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Adult Neuro > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

1
Q

Vestibular system is a key _____ receptor

A

sensory

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2
Q

VS is sensitive to:

A
  1. head movement
  2. head position
  3. effect of gravity
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3
Q

Function of VS

A
  1. detect movement
  2. maintain gaze stability during motion
  3. maintain balance
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4
Q

When not functioning properly, what other systems compensate and what is the main impairment

A

Visual and SS compensate (body must learn this)

balance is an issue

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5
Q

What are the peripheral parts of VS?

A

Labyrinth! = 3 SC canals and otolith (saccule + utricle)

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6
Q

What type of movement/position does the otolith (saccule and utricle) respond to?

A

static positions

linear acceleration

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7
Q

What type of movement/position do the semicircular canals respond to?

A

Angular head movements
Anterior = head nod (tilt in sagital plane)
Posterior = head tilt (tilt in frontal plane)
Horizontal = head turns (tilt in transverse plane)

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8
Q

What is the pathway of information transmission from SC canals –> brain?

A

endolymph in SC canal moves –> hair cells moved in opposite direction –> sends info to cortex –> stabilizes eyes to target

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9
Q

Push-Pull Phenomenon

A

Activation of SC canal on one side inhibits SC canal on other side
*i.e. head turn to right = activation R horizontal SC canal (don’t move eyes here) + inhibition of L horizontal SC canal (turn eyes that way)

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10
Q

Central structures of VS

A
  1. cochlea nerve and vestibular nerve (inflammation/injury to one can cause issues with the other)
  2. Facial nerve (issues here can cause issues in chochlea or vestibular nerve)
  3. Cerebellum (inhibition or facillitation of VOR)
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11
Q

Lesion in central v peripheral structures (recovery time)

A

longer recovery time for central lesions- pt must learn compensation strategies

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12
Q

Corrective saccade

A

eyes correct themselves to reorient to center (occurs in healthy system)

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13
Q

Saccade

A

voluntary corrective movement

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14
Q

Smooth pursuit

A

slow saccades - voluntary

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15
Q

Nystagmus

A

involuntary; quick corrective movement of the eyes back to the center

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16
Q

Retinal Slip

A

image slips from person’s eyes; they are unable to process changes to a moving image (see it as more than 1 object in front of you)

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17
Q

Vestibulo-Occular Reflex (VOR), purpose, types/what senses it

A

purpose: hold images steady on retina with head movement
Angular VOR: sensed by SCC
Linear VOR: sensed by otolith
Ocular Tilt Reflex: sensed by utricle

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18
Q

Nystagmus- what side is the lesion on

A

typically the side with a quicker nystagmus is the side of the lesion (direction of the fast phase)
*evaluate during tonic and dynamic system- central lesions have nystagmus in both

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19
Q

Tonic System deficit

A

nystagmus present without movement (at rest)

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20
Q

Dynamic system deficit

A

nystagmus with movement

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21
Q

What is considered a “Central lesion” v “Peripheral lesion”

A 
central = everything past internal auditory canal (disorders of the CNS)
Peripheral = everything before internal auditory canal (SCC and otolith)
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22
Q

Peripheral lesion symptoms

A
  1. Dizziness with positional changes
  2. hearing loss, tinnitus
  3. balance problems
  4. symptoms with head movement during gait
  5. acute nystagmus
  6. nystagmus only present chronically if they have NOT learned to compensate
  7. oscillopsia- jumping of objects in visual field (can’t focus, feel like its moving up and down)
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23
Q

Central Lesion Symptoms

A
  1. constant dizziness
  2. Downbeating nystagmus (but present with anterior SCC deficit- differentiate whether it is present at rest)
  3. Cerebellar signs/sx (ataxia/imbalance)
  4. Associated head injuries/cervical injuries
  5. Horner’s Dyndrome
  6. swallowing difficulty
  7. Sensory changes
    • babinski, clonus, changes in DTRs
  9. Impaired balance and gait
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24
Q

