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PCE - Neurology > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

1
Q

What systems may be at fault when their is dizziness

A

cardiovascular, neurological, visual, psychogenic, cervicogenic, meds, vestibular

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2
Q

What are 3 vestibular functions

A

Gaze stabilization
Postural stabilization
Resolution of sensory motor mismatch

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3
Q

What does gaze stabilization do

A

Keeps objects in visual field clear with head movement

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4
Q

What does postural stabilization do

A

Maintain balance and equilibrium

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5
Q

What is the result of sensory motor mismatch

A

Sea sickness

Motion intolerance

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6
Q

How many semicircular canals are there? Names?

Function

A

3 Horizontal, anterior, posterior

gaze/angular displacement of the head

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7
Q

How do the semicircular canals detect angular displacement of theh ead

A

Movement of endolymph within the canals will deflect hair cells and excite or inhibit neurons (CNVIII)

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8
Q

How many otoliths are there? names?

A

2

Utricle
Saccule

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9
Q

Function of utricle

A

Detects horizontal plane motion

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10
Q

Function of saccule

A

Detect sagittal plane motion

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11
Q

Combined function of utricle and saccule

A

Detect acceleration and deceleration, gravitational pull = Postural

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12
Q

What are 3 common vestibular S&S

A
  • Vertigo
  • Dizziness
  • Oscillopsia
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13
Q

What is vertigo?

A

the subjective experience of nystagmus (room spinning around you) - get it with BPPV * always vestibular in origin

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14
Q

What is dizziness

A

discrepancy between R and L side, patient can’t work out where they are in space
- *non-specific, may or may not be vestibular in origin

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15
Q

Is vertigo or dizziness always vestibular in origin

A

Vertigo

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16
Q

What is oscillopsia

A

Blurred vision (Not diplopia)

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17
Q

Which antibiotic effects the vestibular system

A

Gentomycin

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18
Q

What does BPPV stand for

A

Benign paroxysmal positonal vertigo

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19
Q

Of people with BPV, 90% present with crystals in the _____, 80% of these are ____

A

in Posterior SCC

80% canalithiasis (free floating in canal)

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20
Q

BPPV S&S

A

brief (< 30 sec), delayed, transient vertigo with looking up/down, rolling to that side of bed, sit to supine;
+/- vertigo,
nystagmus,
vomiting

21
Q

BPPV AX

A

Dix Hallpike * look for down beating nystagmus

22
Q

Contraindications to Dix Hallpike

A

cervical spine instability, VBI, Arnold- Chiari malformation, acute whiplash, RA, prolapsed IV disc with radiculopathy, cervical myelopathy

23
Q

BPPV Rx

A

Modified Epley Maneuver*, Semont/Liberty maneuver, Brandt-Daroff - very good prognosis after first treatment

24
Q

What is improtant o do after Maneuvers to treat BPPV

A

keep head down at end of maneuver because you can put the crystal in the horizontal canal

25
Q

What is Meniers Disease

A

Over accumulation of endolymph

26
Q

What is the vestibulo occular reflex (VOR)

A
  • reflex that moves your eyes in the opposite direction that your head is turning
  • allows for visual fixation*
27
Q

Is VOR deficient in UVL (unilateral vestibular loss) or BVL (Bilateral vestibular loss)

A

Both

28
Q

Causes of UVL

A

Infection, trauma, disease (Meniere’s Disease), surgery

29
Q

Acute S&S of UVL

A
  • spontaneous nystagmus away from the affected ear
  • reduced VOR
  • vertigo (resolves in a few days)
  • dizziness
  • oscillopsia
  • imbalance
  • ?vomiting
30
Q

Chronic S&S of UVL

A
  • dizziness, oscillopsia, imbalance

- symptoms worse after rapid head movements: depends on compensation

31
Q

UVL Ax

A
  • head-thrust, dynamic visual acuity test, balance and gait assessment + Dix Hallpike
32
Q

UVL Rx

A
  • exercises to resolve conflict and symptoms (adaptation exercises, balance, walking program, functional tasks)
  • education on impact of stress on symptoms
  • maintain general fitness
  • address falls risk, mobility aids
  • improve any balance deficits * 6-8 wks
33
Q

Is BVL always equal side to side

A

No can be unequal

34
Q

Is the dizziness and vertigo in BVL

A

No

35
Q

What normally causes BVL

A

Ototoxic drugs (gentamicin)

36
Q

BVL S&S

A

Decreased balance with eyes closed + Increase oscillopsia

37
Q

What are some general ototoxic meds

A 
antibiotics (gentamicin)
anticancer drugs
env. chemicals
loops diuretics
aspirin
38
Q

Balance Ax

A
  • static (Romberg
  • sharped Romberg (tandem stance))
  • dynamic (reach arm forward
  • movement with eyes opened and closed)
  • composite tests (berg)
39
Q

Different Gait Ax

A

eyes open/closed
head turns
different surfaces
negotiating objects

40
Q

Central vestibular disorders Causes

A
  • stroke
  • TBI, MS
  • tumor
  • neurodegeneration
  • epilepsy
41
Q

Central vestibular disorder red flags:

A

direction changing nystagmus

inconsistency in test results

42
Q

Central vestibular disorders Dx

A

By a collection of occulomotor tests

43
Q

Central vestibular disorders Rx

A

Based on neuroplasticity
- Exercises (habituation, substitution, balance, walking program, functional tasks
8-12 weeks

44
Q

2 types of motion sensitivity

A

1) sensitivity to head movement

2) sensitivity of moving environment

45
Q

Motions sensitivity Rx

A

8–12 weeks of sensorimotor mismatch exercises

46
Q

Cervicogenic dizziness Dx

A

Disorder of exclusion

47
Q

Cervicogenic dizziness Rx

A

management of vestibular dysfunction

  • proprioception neck symptoms
  • Increase motor control and endurance (deep neck flexors)
48
Q

What is an acoustic neuroma?
When is it most common?
What does it cause?

A
  • intracranial tumor of myelin around CN VIII

- common later in life 50-60 yrs causes central vestibular loss

PCE - Neurology (8 decks)

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