Vestibular disease

Question 1

The vestibular system

Answer 1

Includes vestibulocochlear nerve (VIII), parts of the inner ear and brainstem

Question 2

Functions of the vestibular system (3)

Answer 2

1. maintain balance & orientation in respect to gravity
2. position of the eyes, trunk & limbs
3. controls eye movements in relation to the head

Question 3

General signs of dysfunction

Answer 3

imbalance
abnormal head/limb/body/eye position
abnormal eye movements

Question 4

Specific sings of vestibular syndrome

Answer 4

Head tilt towards the lesion (except in paradoxical Vestibular syndrome)
Ataxia, wide based stance.
Circling, leaning, falling or rolling towards the lesion
Eyes: strabismus (= eyes don’t align. often positional), nystagmus
Horner’s

Question 5

Common central causes of vestibular dz

Answer 5

Infarction
Meningoencephalitis
Head trauma
Metranidazole toxicity
Brain tumour

Question 6

Common causes of peripheral vestibular disease

Answer 6

Nasopharyngeal polyps
Otitis media/interna
Trauma to middle/inner ear
Toxicity - ahminoglycosides, chlorhexidine 
Middle/inner ear neoplasia

Question 7

Paradoxical vestibular syndrome is seen when

Answer 7

the flocullonodular lobe or caudal cerebellar peduncle are involved causing loss of inhibition of vestibular nuclei on the contralateral side.
PRDs usually ipsilateral to the lesion