Vestibular Flashcards
Common cause for Bilateral Vestibular hypofunction
ototoxic agents like gentamicin, PVH also
BL Meniere’s disease
trauma, autoimminune, neurodegenerative, alchohol
*pathologic, not just positional like BPOPV
Describe oscillopsia
Sensation of moving objects (oscillating)
Usually BL pathology
Diff between unilateral and BL vestibular hypofunction
UVH - vertigo and nystagmus due to imbalance between two sides
BVH - Typically not vertigo, nystagmus b/c balanced pathology, but there is disequilibrium, oscillopsia, instability with posture/gait
What is a diagnostic test for posterior canal BPPV
Dix Hallpike is the test
Epleys Maneuver is treatment
No saccades or smooth pursuit issues
What is diagnostic test and treatment for horizontal canal BPPV
Supine roll is the test
Barbecue roll is the manuever
What are some signs of a central lesion
Pure ubeating or downbeating nystagmus, wide BOS, direction-changing nystagmus, catch up saccades,
abnormal smooth pursuits b/c coordination of eyes not intact
Pendular nystagmus (equal speeds)
Interventions for central lesions
balance training, gaze stabilization exercises, etc.
Interventions for UVH
Habituation training, balance training,
Amount of training is 1-2 times per week
Greater amount of weeks for BL or chronic vs UL acute
Signs of peripheral lesion (general)
Slow and fast paced jerk nystagmus (not equal speed)
normal smooth pursuit and saccades because coordination of eyes intact
Wha is an abnormal saccade
inaccurate, jerky too fast or too slow when looking back and fourth
What is an abnormal smooth pursuit
Cant follow moving target
Unilateral hypofunction causes
Menieres disease, trauma, surgery, ototoxic medication
Push pull relationship
corresponding planes on one side vs the other. One side is excited while the other is inhibited
VOR
Vestibular Ocular Reflex
VSR
Vestibular spinal reflex
controlled by vestibulospinal tracts and reticulospinal tracts
Vertigo is
Mismatch between vestibular inputs and the expected based on movement completed
Peripheral dx
unilateral, BL hypofunctions, BPPV, Menieres
BPPV diagnostic criteria
1-2 second latency, then increases early on, lasts 30 sec to 2 min, will go away after precipitating positon maintained
Movement provoked,
Dix hallpike steps and results
Sitting turn head 45 degrees to affected side
Bring down to supine with head into 30 ext off table
Hold 1 - 2 min
Confirmed w/ upbeat torsional and slight horizontal, fast beating
Canalithiasis vs cupulithiasis (stuck)
Key difference
The canal has latency and set time 30 sec to 2 min
cupulo (octonia stuck) so NO latency and stays until position is changes because it is stuck
Menieres Disease
Starts with fullness of the ear, tinnitus, loss of hearing, then UVH symptoms
Intervention: MEDS, no vestibular exercisers in acute phase.
Geotropic
nystagmus beats towards ground due to canalisthesis
ageotropic for cupolo
For PSSC
Brandt-Daroff exercises for pSCC BPPV
▪ Primarily used for BPPV
desensitization
▪ “Originally designed to habituate
the CNS to the provoking position”
▪ “…not effective to remove
displaced otoconia.
Semont liberatory specifically for
BPPV cupulo
