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PHTH 528 - Neuro Midterm > Vestibular Disorders and Interventions > Flashcards

Vestibular Disorders and Interventions Flashcards

1
Q

What is the anatomy of the peripheral vestibular system?

A

Semicircular canals
- which has an anterior, posterior and horizontal

Otholith organs
- consisting of the saccule and utricle

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2
Q

What kind of disorder is a benign paroxysmal positional nystagmus/vertigo (BPPN/V)

A

a peripheral vestibular disorder

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3
Q

What are the causes of BPPN/V?

A

Infection
Head trauma
Vestibular weakness
advancing age

Most common disorder resulting in dizziness in older populations

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4
Q

What is the mechanical disorder
caused by?

A

Otooconia displaced from the macula of the utricle

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5
Q

What are symptoms of BPPV?

A

Vertigo
Nausea (with or without vomitting)
Nystagmus (involuntary, rapid and repetitive movement of the eyes) - MOST IMPORTANT

Vertigo: change in head position such as when turning over in bed, getting into or out of bed or when bending over/coming up

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6
Q

What is cupololithiasis?

A

immediate
persistent in duration
Nystagmus: no change in intensity

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7
Q

What is canalithiasis?

A

Latency within (1-40 sec)
Short in duration (< 1 min)
Nystagmus: fluctuates in intensity

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8
Q

What are the similarities between cupulolithiasis and canalithiasis?

A

The direction defines the affected canal

BPPV: nystagmus
- torsional/rotational - vertical (anterior and posterior) canals
- horizontal - horizontal canals

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9
Q

What are the steps needed for a loaded Dix Hallpike test?

A
  1. patient is turned (45 deg) towards the affected ear while in long seat position
  2. Flex the head 30 deg for 30 sec
  3. Patient is quickly moved into a supine position with the head extended and rotated 45 deg towards the ear

Patient is 20-30 deg off the table when in supine position

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10
Q

What is the indication of an up beating torsional Nystagmus?

A

Posterior canal

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11
Q

What is an indication of a down beating torsional Nystagmus?

A

Anterior canal

Usually vertigo with bending over, emptying the dishwasher, weeding

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12
Q

What is the treatment process of a modified epley manuever?

Which is a treatment instead of a test

A
  1. Rotate the head to 45 deg towards the treatment side
  2. Lie back while keeping the 45 deg rotation and at least 20 deg of extension
  3. Hold until sx subside around 30 sec
  4. rotate the head to the opposite direction at 45 deg while keeping that extension - again hold until sx subsides around 30 sec
  5. Roll onto the same side while keeping the 45 deg rotation, tuck the chin to the shoulder - hold until sx subsides around 30 sec
  6. Help patient sit up while keepin the head down and guard for any other eye movements
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13
Q

Why tuck the chin in during a modified epley?

A

Helps with the migration of otoconia towards the utricle

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14
Q

How do you know if the modified epley was successful?

A

when nystagmus is in the same direction

  • if it reverses when sitting up = less chance it worked
  • no nystagmus when sitting up = success
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15
Q

What assessment is used to dermine an affected horizontal canal?

A

A supine roll test

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16
Q

What indicates a positive test for the supine roll test?

A

Horizontal nystagmus without torsion

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17
Q

What is geotropic nystagmus?

A

Canalithiasis
- the involved ear is generally the side with the stronger nystagmus

Geotropic - towards the ground

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18
Q

What is ageotropic nystagmus?

Ageotropic - away from the ground

A

Cupulolithiasis
- the involved ear is generally the side with the weaker nystagmus

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19
Q

What is the dix-hallpike test differential diagnosis?

A chart

A
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20
Q

What is the supine roll test diffential diagnosis?

A chart

A
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21
Q

What diagnosis is the CRM “epley” treating?

CRM - canalith repositioning maneuver

A
  • BPPV due to canalithiasis
  • Posterior SCC canalithiasis (most common)
  • Both anterior and posterior SCC

https://www.youtube.com/watch?v=CPLOd6vqWKI

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22
Q

What diagnosis is the liberatory/sermont maneuver treating?

A
  • BPPV due to cupulolithiasis
  • Posterior SCC cupulolithiasis (most common)
  • Both anterior and posterior SCC

https://www.youtube.com/watch?v=dvC1xrks7qc&t=194s

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23
Q

What diagnosis is the BBQ roll treating?

Also called: Gufani maneuver and prolonged positioning

A

Horizontal canal BPPV

https://www.youtube.com/watch?v=6zsfIa_Z8_k

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24
Q

What diagnosis is the brandt-daroff exercise used for?

A home exercise program

A
  • persistent/residual or mild vertigo (even after CRM)
  • for the patient who may not tolerate CRM
  • to treat posterior SCC BPPV

https://www.youtube.com/watch?v=jkfq3EvhbbM

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25
Q

What is the clinical decision making for BPPV intervention?

A
26
Q

What is central vestibular pathology?

A
  • brain stem vascular disease
  • arteriovenous malformations
  • acoustic neuromas
  • tumors of the brain stem and cerebellum
  • multiple sclerosis
  • vertebrobasilar migraine
27
Q

What is the symptoms of central vestibular disorder?

A
  • severe ataxia
  • abnormal smooth pursuit
  • abnormal saccadic eye movemeent tests
  • no hearing loss
  • diplopia
  • altered consciousness
  • lateropulsion
  • acute vertigo (not usually suppressed by visual fixation)
  • Nystagmus = pure veritcal pendular nystagmus / no rotational component and persist longer

nystagmus is single axis/eyes oscillate at equal speeds

28
Q

What is peripheral vestibular pathology?