Symptoms common in peripheral and central lesions

A
  1. Spinning/vertigo (worsened with 3D shapes)
  2. Vomitting
  3. Nausea
  4. Headache
  5. dizziness
  6. impaired balance
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25
Q

Acoustic Neuroma (vestibular schwannoma)

A

will be walking more to one side than the other
benign tumor, begins on vestibular portion of acoustic n.
other symptoms: hearing and balance, tinnitus, disequilibrium, vertigo (all caused by compression of CN VIII)
if grows enough- expansion to cerebellopontine angle (near brainstem and CNVII)

26
Q

Peripheral Pathologies

A
  1. Benign Paroxysmal Positional Vertigo (BPPV)
  2. Cervicogenic Vertigo
  3. Labrynthitis (inflammation of inner ear)
  4. Perilymph Fistula
  5. Meniere’s Disease (inflammation of inner ear)
27
Q

Benign Paroxysmal Positional Vertigo (BPPV): Cause

A

Free floating otoconia
Otoconia belon in utricle; they dislodge and enter SCC
disruption of endolymph mvt –> false info sent to brain
*can occur spontaneously or following head trauma/labrynthitis

28
Q

Benign Paroxysmal Positional Vertigo (BPPV): main symptom

A

vertigo with POSITIONAL changes

29
Q

Benign Paroxysmal Positional Vertigo (BPPV): Diagnosis

A

onset of nystagmus and vertigo only when moved in plane of SCC

  1. horizontal nytagmus –> horizontal SCC
  2. Downwards nystagmus –> anterior SCC
  3. Upwards nystagmus –> posterior SCC
30
Q

Benign Paroxysmal Positional Vertigo (BPPV): Evaluation

A

Gold standard = Dix Hallpike test
Anterior + posterior SCC = sidelying test
Horizontal SCC = horizontal roll test

31
Q

Benign Paroxysmal Positional Vertigo (BPPV): Treatment

A

Canalith Repositioning Maneuver –> helps remove otoconia
Rotate head to affected ear –> lower into supine with head off the table
Turn head to other side , then further so parallel to floor, then rapidly further so face is almost to the floor
return to upright and head to normal

32
Q

Cervicogenic Vertigo: Cause

A

occurs in pt with longstanding vertigo
cervical spine receptors not firing as much–> turning head in limited motion for long time
when they finally turn their head further, exposure to visual field they haven’t seen in a long time (makes them even dizzier)

33
Q

Perilymph Fistula

A

holes in the oval or round window- endolymph enters into air-filled middle ear (not much you can do for this pt)

34
Q

Central Pathologies

A
  1. CVA
  2. MS
  3. BL Vestibulopathy (inflammation of neurons by toxic substances)- hard to get better, not reversible
  4. head injury
35
Q

Dix Hallpike Test

A

gold standard for BPPV (posterior canal of side tested and anterior of opposite side)
CANNOT be performed if VBI or stenosis
side of dysfunction = side head is turned to

36
Q

Dynamic Visual Acuity Test

A

assessment of gaze stability

no reliability established in pts with TBI

37
Q

Saccadic Testing

A

Smooth pursuits: pt scans the room, want eyes and head to have same ROM
Saccadic: pt looks back and forth from your fingers without head mvt

38
Q

VOR testing

A

letter held at arms length from pt- maintain vision on letter with side-side head turns
looking for when they have retinal slip (trying to induce this)

39
Q

VOR cancellation testing

A

want head and eyes to turn in same direction at same velocity
head mvt side-side while looking at pen (pen is moving with their head- movement is fast, about 2Hz)

40
Q

Subjective Visual Vertigo testing (SVV)

A

Ability to identify whether an object is upright
with SVV- head is tilted – can’t identify verticle
*correct their head to midline! (better BL visual input)

