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NEUROLOGY > Vastibular and Auditory pathway > Flashcards

Vastibular and Auditory pathway Flashcards

1
Q

Where is the vestibule?

A
  • central portion of inner ear

the system is found within the TEMPORAL bone

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2
Q

What is the vestibular system responsible for?

A
  • balance, posture and equilibrium

- coordinates head and eye movement

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3
Q

What makes up the Vestibular system?

A
  • 3 Semicircular canals —-that lie on diff. planes
    (X,Y,Z)
    —-filled with endolymph
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4
Q

What do the ampulla of the semicircular canals contain?

A
  • – hair cells that BEND with rotation
  • —-these hair cells RELEASE NT > AP prodn
  • —-signals produced is based on MOTION
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5
Q

Which organs of the vestibule contain otolith?

A

-UTRICLE and SACCULE

otolith= ear stones= Calcium carbonate crystals

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6
Q

What is the otolith responsible for?

A
  • —sits on TOP of hair cells
  • drags hair cells in response to LINEAR MOTION (up, down, forward and backward)
  • —-generating VESTIBULAR neural activity
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7
Q

Where does the Vestibular nerve send signals to ?

A
  • the BRAINSTEM (vestibular nuclei)

- the CEREBELLUM

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8
Q

Where is the vestibular nuclei found?

A
  • beneath the FLOOR of the 4th ventricle (in PONS/ MEDULLA)
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9
Q

3 typical symptoms a.w dysfxn of the Vestibular system?

A
  • VERTIGO: spinning room (when head is still)
  • nystagmus
  • N.V
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10
Q

Describe how nystagmus presents as?

A
  • rhythmic beating of the eyes
  • –slow drift of eye to one direction
  • —correction to the other directions
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11
Q

What form of nystagmus does a pt have, if their RIght eye quickly corrects to the left side?

A
  • Left-ward nystagmus

- –named for direction of the fast correction

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12
Q

Name the diff. types of nystagmus, which indicate a PERIPHERAL vestibular dysfxn.

A
  • left, right and torsional

- –issues with the vestibular apparatus in the INNER ear

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13
Q

Name the types of nystagmus a.w CENTRAL vestibular dysfxn.

A

UPBEAT and DOWNBEAT

—in brainstem lesions (strokes/ tumors)

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14
Q

Which form of nystagmus is bad, central or peripheral?

A

CENTRAL

  • –indicative of potential:
  • brainstem/cerebellar lesion
  • TIA/ vertebrobasilar stroke
  • tumor (posterior fossa)
  • cerebellar infarction and hemorrhage
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15
Q

Name benign causes of nystagmus.

A 
- peripheral lesions/ conditions
> Inner Ear problem
> BPV (benign positional vertigo) 
> vestibular neuritis
> Meniere's disease
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16
Q

What are the signs of Central vertigo?

A
  • pure VERTICAL nystagmus
  • —nystagmus changes direction with gaze (look r; upbeat/ L= downbeat)
  • DIPLOPIA
  • DYSMETRIA (nose-finger test)
  • —skew deviation (vertical misalignment of the eyes)
  • POSITIONAL testing= IMMEDIATE nysatgmus

—-other CNS symptoms

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17
Q

What is seen with peripheral nystagmus?

A
  • mixed horizontal and torsional nystagmus
  • —DELAYED nystagmus (on positional testing)
  • —nystagmus FATIGUES over time
  • —-stable ROMBERG
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18
Q

How to perform postional testing?

A
  • DIX-HALLPIKE MANEUVER
  • –done to reproduce vertigo and cause NYSTAGMUS
  • –seated pt, turn head to side; rapidly lie pt on table; heading hanging over end
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19
Q

What helps DX BPV?

A
  • Dix Hallpike Maneuver
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20
Q

What is seen in a typical DHM?

A
  • BPV
  • —no symptoms for 5-10s
  • —-room spins (vertigo) and TORSIONAL nystagmus occurs
  • —resolved with SITTING up
  • FEWER symptoms with repeated maneuvers
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21
Q

Why does BPV develop?

A
  • Nystagmus that develops due to HEAD turning and positioning
  • due to calcium debris in the semicircular canals; weighs down on hair cells (CANALITHIASIS) —-
22
Q

What helps BPV to go away?

A
  • Epley Maneuver (repositions otoconia)
23
Q

What causes vestibular neuronitis?

A
  • VIRAL or POST-inflammatory neuropathy of the VESTIBULAR portion of CN VIII
  • –benign/ self limited
24
Q

What occurs in Meniere’s disease?

A
  • endolymph fluid accumulation
    (HYDROPS)
    —swelling of the labyrinthine system
25
Q

What are the signs and symptoms of Meniere’s disease?

