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3D week 5 - the ear > vertigo (see DM) > Flashcards

vertigo (see DM) Flashcards

1
Q

what modulates normal balance

A

continuous interaction between vestibular, proprioceptive and visual mechanisms which are all modulated by the CNS

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2
Q

what is vertigo

A

a sensation of dizziness or abnormal motion resulting from a disorder of the sense of balance

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3
Q

how do environmental factors affect balance control (sensory pathway)

A

environmental interaction -> visual, vestibular and somatosensation systems provide info about the body position -> compare, select and combine sense -> determination of body position

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4
Q

if there is a lesion in the Thalamo-Cortical Structure what is the presentation (vestibular)

A

conscious illusion of spinning

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5
Q

if there is a lesion in the occulomotar nuclei what is the presentation (vestibular)

A

nustagmus

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6
Q

if there is a lesion in the spinal chord what is the presentation (vestibular)

A

lateropulsion (tendancy to veer to one side)

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7
Q

if there is a lesion in the cerebellum what is the presentation (vestibular)

A

gait ataxia

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8
Q

if there is a lesion in the autonomic medullary centres what is the presentation (vestibular)

A

autonomic symtpoms e.g. sweating, vomiting

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9
Q

what is vestibular compensation

A

a process that allows the brain to regain balance control and minimise dizziness symptoms when there is damage to one of the vestibular organs - due to ON/OFF tonic signaling from the vestibular organs

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10
Q

what changes are seen in the brains of ballet dancers (vestibular)

A

through spotting, the brain has adapted to suppress activity in the cerebrum and cerebellum associated with vestibular function

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11
Q

examples of general medical causes of vertigo (6)

A
  1. Anaemia
  2. postural Hypotension
  3. Carotid Sinus Syndrome
  4. Dysrhythmia
  5. Hypoglycaemia
  6. Hyperventillation
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12
Q

examples of neurological causes of vertigo (8)

A
  1. Epilepsy
  2. Migraine
  3. Syncope
  4. Psychogenic
  5. Multiple Sclerosis
  6. Cerebral Ischaemia
  7. Infective disorders
  8. Tumours
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13
Q

otological causes of vertigo (10)

A
  1. Menière’s Disease
  2. Post Traumatic Syndrome
  3. Positional Nystagmus
  4. Vestibular Neuronitis
  5. Infection
  6. Otosclerosis and Paget’s Disease
  7. Vascular accidents
  8. Tumours
  9. Auto-immune disorders
  10. Drug intoxication
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14
Q

what are the 3 most common peripheral vestibular causes of vertigo

A
  1. Benign Paroxysmal Positional Vertigo (BPPV)
  2. Menière’s disease (or syndrome)
  3. Vestibular Neuronitis
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15
Q

how does alcohol cause vertigo

A

the endolymph becomes less viscous with the consumption of alcohol, this allows the hair cells to move more easily within the ear, which sends the signal to the brain and results in exaggerated and overcompensated movements of body

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16
Q

what is “true vertigo” a disease of

A

the semicircular canals and their CNS connections - has accompanying symptoms of gait unsteadiness, nausea, vomiting etc.

17
Q

what is the commonest cause for single attack of vertigo

A

vestibular neuronitis

18
Q

what is the commonest cause for recurrent spontaneous vertigo

A

migraine

19
Q

what is the commonest cause for positional vertigo

A

BPPV

20
Q

what does a vertigo attack that lasts seconds indicate the cause could be

A

vestibular paroxsysms, cardiac arrythmias, BPPV

21
Q

what does a vertigo attack that lasts hours indicate the cause could be

A

meniere’s disease, migraine

22
Q

what does a vertigo attack that lasts days indicate the cause could be

A

vestibular neuronitis, brainstem/cerebellar stroke

23
Q

how to distinguish BPPV from other positional causes e.g. orthostatic hypotension

A

BPPV arises from a specific reorientation of the head e.g. rolling over in bed or turning the head, rather than a change in head position e.g. sitting to standing

24
Q

what does vertigo + red eyes, skin rashes arthritis etc. indicate

A

autoimmune inner-ear disease

25
Q

what does vertigo + diplopia, dysarthria, numbness, paresis etc. indicate

A

posterior fossa lesion (incl. ischaemia) or basilar migraine

26
Q

what is romberg’s test

A

asking the patient to stand up with their feet together and to close their eyes -> A positive Romberg means that the patient shows a tendency to actually fall

27
Q

what does a +ve romberg’s test indicate

A

dorsal column or severe afferent polyneuropathy

28
Q

what is unterberger’s test and what will a +ve result show

A

involves asking the patient to step up and down on the spot with eyes closed;
+ve result - In unilateral vestibular lesions the patient rotates towards the hypoactive side

29
Q

what is first degree nystagmus

A

Nystagmus with gaze deviation in the direction of the fast phase - i.e. it only occurs when the gaze is deviated

30
Q

what is second degree nystagmus

A

nystagmus when looking at a fixed spot straight ahead

31
Q

what are frenzel glasses

A

help to visualise nystagmus - magnifies the eyes and making it easier to see subtle movement and also preventing the patient from using ocular fixation to prevent nystagmus occurring

32
Q

what do saccades in the eyes indicate

A

central lesion (brain) -> pursuit is normal in vestibular disorders

33
Q

how does the vestibulo-ocular reflex stabilise the eyes during head movement

A

generates eye movement of the same speed, but opposite direction to head movements

34
Q

central vs peripheral nystagmus fatigability

A

central - persistant
peipheral - disappears on repitition

35
Q

what does an abnormal VOR indicate

A

vestibular lesion

36
Q

what types of drugs can cause vertigo

A

antidepressants, anticonvulsants, anxiolytics, anti-hypertensives, muscle relaxants

37
Q

what tumours commonly arise at the cerebello-pontine angle and what syptom do pts usually resent w

A

vestibular schwanomma - present w unilaterla hearing loss as the tumour grows on the vestibular nerve and exerts pressure onto the adjeacted auditory nerve -> tumour grows slowly and brain can recieve vestibular info from the other ear and so vertigo is not usually a presentaiton

38
Q

how does vestibular rehabilitation work

A

due to central compensation and CNS neuroplasticity rehabilitation exercises (e.g. cawthorn-cooksey) can allow for recalibration og vestibular reflexes

39
Q

why does nystagmus occur in BPPV

A

when the cupula is artificiall displaced by the crystals of otoconia it stimulates the VOR which triggers the slow phase of nystagmus, as the eyes respond to canalith-induced deflection of the cupula. This is then followed by a saccade in the opposite direction (the fast phase of nystagmus) via a corrective response by the brain

3D week 5 - the ear (5 decks)

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