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Neuro III > Vestibular Anatomy and Function > Flashcards

Vestibular Anatomy and Function Flashcards

1
Q

What are the 3 Roles of the Vestibular System?

A
  1. Stabilize visual image during head movement
  2. Provide sensory info for spatial orientation
  3. Maintain postural stability when stationary and during movement
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2
Q

Controls the body position in space for stability and orientation between body segments and the environment, appropriate for a task

A

Postural control

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3
Q

Maintenance of the COM within the BOS

A

Postural Stability

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4
Q

Ability to maintain a relationship between body segments and between body and environment for a task

A

postural orientation

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5
Q

_____ System
-recognizes motion

A

Visual

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6
Q

Children <7.5 rely on what system for balance?

A

Vision

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7
Q

What 3 things make up the vestibular system?

A
  1. Gaze stabilization
  2. Spatial orientation
  3. Postural stability
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8
Q

____ System
-recognizes relative body movements and position
base of support, joint proprioception, pressure, cervical proprioception and kinesthesia

A

Somatosensory

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9
Q

Explain central processing

A

adaptive strategies that change with the demands of a task

anticipatory strategies “pretune” sensory and motor systems based on prior learning

Ex: Cognitive override due to consideration of motivation intent and attention

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10
Q

Give an example of central processing

A

a volley baller going to dive for the ball the central portion of the brain overrides the body going outside of its BOS.

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11
Q

What arteries supply blood to the vesibular peripheral organ?

A

Posterior blood supply
1. Basilar Artery
2. Anterior Inferior Cerebellar Artery

Labyrinethine artery
-anterio-vestibular artery
-common cochlear

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12
Q

What are the two otoliths?

A

utricle and saccule

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13
Q

What motion is recognized by the utricle

A

horizontal plane motion

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14
Q

What motion is recognized by the saccule

A

vertical plane motion

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15
Q

Explain what otoconia do?

A

provide shear forces for hair cell deflection

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16
Q

Are otoconia gravity dependent and what does that mean?

A

Yes Otoconia are gravity dependent
if you tip your head Otoconia shift deflecting hair cells sending signals to the brain.

these otoconia should not fall off the otolithic membrane but if they do thats what causes vertigo

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17
Q

What motion do the otoliths regonize

A

forward/backward
up/down
tilting

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18
Q

What does tonic discharge mean?

A

both ears have discharge even at rest

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19
Q

Explain the push pull relationship between the otolith organs

A

if you tilt head left discharge increases while the right discharge decreases

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20
Q

What motion is recognized by the semicircular canals?

A

angular motion-rotation

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21
Q

What do the hair cells do?

A

tell your brain that you have moved

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22
Q

How many semicircular canals are there?

A

3
anterior
posterior
horizontal

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23
Q

Describe what happens if you move down and to the right what canal stimulates and what decreases?

A

stimulates right anterior and decrease left posterior

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24
Q

Where does Cranial nerve VIII have its cell bodies?

A

scarpas ganglion
has bipolar ends

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25
Q

Describe cranial never VII and VIII course of action?

A

travel together through the internal auditory meatus
enter the pontomedullary junction of the brain

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26
Q

Explain where the CN VII VIII enter the brainstem in terms of nuclei

A
  1. superior vestibular nuclei
  2. inferior vestibular nuclei
  3. lateral vestibular nuclei
  4. medial vestibular nuclei
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27
Q

Do the vestibulospinal mechanisms for postural control continue to develop beyond 15 years of age?

A

true

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28
Q

The vestibulo cerebellum is

A

Flocculonodular lobe

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29
Q

What do the vestibular nuclei do to the cerebellum

A

can fine tune communicate info from the nuclei to the cerebellum for input and output

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30
Q

What is responsible for the discrimination between self movement and environment movement?

A

thalamus

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31
Q

Explain what the reticular formation does?