A
  1. TINNITUS
  2. Sensorineural hearing loss (WEBER is LOUDER in NORMAL ear) —Rinne: AC> BC
  3. Vertigo
26
Q

How to treat meniere’s disease?

A
  • avoid high salt (REDUCES swelling)
  • avoid caffeine, nicotine (vasoconstrictors, reduce flow from inner ear)
  • diuretics
27
Q

What are the 3 bones of the inner ear? What do these bone do?

A

Malleus, INcus and Stapes

- amplify the tympanic membrane motion

28
Q

What does the stapes do?

A
  • PUSHES the fluid-filled cochlea

- —-> tiny hair cells get stimulated; depending on freq. of sound ===> electrical signal is generated

29
Q

Once sound is picked up by the cochlear nerve, where to next?

A
  • cerebellopontine angle
  • —LATERAL pons

—–at this angle most brainstem lesions with hearing loss is here

30
Q

What is conductive hearing loss? Why may it come about?

A
  • Sound waves CAN’T convert to NERVE signals

- —d.t obstruction (WAX), INFECTION (otitis media) or otosclerosis (bony OVERGROWTH of stapes)

31
Q

What causes sensorineural hearing loss?

A
  • issue with the nerve
  • d.t Cochlea disease/ cochlear nerve failure (acoustic neuroma)
    or CN damage
32
Q

What is presbycusis?

A
  • age-related hearing loss

- –degen. of ORGAN of CORTI > sensorineural hearing loss (slow developm)

33
Q

What is a NORMAL Weber’s Test?

A
  • should be heard EQUALLY in both ears; when tuning fork is placed on the forehead
34
Q

Does the Weber test indicate what type of hearing loss the pt has?

A

NO

—just makes you aware of A POTENTIAL hearing defect

35
Q

In Weber test, if the pt has conducitve hearing loss in the right ear. What is the expected results in this test?

A
  • LOUDER in the BAD ear in CONDUCTIVE hearing loss
  • —no background noise
  • –louder in R ear
36
Q

IF the pt has sensorineural hearing loss in the L ear, what is expected in the Weber test?

A
  • LOUDER in the GOOD ear
  • —no nerve to sense condxn
  • –LOUDER in R ear
37
Q

What is a normal Rinne Test?

A
  • AC >BC

should be easy for sound waves to move through AIR and not bone

38
Q

What is expected in conductive hearing loss in Rinne Test ?

A

—pt CANNOT hear NEXT to the ear

AC

39
Q

What is expected in Sensorineural hearing loss in Rinne test?

A
  • AC >BC
  • —but BOTH are reduced
  • –in bad ear just 5s of AC and BC (as opposed to 10s in good ear)
40
Q

What are the results for RINNE and WEBER in CONDUCTIVE HEARING LOSS?

A

WEBER: LOUDER in BAD ear

RINNE: AC

41
Q

What results for sensorineural hearing loss?

A

WEBER: louder in GOOD wear

RINNE: reduced AC>BC (like normal)

42
Q

How to truly diagnose hearing loss?

A

with AUDIOMETRY

43
Q

When may one experience SUDDEN hearing loss?

A
  • after LOUD noise

- —d/t TYMPANIC membrane rupture

44
Q

What occurs with LONG -term exposure to noise?

A
  • damage tociliated cells of Organ of Corti

- —-high freq. is LOST

45
Q

Where do fibres carrying info with LOW freq. sound end?

A
  • in the ANTEROLATERAL part of the auditory cortex

——posteromedial part for HIGH freq. sound)

46
Q

What happens with damage to Broca’s area?

A
  • diff. to PRODUCE language
  • -aka MOTOR aphasia
  • no problem comprehending
47
Q

What occurs with damage to Wernicke’s Area?

A
  • can’t comprehend language

- —-puts words out of order and make up meaning less word

48
Q

What does the vestibular nuclei relay info to ?

A
  • thalamus
  • Cerebellum
  • Nuclei of CNs III, IV, VI
  • Cerebellum
  • Spinal cord
49
Q

Where does the LOWER visual field projected to ?

A
  • to the gyrus SUPERIOR to the calcarine sulcus

—upper is projected to gyrus inferior to the calcarine sulcus

50
Q

Where does the macula project to?

A
  • to the POSTERIOR pole of VISUAL cortex

- —occupies GREATER proportion of the cortex

51
Q

How does the upper visual field end up projecting to the gyrus INFERIOR to the calcarine sulcus?

A

—-upper visual field fibres from the geniculocalcarine tract will first LOOP anteriorly AROUND the TEMPORAL part of lateral ventricle in Meyer’s loop

NEUROLOGY (36 decks)

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