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Neuro > Vestibular > Flashcards

Vestibular Flashcards

1
Q

What are the reflexes of the eyes?

A

VOR
Vestibulocollic reflex (VCR)
Vestibulospinal reflex (VSR)

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2
Q

definition: Generates eye movements that enable clear vision while the head is in motion

primary mechanism for gaze stability during movement

A

VOR

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3
Q

definition: eye reflex
- Acts on neck musculature to stabilize the head
- Looks like ataxia

A

vestibulocollic reflex (VCR)

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4
Q

definition: Generates compensatory body movement in order to maintain head and postural stability to prevent falls

A

vestibulospinal reflex (VSR)

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5
Q

The vestibular system is a (open/closed) system

A

closed

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6
Q

Includes the:
3 semicircular canals (SCC)
Cochlea and vestibule
Perilymphatic fluid

A

bony labyrinth

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7
Q

definition: structure that is suspended within bony by perilymphatic fluid and connective tissue

contains:
- membranous portions of the 3 SCC
- otholiths
- endolymphatic fluid

A

membranous labyrinth

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8
Q

The membranous portions of the 3 SCCs have one widened end to form the ___.

A

ampulla

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9
Q

(true/false) Endolymph and perilymph do not mix under normal circumstances

A

true

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10
Q

Where is perilymphatic fluid found?

A

in the bony labyrinth

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11
Q

Where are the hair cells of the vestibular system found?

A

ampulla and otoliths

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12
Q

definition: calcium carbonate crystals that weight the otolithic membrane down

  • Can fall off, move into the ampulla, and get lodged in the cupula
A

otoconia

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13
Q

What do the SCCs provide?

A

sensory input about the head velocity

–> enables VOR to generate eye movement that matched the velocity of the head

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14
Q

Each canal plane within each labyrinth is _____ to the other canal planes

A

perpendicular

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15
Q

(true/false) Angular head motion occurs in a shared plane

A

true

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16
Q

Endolymph of the coplanar pair is dislocated in ___ directions with respect to ampullae

A

opposite

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17
Q

Coplanar pairing of canals is associated with a push-pull change in the quantity of ___ output.

A

SCC

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18
Q

definition: push-pull pairing

A

co-planar pairing

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19
Q

The canals are arranged in such a way that each canal on the left side has an almost ____
counterpart on the right side.

A

almost parallel

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20
Q

Horizontal canals are ___% elevated.

A

30%

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21
Q

What do otoliths do?

A
  • Register forces related to linear acceleration
  • Respond to both linear head motion and static tilt
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22
Q

Otoliths respond to ___ motion and ___.

A

linear motion and acceleration

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23
Q

The vestibular nerve transmits AFFERENT signals from the labyrinths along its course through the ______.

A

internal auditory canal (IAC)

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24
Q

What structures do the internal auditory canal contain?

A

Vestibular nerve
cochlear nerve
facial nerve
nervus intermedius
Labyrinthine artery

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25
Q

definition: Afferent projection from the bipolar neurons of Scarpa’s (vestibular) ganglion

A

Vestibular nerve

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26
Q

What is the primary central processor of vestibular input? What does it do?

A

Vestibular nuclear complex

Implements direct, fast connections between incoming afferent information and motor output neurons

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27
Q

What is considered as an adaptive central processor of vestibular input? What does it do?

A

cerebellum

Monitors vestibular performance and readjusts vestibular central vestibular processing if needed

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28
Q

What are the 4 major nuclei of the vestibular nuclear complex?

A

Superior
Medial
Lateral
Descending

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29
Q

There are at least ____ minor nuclei in the vestibular nuclear complex

A

7

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30
Q

What are the components of VOR?

A

Angular (SCC) and linear (otoliths)

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31
Q

Gaze stabilization is correlated with ___ VOR.

A

angular

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32
Q

When does BPPV occur?

A

With changes in position

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33
Q

What does true vertigo include?

A

The sensation of spinning

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34
Q

What are characteristics of BPPV?

A
  • Brief episodes of vertigo
  • Uncommon in children but reported in adults of all ages
  • May have both spontaneous occurrence and remission
  • Reports of this happening before
  • Head trauma
  • Viral neuronitis
  • balance issues
    vague sensations/floating feeling
  • lightheadedness
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35
Q

What is the most common vestibular disorder?

A

BPPV

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36
Q

What causes BPPV?

A

movement of detached otoconia within the ear

OR

otoconia are adherent to the cupula

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37
Q

definition: otoconia are adhered to the cupula

A

cupulolisthasis

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38
Q

definition: movement of detached otoconia in the endolymph of the ear canal

A

canalithiasis

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39
Q

Debris adhere to the cupula (decreases/increases) density

A

increases

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40
Q

What are the characteristics of cupulolisthiasis?

A
  • immediate onset of vertigo when moved into a provoking position
  • nystagmus
  • persistence of vertigo and nystagmus as long as the patient’s head is in a provoking position
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41
Q

What are the characteristics of canalithiasis?