A

interprets info from all vestibular nuclei

can determine if motion from a rollercoaster causes vomiting
can determine that rocking a baby is safe and soothing

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32
Q

Why is our vestibular cortex so small?

A

we aren’t that conscious of the motion that occurs around us

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33
Q

What is the blood supply for the inferior vestibular nucleus

A

posterior inferior cerebellar nucleus

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34
Q

What blood supplies the pons and more superior vestibular nuclei

A

basilar artery

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35
Q

Explain the Vestibular ocular reflex

A

Stabilizes gaze during head movements

ex: if you turn your head your extra ocular eye muscles will go the other way

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36
Q

When is the VOR intact and mature

A

by one year

37
Q

Describe the flow of input for VOR

A

inner ear–vestibular nuclei— MLF— extra ocular eye muscles

38
Q

Describe the vestibulo-spinal reflex

A

coordinates head and body movements to maintain head in upright position

39
Q

Explain the path of VSR

A

info from inner ear–> vestibular nuclei–> descends to the cervical spinal cord–> to extension response to catch our balance

40
Q

What tracts does the VSR utilize?

A

LVST- Lateral vestibulo-spinal tract
MVST- Medial vesibulospinal tract

41
Q

Describe what the Vestibulo-colic reflex does?

A

head righting
stabilizes head/neck
produces coordinated movements to track a moving target

think of the chicken video

42
Q

Describe ATNR (asymmetric tonic neck reflex)

A

neck rotation excites ipsilateral extensors and contralateral flexors

43
Q

Describe STNR (symmetric tonic neck reflex)

A

neck extension excites ipsilateral UE extension LE flexion

44
Q

Cervico- occular reflex

A

eye movements are driven by neck proprioception
supplements the VOR when needed
facilitated when vestibular organ is injured

45
Q

Cervicospinal reflex

A

can supplement the VSR by alerting tone in the body

46
Q

cervicocolic reflex

A

stabilizes the head on the body
may be facilitated after vestibular loss

47
Q

What are some Central Pathologies of vestibular disfunction

A

Traumatic Brain injury
Multiple Sclerosis
Stroke
Brain tumor
Vestibular migrane

48
Q

What is the most common cause of true vertigo?

A

Benign Paroxysmal Positional Vertigo

49
Q

What is the 2nd most common cause of true vertigo?

A

neuritis- CN VII becomes inflammed

50
Q

A floor warping, ceiling spinning, brain churning, think you’re gonna die and afraid you might not- hangover

A

Endolymphatic Hydrops Meniere’s Disease

51
Q

Describe some of the presentation of Meniere’s disease

A

acute episodes of 30 min to 24 hours
usually recovery in 72 hours

52
Q

What is the treatment of meniere’s disease? PT involvement

A

Surgery or ablation- managed medically

PT can help with education

53
Q

What is the presentation of Perilymph Fistula?

A

vertigo after very loud sounds
Congenital, prior ear surgery, barotrauma

54
Q

What is the treatment for Perilymph Fistula? PT involvement

A

PT will refer!

55
Q

What is the presentation of Superior Canal Dehiscence?

A

Creates a window through the bone

vertigo and oscilopsia induced by loud noises

56
Q

What is the treatment for Superior Canal Dehiscense?

A

Primarily medical management
PTs Refer!!

57
Q

What is the common presentation of Mal de Debarquement Syndrome?

A

perception of motion when stationary and eyes are open
Usually occurs after exposure to motion, such as a cruise
Difficulty adapting back to stable environment

58
Q

What is the treatment for Mal de Debarquement Syndrome? PT involvement?

A

Possible treatment with medication
focus on somatosensory referencing to vestibular sense

Know how to examine- as a pt
Very common but very hard to treat

59
Q

What is the presentation of Peripheral Neoplasm Acoustic Neuroma?

