vestibular Flashcards
is diplopia (double vision) a central or peripheral sign?
central
what is labyrinthitis and what are some sx?
inflammation of the labyrinth
sudden onset of vertigo, nausea, vom
(+) head impulse test
lasts days to weeks
HEARING LOSS, TINNITUS
in anterior canal BPPV, which way does the nystagmus beat?
downbeating torsional
in posterior canal BPPV, which way does the nystagmus beat?
upbeating torsional
PUP
how do you treat right cupulolithiasis?
Semont/Liberatory maneuver
- head rotated 45* to L side
- pt is moved from sitting to R sidelying and stays here for 1 min
- pt is rapidly moved 180* to L sidelying
- after 1 min, return pt to sitting
how long does dizziness last in canalithiasis?
<1 min
what is vestibular neuritis and what are some sx?
inflammation of the nerve
sudden onset of vertigo, nausea, vom
(+) head impulse test
lasts days to weeks
no hearing loss
what are the two types of BPPV?
canalithiasis
cupulolithiasis
what should you do if you suspect a central vestibular pathology?
refer to physician
is horizontal nystagmus a peripheral or central pathology?
peripheral
how can you assess oculomotor?
smooth pursuits and saccades
will you see ataxia in central or peripheral vestibular disorders?
central (cerebellum could be affected)
does geotropic nystagmus indicated canalithiasis or cupulolithiasis?
canal, ageotropic is cupulo
is VOR intact in BPPV?
YES
what is a slow growing tumor that develops from the balance and hearing nerves supplying the inner ear?
acoustic neuroma/vestibular schwannoma (also want to refer to dr)
will also have tinnitus and hearing issues and LOB/ataxia
for geotropic nystagmus, will the affected side have stronger or weaker sx?
stronger
what are the two otolith organs
saccule
utricle
how can you treat unilateral vestibular hypofunction?
VOR x1 and VOR x2 exercises
postural stability and balance
habituation
what is VOR responsible for?
maintaining focus on an image during rapid head movements
supine roll is a ____, BBQ roll is a _______
test, treatment for horizontal canal (head turned to affected side)
how to treat horizontal canal BPPV?
CRM
position head to affected side
can BPPV be bilateral?
yes
oscillopsia, loss of gaze stabilization, spontaneous nystagmus that can be suppressed with visual fixation, disequilibrium, and ataxia are all signs of what?
acute unilateral vestibular hypofunction (UVH)
BPPV, vestibular neuritis, labyrinthitis, and acoustic neuroma are all types of _____ vestibular pathologies?
peripheral, labyrinth related
can BPPV happen in any canal?
Yes, but most commonly posterior
anterior is very rare and they prob won’t ask about it
what is the most common disorder resulting in dizziness in older populations?
BPPV
will you see hearing loss in central or peripheral vestibular disorders?
peripheral
will visual fixation help central or peripheral disorders?
peripheral
how do you treat bilateral vestibular hypofunction
VOR x1
imaginary targets
walkig
which way does a ageotropic nystagmus beat?
away from the ground
will you have hearing loss with labyrinthitis or vestibular neuritis?
labyrinthitis
you are doing a head impulse test on a pt. when you turn their head right and then quickly to the center, their eyes lag and take longer to catch up to center, what does this indicate?
R sided hypofunction/R VOR affected/+ head impulse
while the exact cause of BPPV is not really known, they think it can be because of…
infection
head trauma
vestibular weakness
advancing age
what neurological condition would be related to central vestibular pathology?
MS, UMN disorder
how will I treat someone with posterior canalithiasis BPPV?
Epley/canalith repositioning maneuver (CRM)
which way does a geotropic nystagmus beat?
to the ground (geo)
if pt can’t tolerate the CRM, what can you do instead?
brandt daroff
same as semont basically except you have a head turn before you do the 180 to the other side
you will do both sides
what cranial nerve can be affected by acoustic neuroma?
facial nerve, resulting in facial numbness
will you see vertical nystagmus in central or peripheral?
central
describe the epley maneuver
- 45* to symptomatic side and 30* below horizontal (dix-hallpike position)
- rorate 45* to the otherside maintaining the 30* of extension
- roll to sidelying (uninvolved side) with nose down
- slowly sit up, maintaining head position flexed and rotated
slowly return the head to upright and remain sitting 3-4 min then repeat until no sx are seen
maintain each position for 1-2 minutes or until the vertigo and nystagmus has stopped
what kind of nystagmus will you see in peripheral disroders?
jerk (slow and fast phases)
what disease is described as an overproduction of fluid within the inner ear, causing increased pressure and vertigo?
meniere’s
pts may have hearing loss, tinnitus, aural fullness, and it can last min to hours
rec a diet lower in salt to decrease water content
what the larger part of the canal called that crystals sometimes get stuck in?
cupula
is smooth pursuit and saccades normal in central or peripheral vestibular disorders?
they are normal in peripheral
what test assesses BPPV? explain the steps
dix-hallpike
pt’s head is turned 45 degrees to affected ear
pt moved quickly into a supine position with head extended 20-30 degrees (maintaining 45 deg rotation)
the labyrinth is made up of what two things?
semicircular canals and otolith organs
what test is used for horizontal canal BPPV?
supine roll
pt supine, cervical spine flexed to 20. head quickly turned 90 to one side, check for nystagmus or vertigo. head is then turned gently to the neutral staring position. they you repeat on other side
for ageotropic nystagmus, will the affected side have stronger or weaker sx?
weaker
what kind of nystagmus will you see in central vestibular disorders?
pendular (eyes oscillate at equal speeds)
how long does dizziness last in cupulolithiasis?
> 1 min, “cupulo” is longer than “canal”
describe what happens in BPPV?
calcium carbonate crystals, or otoconia, are normally in the utricle but then they get dislodged and float inside canals or cupula causing dizziness
whats the biggest symptom in BPPV (that you’d see in the clinic, not in the history)?
nystagmus