41
Q

Head Thrust Test

A

slowly turning their head from side-side, quickly move the head back to midline –> looks for the corrective saccade
(+) test = eyes lagging when head is thrust back to midline

42
Q

Fukuda Step Test

A

pt marches with high knees and eyes closed (looking for sideways deviations)
involved side = side of deviation
not good interrater reliability (distance deviated not always measured), not always positive in only vestibular dysfunctions

43
Q

Sidelying Test

A

testing anterior and posterior SCC
sitting at EOB – rotate 45 degrees AWAY from side to be tested
quickly bring head into CL sidelying (rotate to L, SL to R)
pt reports vertigo, observe for nystagmus
repeat to other side

44
Q

Horizontal Roll Test

A

testing horizontal SCC
pt in supine – head flexed 20deg – quick head rotation
pt reports vertigo, observe for nystagmus
slow return of head to midline, quick roll to other side

45
Q

Sensory Organization Test: Purpose, administration

A

purpose: assess effective use of visual, vestibular, and proprioceptive information (how the body organizes information between the systems)
Pt stands on moving board with visual frame (that moves) in front of them

46
Q

SOT: categories/conditions

A
  1. eyes open, fixed surface, fixed visual surround
  2. Eyes closed, fixed surface, fixed visual surround
  3. Eyes open, fixed surface, sway visual surround
  4. Eyes open, sway surface, fixed visual surround
  5. eyes closed, sway surface
  6. eyes open, sway surface, sway visual surround
    * vestibular dysfunction, usual fall in categories 5 and 6
47
Q

Activities Specific Balance Confidence Scale and Dizziness Handicap Inventory (pros and cons)

A

pros: good psychometric properties
Cons: limited research in vestibular population

48
Q

Referral back to physician

A
  1. new onset UMN s/s
  2. swallowing difficulties
  3. sensory changes
  4. changes in pupillary size/ptosis
  5. loss of consciousness
  6. new onset LOB
  7. fluctuating hearing loss
  8. visual field cut
  9. memory loss
49
Q

UL v BL vestibular hypofunction (prognostic differences, inital system they rely on)

A 
UL = better prognosis, expect recovery, initially rely on SS cues
BL = poorer/longer recovery time, requires compensation, initially rely on visual cues
50
Q

Acoustic Neuroma Treatment

A

can teach VOR to these pts- hope is for some return

a lot of rememberance issues

51
Q

Central lesions: focus of treatment

A

balance issues

52
Q

Examples of Compensation strategies

A

using the unaffected side to help them

avoiding putting themselves in positions of known balance compromise

53
Q

Treatment: Adaptation

A

teaching VOR exercise- hope is that practice will help them get better
aim: reduce retinal slip, decrease symptoms, improve postural stability

54
Q

Treatment: Habituation

A

a series of progressively more complex repeated movements designed to provoke symptoms (will make them dizzy)

55
Q

Treatment: Substituation

A

use of alternative strategies to replace lost or compromised function (using SS and visual systems to help)

56
Q

Vestibular Eval: Steps

A
  1. Check vision (glasses, distance for dbl vision, skew deviations)
  2. Check the cranial nerves (“H”)
  3. Check for visual field cut (PT and pt cover eye, introduce finger from periphery)
  4. Check smooth puruit
  5. VOR testing (horizontal and vertical)
  6. VOR cancellation testing
  7. Head thrust
  8. Reading test
57
Q

When are skew deviations seen

A

with cerebellar and brainstem strokes - skew deviation present on same side

58
Q

Checking for skew deviations

A

pt with eyes closed, ask them to open and look at your finger
when eyes open, one will be higher or lower

59
Q

Reading Test

A

Read with head in midline, record # of lines able to read
Read while turning head side-side, record # of lines able to read
Compare the 2 numbers
(+) test = more than 2 lines of difference

60
Q

Checking for visual field cut: implications of periphery loss v nasal field loss

A 
periphery = pituitary lesion
Nasal = optic chiasm

Adult Neuro (15 decks)

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