A
  • delay in onset of vertigo from 1-40 seconds after the patient was moved into a provoking position
  • nystagmus
  • fluctuation in the intensity of vertigo and nystagmus which increase and then decrease within 60 seconds
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42
Q

What SCC is commonly involved with BPPV?

A

posterior

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43
Q

(true/false) BPPV will not have nystagmus when returning to a sitting position

A

FALSE (it will be present)

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44
Q

What is the most common BPPV test?

A

dix-hallpike

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45
Q

What is a (+) test on Dix-hallpike for right posterior SCC involvement?

A

up-beating and right torsion

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46
Q

What is a (+) test on Dix-hallpike for right anterior SCC involvement?

A

down-beating and right torsion

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47
Q

What is a (+) test on Dix-hallpike for left anterior SCC involvement?

A

down-beating and left torsion

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48
Q

(true/false) Dix-hallpike test can trigger vertigo due to anterior canal being in a more dependent position when downward

A

true – will be down-beating and torsional

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49
Q

What test is done to rule out horizontal canal BPPV?

A

roll test

50
Q

When do you perform a roll test?

A

After getting a (-) dix-hallpike test

51
Q

(true/false) During a roll test, vertigo and nystagmus will occur when the head is turned to the right AND the left

A

true

52
Q

When do you rule in horizontal canal BPPV during the roll test?

A

When nystagmus is present

53
Q

Duration of nystagmus and patient’s complaints are believed to be worse when the head is turned toward the affected ear in ________.

A

canalithiasis

54
Q

Duration of nystagmus and patient’s complaints are believed to be worse when the head is turned toward the less symptomatic ear in _____.

A

cupulolisthiasis

55
Q

You will see ___ nystagmus with canalithiasis.

A

geotropic (quick downward beating)

56
Q

Nystagmus with canalithiasis (will/will not) fatigue.

A

it will

57
Q

Nystagmus with cupulolisthiasis (will/will not) fatigue.

A

will not

58
Q

You will see ___ nystagmus with cupulolisthiasis.

A

apogeotopic (quick beats upward)

59
Q

What treatment(s) are used with anterior/posterior canal BPPV?

A

CRP/CRT for ant/post canal BPPV (Epley)
Brandt-Daroff habituation exercises

60
Q

What are post treatment instructions after performing the epley?

A

Stay upright for 5-20 minutes after treatment

61
Q

What are the treatment(s) for posterior SCC cupulolisthiasis and canalisthiasis? Which one are they more commonly used for?

A

semont/liberatory maneuver
More commonly used with cupulolisthiasis

62
Q

What are the treatment(s) for horizontal SCC BPPV w/ Canalisthiasis?

A

CRT for Horizontal SCC BPPV, canalisthiasis (270/360 degree roll)

appiana

Forced prolonged sitting

63
Q

What are the treatment(s) for horizontal SCC BPPV w/ cupulolisthiasis?

A

semont/casini for Horizontal canal cupulolisthiasis

64
Q

When performing CRP/CRT for anterior/posterior canal BPPV, the patients eyes (should/should not) be fixed.

A

should not… use frenzel lenses or IR goggles

Why? Horizontal and vertical nystagmus can be suppressed by visual fixation

65
Q

What should you do first when treating balance problems caused by BPPV?

A

attempt to resolve vertigo first

66
Q

Vague imbalance with BPPV tends to resolve without intervention after ___ weeks.

A

2 weeks

67
Q

(true/false) Medication can delay vestibular adaptation.

A

true

68
Q

What are s/s of CNS pathology?

A
  • acoustic neuromas
  • MS
  • brainstem TIAs
  • cerebellar disorders
  • migraines
  • numbness
  • tingling
  • weakness
  • slurred speech
  • tremors
  • decreased coordination
  • UMN s/s
  • LOC
  • memory loss
  • visual field loss
  • CN dysfunction
  • spontaneous nystagmus after 2 weeks
  • vertical nystagmus without torsion
69
Q

Vertical nystagmus without torsional component (is/is not) BPPV

A

is not BPPV

70
Q

Asking patient to look at a point and have them follow it while keeping their head still (keep the white of their eye in focus)

A

gaze-evoked nystagmus

71
Q

Seeing if the nystagmus occurs at the end range of eye movement

A

end-point nystagmus

72
Q

(true/false) End-point nystagmus is not normal

A

False (it is normal)

73
Q

Direction-changing, gaze-evoked nystagmus is a sign of _____.

A

central lesion

74
Q

When does spontaneous nystagmus occur?

A

Room light while resting

75
Q

definition: Tracking a moving object- 4 seconds from one side back to other

A

smooth pursuit

76
Q

Smooth pursuit test can asses what CNs?

A

III, IV, VI

77
Q

definition: Look back and forth between two horizontal or vertical targets

A

saccadic eye movements

78
Q

definition: an illusion of an unstable vision, made up of the perception of the to-and-fro movement of the environment

A

oscillopsia

79
Q

(true/false) Skew deviations during oculomotor and VOR testing are named after the elevated side event though the side affected is the dropped eye.

A

true

80
Q

Skew deviations should resolve within ___-___days of insult

A

3-7 days

81
Q

definition: when the eyes are not aligned

A

Skewed deviation

82
Q

Dynamic visual acuity test evaluates ____ function.