A

Tumor affecting CN VII

60
Q

What is the treatment for Peripheral neoplasm acoustic neuroma? PT involvement

A

surgical removal or radio-surgery

Commonly and appropriately referred to PT for treatment

61
Q

What is persistent Postural Perceptual Dizziness?

A

Persistent dizziness
Non-spinning Vertigo
Perceived unsteadiness
A result of long term maladaption

62
Q

What is the treatment of persistent postural perceptual dizziness?

A

Commonly and appropriately referred to PT for treatment

63
Q

___%. of those with whiplash dizziness can take longer than 20 weeks to return to work

A

20%

64
Q

What is the primary symptom of wiplash?

A

Neck pain

65
Q

What are common subjective findings with patients who have cervicogenic dizziness?

A

occipital or bitemporal HA
Neck Pain
People tell me my head is not straight

66
Q

What are some common subjective findings of someone who is just having dizziness non specific?

A

Dizziness
Sensation of falling
Difficulty reading
Feeling tired

67
Q

What are some medical and audiologic tests commonly used to diagnose vestibular disorders?

A

Electronystagmography
Videonystagmography
Medical diagnostic testing- rotary chair testing
Autiogram

68
Q

Medications such as Cisplatin and gentamycin, streptomycin can cause what?

A

ototoxic

69
Q

When should you use the vertebral artery test?

A

neck trauma
cervical surgery and/or arthritis

70
Q

Is there a high specificity or sensitivity with the vertebral artery test

A

Specificity if it is positive likey they have insufficient blood flow

71
Q

What are the 5 Ds and 3 Ns

A

Dizziness
Diplopia
Dsyphagia
Dysarthria
Drop attack
Numbness
Nystagmus
Nausea

72
Q

What are test can be used to diagnosis an issue with VOR?

A

Head impulse test
Head thrust test

73
Q

How do you test gaze stability?

A

Dynamic Visual acuity
SNELLN chart

74
Q

What are 3 positional testing for BPPV

A

Dix- hallpike
Sidelying Test
Roll Test

75
Q

What are some test for postural control?

A

Berg Balance
Mini Best Test
Four Square step
CTSIB
ROmberg
FUnctional reach

76
Q

How to test for head righting response?

A

sitting on rocker board
Standing on rocker board
Tandem standing

77
Q

What is a normal loss of line during the VOR head motion visual acuity testing

A

loss of 2 lines is normal

78
Q

Nystagmus is named for what

A

the fast phase direction

79
Q

Your patient has dizziness/vertigo what is the treatment

A

Habituation: Exercises designed to perform several repetitions of body movements or watch visual motion that cause mild to moderate symptoms

80
Q

Your patient has Visual blurring with head movements what is the treatment

A

Gaze stability
adaptation exercise to maximize remaining vestibular function

81
Q

Your patient has imbalance and/or falls what is your treatment

A

Balance and gait
may involve changes in base of support to increase balance challenge and weight shifting to improve center of gravity control

82
Q

produce an error signal and recalibrate vestibular input
up-train or force use particular senses
central selection, prioritization, integration

A

remediation=adaptation/uptraining

83
Q

Repetition of provoking movement with cautious symptom provocation and settling

A

sensory habituation=desensitization

84
Q

If sensory information is missing
inherent limitaitons- may need additional compensations under certain circumstances

A

sensory substitution= Compensation

85
Q

What should be considered with central pathologies

A

Consider burden and location of damage
uptrain vestibular function when able
compensate with vision and somatosensory when maximum adaptation has occured

86
Q

If patient has dizziness when the head is moved where is a strong hypothesis this is coming from?

A

cervical

87
Q

If patient moves body and the head doesnt move and the patient has dizziness then what is your hypothesis?

A

vestibular

88
Q

During a smooth pursuit neck torsion test the neck is placed at ____ degrees of rotation

A

45 degrees

89
Q

What is a negative test for the smooth pursuit neck torsion test?

A

saccades, increase dizziness

Neuro III (23 decks)

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