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NM III > Vestibular disorders > Flashcards

Vestibular disorders Flashcards

1
Q

Symptoms of vestibular dysfunction

A

Oscillopsia (illusion that environ. is moving)
Disequilibrium/imbalance
Vertigo, abnormal sense of mvmt, disorientation

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2
Q

Dizziness definition

A

sensation of disturbed or impaired spatial orientation without a distorted sense of motion

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3
Q

Vertigo definition

A

sensation of self motion when no self-motion is occurring

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4
Q

presyncope definition

A

sensation of impending loss of consciousness

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5
Q

syncope definition

A

transient loss of consciousness due to transient cerebral hypoperfusion

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6
Q

Framework for approaching examination of acute dizziness/vertigo

A

TiTrATE approach
- timing
- triggers
- targeted exam
- test/PT treatment

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7
Q

Timing

A

Acute vestibular syndrome: sudden and continuous dizziness lasting days to weeks

Episodic vestibular syndrome: intermittent dizziness lasting seconds, minutes, or hours

Chronic vestibular syndrome: longstanding (>3 mo) vestibular symptoms

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8
Q

Triggers

A

trauma, toxin exposure, exertion, head motion/change in position

spontaneous (no trigger)

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9
Q

Acute timing triggers and causes

A

Acute (>24 hrs)

Triggers: trauma, toxin exposure

Benign causes: vestibular neuritis

Serious causes: ischemic stroke of lateral BS, cerebellum, or inner ear

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10
Q

Episodic timing triggers and causes

A

Triggers: head motion, change in body position, exertion

Benign causes: BPPV, orthostatic hypotension, vestibular migraine

Serious causes: TIA, posterior fossa mass lesion, cardiac arrhythmia

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11
Q

Peripheral causes

A

Vestibular neuritis
Labyrinth neuritis (effects hearing)
BPPV

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12
Q

Central causes

A

Stroke
TIA
MS
Vestibular migraine

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13
Q

Central findings

A
  • Direction changing nystagmus
  • Vertical and purely torsional fixation nystagmus
  • Vertical refixation skew deviation
  • negative bilateral head impulse test
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14
Q

I.N.F.A.R.C.T.

A

In a patient with acute, spontaneous dizziness, INFARCT points to CENTRAL issue

  • Impulse negative bilaterally
  • Fast-phase alternating nystagmus
  • Refixation during cover test (skew)
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15
Q

Nystagmus

A

involuntary rhythmic oscillation of the eye; named for direction of fast-phase of mvmt

  • spontaneous
  • gaze evoked

Smooth pursuit, saccades

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16
Q

Test of skew

A

Cross-cover test
Looking for vertical refixation of eye
Skew deviation points to central lesion

17
Q

Head impulse test

A

Tests VOR integrity

Normal: eyes stay on nose w/ thrust

Abnormal: corrective saccade (eye-refixation) w/ thrust

Positive test = peripheral finding

18
Q

Other exam red flags

A

New postural/gait instability
5 D’s
Sudden, severe, or sustained pain (posterior neck)
CN signs
Sensory changes
Excessive vomiting

19
Q

Common peripheral pathologies

A

Benign paroxysmal positional vertigo (BPPV)
- most common cause of vertigo

Vestibular hypofunction

Less common:
- acoustic neuroma
- meniere’s disease
- perilymph fistula

20
Q

Vestibular hypofunction causes

A

Damage to inner ear or CN VIII

Cause:
- vestibular neuritis
- labyrinthitis

Ototoxic medication
- gentamycin
- chemotherapy agents, cisplatins

21
Q

Vestibular hypofunction findings

A
  • Vertigo for hours/days (acute)
  • chronic phase may present vertigo only w/ head mvmt
  • nausea/vomiting
  • imbalance
  • nystagmus (beats towards healthy ear)
  • positive head impulse test
  • no central signs
22
Q

Vestibular hypofunction treatment

A

Medical management
- anti-vertigo (meclizine)
- anti-nausea (zofran)

Vestibular rehabilitation
- See CPG
- gaze stabilization

23
Q

Peripheral neoplasms acoustic neuroma

A

Schwannoma, small, encapsulated, slow growing

Puts pressure on facial n.

Can be seen on MRI

Surgical removal or radiosurgery

24
Q

Endolymphatic hydrops Meniere’s disease

A

Acute episodes: 30 min to 24 hr
Recovery w/in 72 hours

Progressive hearing/vestibular impairments

Endolymphatic hydrops
- malabsorption of endolymph in the duct and sac

Surgery or ablation

25
Q

Superior canal dehiscence (SCD)

A

Creates a window through the bone
Can be seen on CT

Features:
- vertigo and oscillopsia induced by loud noises
- autophony
- surgical repair is possible

26
Q

Persistent postural-perceptual dizziness (PPPD)

A

Central, functional neurologic disorder

BPPV can become PPPD

27
Q

PPPD diagnostic criteria

A

One or more symptoms of dizziness, unsteadiness, or nonspinning vertigo are present on most days for 3 mo or more

Persistent symptoms occur without specific provocation, but are exacerbated by
- upright posture
- active/passive motion w/o regard to direction or position
- exposure to moving visual stimuli or complex visual patterns

Disorder is precipitated by conditions that causes vertigo, unsteadiness, dizziness, or problems w/ balance including acute, episodic, or chronic vestibular syndromes, other neurologic or medical illnesses or psychologic distress

28
Q

Pathophysiological mechanism of PPPD

A

Precipitants:
- vestibular crisis
- medical event
- acute psychological distress

Acute adaptation
- visual-somatosensory dependence
- high-risk postural control strategies
- environmental vigilance

No recovery in PPPD

29
Q

PPPD presentation

A

Persistent hypersensitivity to vision
- sensitivity to busy/moving env.
- difficulty w/ visually demanding tasks

Perceived somatizations
- head fullness, lightheadedness, “walking in fun house”
- sense of unsteadiness

30
Q

PPPD treatment

A

3-pronged approach
- medication (SSRIs, SNRIs)
- PT w/ strong education component
- Cognitive behavioral therapy

31
Q

Mal de debarquement syndrome (MdDS)

A

Perception of motion when stationary and eyes are open

“getting off the boat” syndrome

Occurs after prolonged exposure to motion (cruise)

difficulty adapting back to stable env.

32
Q
A

NM III (4 decks)

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