A

VOR function

83
Q

What test is this? What is a (+) test?

  1. read the eye wall chart with head in stationary
  2. gently oscillate the head
A

Dynamic visual acuity…

(+) visual acuity degrades by 3 or 4 lines (uncompensated unilateral vestibular loss)

84
Q

(true/false) Coordination is commonly affected with vestibular lesions

A

FALSE

85
Q

What vestibular disorder is postural issues found with?

A

central vestibular disorders

86
Q

What system does the vestibular system influence?

A

autonomic nervous system

–> explains why indiv. have trouble breathing, experience nausea, or have irregular heartbeat when feeling overwhelmed

87
Q

What kind of lesion is peripheral vestibular hypofunction (Unilateral vestibular hypofunction (UVH))?

A

peripheral

88
Q

BPPV makes up ___% of dizziness cases.

A

20%

89
Q

BPPV is responsible for ___% of vertigo cases in adults over 80 y/o.

A

50%

90
Q

What are examples of UVH?

A

vestibular neuritis, one-sided meniere’s disease, age-related vestibular loss

91
Q

Vestibular neuritis is reponsible for __% of dizziness cases.

A

5%

92
Q

Vestibular neuritis is responsible for ___% cases of vertigo

A

15%

93
Q

What are s/s of acute vestibular neuritis?

A
  • vertigo
  • tilt response
  • absence of tinnitus
  • A-febrile
  • static defect
94
Q

Where are structural and functional impairments found with peripheral lesions?

A

VOR
VSR
sensory mismatch
physical deconditioning

95
Q

VOR produces eye movements of EQUAL velocity with (same/opposite) eye direction to the head movement.

A

opposite

96
Q

When is VOR gain reduced with unilateral labyrinthine lesions?

A

immediately after movement

97
Q

What oculomotor tests are not affected by vestibular loss?

A

saccades
smooth pursuit

98
Q

Under normal conditions, what works with VOR to stabilize gaze during eye movements?

A

saccades and smooth pursuit

99
Q

(true/false) acute vestibular dysfunction asymmetry occurs with actual movement of the head

A

false

100
Q

(true/false) chronic vestibular dysfunction asymmetry occurs with actual movement of the head

A

true

101
Q

What reflex contributes to postural disturbances?

A

VSR

102
Q

What do patients with unilateral peripheral deficits experience with postural instability?

A
  • enhanced tibialis anterior responses contralaterally
  • reduced tibialis anterior responses ipsilaterally
  • reduced neck muscle activity
  • increased angular accelerations of the head
103
Q

Those with poor VOR gain have what activity limitations?

A

difficulty seeing during head movement

104
Q

Those with poor VSR gain have what activity limitations?

A
  • decreased confidence in balance
  • reduced gait speed
  • increased risk of falling
105
Q

description: Vertigo, sudden onset, short duration, episodic, daily

A

BPPV

106
Q

description: Vertigo, sudden onset, long duration, one episode followed by imbalance or oscilopsia

A

Vestibular neuritis
labyrinthitis
First occurrence of meniere’s or migraine attack
CVA

107
Q

description: Vertigo, sudden onset, long duration, episodic not daily

A

meniere’s
migraine
recurrent TIA

108
Q

description: Imbalance, gradual onset, continuous or wax and wane

A

UVH
progressive disease
schwanomma
small vessel disease
white matter degeneration
multi-lacunar infarction

109
Q

Spontaneous nystagmus is observed in those with (acute/chronic) UVH

A

acute
–> will suppress after a few days with visual fixation

110
Q

What can smooth pursuit assess?

A

CN III, IV, VI

111
Q

What type of nystagmus is indicative of a central lesion?

A

direction-changing, gaze-evoked nystagmus

112
Q

What is alexander’s law used for?

A

Screen for UVH nystagmus

113
Q

If UVH nystagmus is present, what phase of eye movement has more intense nystagmus?

A

quick phase

114
Q

What is 1st degree nystagmus according to alexander’s law?

A

nystagmus is present only in gaze going towards the fast phase

115
Q

What is 2nd degree nystagmus according to alexander’s law?

A

nystagmus present in primary gaze and stronger in gaze towards the fast phase

116
Q

What is 3rd degree nystagmus according to alexander’s law?

A

nystagmus is present in all gazes and is strongest in gaze towards the fast phase

117
Q

What happens with visual acuity when a person has uncompensated UVH?

A

degrades 3-4 lines on a dynamic visual acuity test

–> oscillate head at 2 Hz

118
Q

Why would one want to perform a loaded dix-hallpike test?

A

Produces longer duration and more intense symptoms –> fewer false negative results

119
Q

When do asymmetrical disturbances of static vestibular function recover?

A

3-14 days

120
Q

What is the point of a retinal slip?

A

Slip results in an error signal that the brain attempts to minimize by increasing the gain of the vestibular responses (Vestibular adaptation)

121
Q

definition: Exercises or movements that systematically expose the individual to a provocative stimulus that over time with repeated exposure leads to a reduction in symptoms.

A

habituation

Neuro (45 decks)

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