Yes), Peripheral (No)

23
Q

What are the clinical signs of bilateral vestibular disease?

A

No nystagmus
No occulovestibular response
Head swaying from L to R

24
Q

What are the inputs to the cerebellum?

A

Visual
Auditory
Vestibular

25
Q

How are clinical signs of paradoxical vestibular disease similar/different to central vestibular disease?

A

Differences - Lesion is opposite side to head tilt

Same - All other clinical signs

26
Q

Where may a lesion occur to cause a paradoxical vestibular disease?

A

Caudal cerebellar peduncle

Para-flocculonodular lobe of cerebellum

27
Q

Outline the altered pathways in central and paradoxical vestibular disease that results in an opposite effect in the extensor muscle e.g. head tilt…

A

Central - Lesion after the vestibular nucleus limiting extensor muscle
Paradoxical - Lesion before the vestibular nucleus increasing extensor muscle

28
Q

What are the clinical signs of a lesion in the rostral lobe of the cerebellum?

A

Decerebellate position

29
Q

What are the clinical signs of a lesion of the caudal lobe of the cerebellum

A

Hypotonia (Poor muscle tone)
Hypermetria
Intention tremor

30
Q

What are the clinical signs of a lesion in the flocculonodular lobe of the cerebellum?

A

Drunken, broad based staggering gait
Loss of balance
Abnormal nystagmus

31
Q

What are the clinical signs of a lesion in the cerebellar nuclei?

A

Dilated pupil
3rd eyelid protusion
Enlarged palpebral fissure

32
Q

What are the clinical signs of cerebellar syndrome?

A 
Spastic, dys/hypermetria
Intention tremor
Ipsilateral menance deficit, normal vision
Broadbased stance
Postrual reactions
33
Q

What is an abnormal gait when a horse/dog is circled?

A

Crossing over of legs

34
Q

Which direction does jerk nystagmus occur?

A

Horizontal, vertical or rotary

35
Q

What is the role of the cerebellum?

A

Fine-tuning of movement

36
Q

Why can SA with vestibular disease suffer from Hroner’s sydrome?

A

Sympathetic fibres pass through bullae of ear thus vestibular disease can cause loss of sympathetic innervation

37
Q

What are the clinical signs of Horner’s syndrome in the horse?

A
  1. Enophthalmus
  2. Ptosis
  3. Miosis
  4. Conjunctival hyperaemia
  5. Prominent third eyelid
  6. Sweating

Neurology (12 decks)

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