A
  • inner ear and vestibular nerve
  • BPPV
  • Followed by uncompensated Meniere disease
  • vestibular neuritis
  • labyrinthitis
  • perilymphatic fistula
  • acoustic neuroma
29
Q

What is the symptoms of peripheral vestibular pathology?

A
  • mild ataxia
  • hearing loss
  • fullness in ears
  • tinnitus
  • sx of acute vertigo usually suppressed by visual fixation
  • sx of acute vertigo usually more intense
  • Nystagmus = upbeating or down beating torsional (vertical with rotational component) or horizontal nystagmus

Spontaneous horizontal nystagmus usually resolves within 7 days in a patient with UVH

30
Q

What is smooth pursuit for oculomotor exam?

A

slow and smooth movements of the eyes to follow a moving target in the environment

31
Q

What is saccade for oculomotor exam?

A

rapid jerky movementof the eyes to bring the image of the target onto the fovea

i.e a rapid movement of the eyes between fixation points

32
Q

What does an abnormal smooth pursuit and saccades indicate?

A

Central vestibular pathology

33
Q

What is VOR?

A

Vestibular ocular reflex
- if head movement/velocity = eye movement/velocity
- a gain of 1/0

34
Q

What is the purpose of VOR?

A

To assist with keeping a stable gaze while we move or the world moves around us
- helps with gaze stability

35
Q

How is VOR in BPPV?

A

Intact

36
Q

What are the sx of an impaired VOR?

Vestibular system asymmetry

A

head movement/velocity ≠ movement/velocity
retinal slip (few degrees) –> major decrease in vision and postural control

37
Q

What is retinal slip?

A

when the eyes lag behind
= blurring of vision with head or eye movement

38
Q

What are the sx when there is a retinal slip?

A

patient will complains of:
- deceased visual acuity
- blurry vision (horizontal)
- jumpy vision (vertical)

39
Q

What are the three systems needed for balance during the CTSIB?

Clinical test of sensory intercation on balance

A
  • inner ear/vestibular system
  • sensory receptors in legs
  • vision/eyes
40
Q

How is the CTSIB interpretation?

A
41
Q

CTSIB interpretation

Condition 1

A

Eyes open on a firm surface
- all 3 systems are available and if pt is having difficulty = all 3 systems may be affected

42
Q

CTSIB interpretation

Condition 2

A

Eyes closed on a firm surface
- somatosensory and vestibular dominant while vision is removed
- If swaying = somatosensory is affected

43
Q

CTSIB interpretation

Condition 4

A

Eyes open on a foam surface
- vision and vestibular dominant while somatosensory removed
- if swaying = vision is affected

44
Q

CTSIB interpretation

Condition 5

A

Eyes closed on a foam surface
- vestibular is dominant while somatosensory and vision removed
- if swaying = vestibular is affected

45
Q

What is the order recruitment of these balance system?

A

vision and somatosensory > vestibular

46
Q

When vision is relied on, when is it unstable during CTSIB and the rationale?

A

Unstable in condition: 2, 3, 5, 6

Rationale: because eyes are closed or conflict between vision and the vestibular system in these conditions

47
Q

When somatosensory is relied on, when is it unstable during CTSIB and the rationale?

A

Unstable in condition: 4, 5, 6
Rationale: because foam/complaints surface present

48
Q

When vestibular is weak, when is it unstable during CTSIB and the rationale?

A

Unstable: 5, 6
Rationale: somatosensory and visual system is not available

49
Q

Differential Diagnosis

What is the pathology of UVH?

Unilateral Vestibular Hypofunction

A

Impairments of balance systems in the inner ear
The peripheral vestibular system is not working properly in one ear
- viral insults, trauma and vascular events

50
Q

Differential Diagnosis

What is the symptoms of UVH?

Unilateral Vestibular Hypofunction

A

Oscillopsia
Resting nystagmus
Postural instability
Dizziness or vertigo
Poor balance (especially with head turns)
blurred vision (when turning head quickly)
Nausea
Trouble walking:
- in dark rooms
- outdoors
- crowded places

51
Q

Differential Diagnosis

What is the pathology BVH?

Bilateral Vestibular Hypofunction

A

Ototoxicity
Meningitis
autoimmune disorder
head trauma
tumor on the 8th cranial
nerve neuronitis

Ototoxiticity - antibiotics such as gentamicin and streptomycin

52
Q

Differential Diagnosis

What are the sx of BVH?

Bilateral Vestibular Hypofunction

A

Oscillopsia
Disequilibrium
no nausa
Ataxia during gait

53
Q

What is oscillopsia?

A

visual blurring with head movements

54
Q

Differential Diagnosis

What is the pathology of otititis media?

A

Infection of the middle ear

55
Q

Differential Diagnosis

What is the sx of otititis media?

A

Fever and ear pain

56
Q

What is the pathology of ototoxicity?

A

Ear poisoning caused by drugs (aminoglycosides) chemicals

57
Q

Differential Diagnosis

What is the pathology of meniere’s disease?

A

Recurrent and usually progressive vestibular disease

58
Q

Differential Diagnosis

What is the sx of meniere’s disease?

A
  • Tinnitus
  • Deafness
  • Sensation of fullness in the ear
  • Vertigo
59
Q

Differential Diagnosis

What is the pathology of acoustic neuroma

A

Tumor on vestibular nerve leading from inner ear to the brain

60
Q

Differential Diagnosis

What is the sx of acoustic neuroma?

A
  • Hearing loss on one side
  • Tinnitus in the affected ear
  • Unsteadiness
  • Loss of balance
  • Dizziness
  • facial numbness

PHTH 528 - Neuro Midterm (8 decks)

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