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Vestibular Disorders Review Flashcards

1
Q

what stimulates the vestibular system

A

linear acceleration
angular acceleration

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2
Q

result of vestibular stimulation

A

clear vision with head motion
postural reflexes
orientation of body/head to vertical

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3
Q

how is the vestibular system function categorized?

what type of loop is it and what systems are involved?

A

feed forward loop
- sensory input to the CNS for processing and then motor output

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4
Q

what sensory input is gathered by the vestibular system

A

motion detection via

visual, vestibular and proprioceptive pathways

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5
Q

in the CNS, where does vestibular information get processed

A

primary processing center = vestibular nuclear complex

secondary processing center = cerebellum

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6
Q

where in the CNS is the primary processing complex

A

medulla and pons

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7
Q

integration of information in 1° and 2° processing centers allows for

A

estimation of head and body orientation

stimulation of a motor response

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8
Q

explain the process of motor output in response to CNS processing

A

motor neurons stimulate

oculomotor reactions (VOR)
cervical muscle reactions (VCR)
postural muscle reactions (VSR)

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9
Q

explain the VOR

A

vestibular oculomotor reflex

ocular muscle stimulation that result in eye movement that is equal and opposite of head movement

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10
Q

what is the purpose of VOR

A

allow for stable vision during head motion

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11
Q

explain the VCR (not tv)

A

vestibulocollic reflex

cervical muscles activate to counter movement sensed by vestibular apparatus

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12
Q

goal of the VCR

A

stabilization of the head

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13
Q

explain the VSR

A

vestibulospinal reflex

postural muscle activation to stabilize the body counteractively

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14
Q

how is the vestibular system divided? where are the respective receptors for each?

A

peripherally - inner ear

centrally - nuclei and tracts in brain cortex, cerebellum and brainstem

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15
Q

explain the exact location where the peripheral and central portions of the vestibular system divide

A

peripheral - CN7 until it enters brainstem

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16
Q

within the inner ear, explain the location of the peripheral vestibular system

A

situated between middle ear and petrous portion of temporal bone

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17
Q

explain the relationship between cochlea and peripheral vestibular system

A

cochlea is within the inner ear but is not a component of the peripheral vestibular system

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18
Q

the anatomy of peripheral vestibular system is made of

A

semicircular canals
ampulla
otolith organs

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19
Q

names of semicircular canals? relationship between contralateral sides

A

anterior
posterior
horizontal

  • weird picture of dude flexing, basically saying that anterior of one side and posterior canal of the other will line up with each other and so will the horizontal canals
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20
Q

what do semicircular canals detect

A

angular motion

ie head flexion, extension, lateral flexion and rotation

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21
Q

anatomy and physiology of the ampulla

A

enlargements of SCC near utricle

made of hair cells that bend as the head moves, detecting movement

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22
Q

what is another name for the vestibule?

what makes up the vestibule?

A

otolith organs

utricle and saccule

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23
Q

what do otolith organs detect

A

linear motion
static tilt of the head

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24
Q

explain static tilt of the head

A

acceleration of head when in a static position

ex - car accelerating or plane taking off
– otoliths will detect the acceleration even though the head is not moving

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25
what does it mean when canals are described as orthogonal
90° to each other
26
explain the idea of "push-pull" relationship of SCCs
when angular motion is experienced in conjugate SCCs neural firing will increase in one vestibular nerve and decrease in the other ie - left rotation will cause left horizontal to fire and right horizontal to inhibit
27
are semicircular canals oriented within cardinal planes
no
28
how do conjugate canals positioning relate to extraocular muscles
they are in optimal pulling directions of extraocular muscles
29
what detects movement within the peripheral vestibular system
hair cells stereocillia
30
what surrounds the peripheral vestibular system?
bony labyrinth
31
what is contained within the bony labyrinth? what is this made of?
membranous labyrinth endolymph fluid
32
describe the anatomy within an ampulla
hair cells that are embedded in the crista and covered by a gelatinous capula
33
explain the heights of different stereocilia and the point of them
tallest - kinocilium shorter ones - stereocilia if stereocilia move toward kinocilium then an excitatory signal is sent --> not sent if moved away from kino
33
34
explain direction of endolymph fluid and and canal movement? what is the point of this
endo will flow opposite of canal movement capula within the ampulla will deflect the steroecilia excitatory signals will be sent to the brain for sense of processing motion
35
explain direction of endolymph fluid and and otolith movement? what is the point of this
endolymph will flow opposite of movement endo will flow towards or away from kinocilium and cause an excitatory or inhibitory response
36
vestibular nuclei will relay information to which CNS locations
cerebellum cerebral cortex spinal cord oculomotor muscles (CN3,4,6)
37
explain oculomotor muscles and their relationship with head movement
eyes will move equally and oppositely of head direction
38
explain VOR in relation to vestibular dysfunction
inability to stabilize gaze via VOR = vestibular dysfunction
39
abnormal head impulse test result
eyes not staying on target saccade to target
40
explain how nystagmus occurs? how is it named?
eye muscle activation in relation to the associated semicircular canals based upon the fast phase, typically away from the side that is functioning improperly
41
Central vs Peripheral Nystagmus
central: pure vertical pure torsional direction changing
42
explain the best practice protocol when testing for nystagmus in relation to lighting
want a darker room with infrared goggles light will allow the eyes to fixate on a target and suppress nystagmus
43
what is alexander's law
nystagmus is direction-fixed during gazing toward center, left and right. intensity increases in the direction of the fast phase decreases in the direction of the slow phase
44
how is dizziness due to vestibular involvement described
sensation that results from the disruption of information from vestibular, visual and somato systems
45
vestibular system dysfunction occurs due to
abnormal firing rate between contralateral vestibular apparatuses impaired CNS or its ability to process
46
signs of vestibular dysfunction
nystagmus positive special tests
47
symptoms of vestibular dysfunction
vertigo - sensation of moving oscillopsia - visual illusion where stationary objects seem to bounce dysequilibrium motion sensitivity
48
how do we quantify symptoms of vestibular dysfunction
description of symptoms tempo - acute, episodic or chronic circumstances of symptoms
49
differentiate peripheral vs central vestibular dysfunction based on - vertigo - nausea - oscillopsia - dysequilibrium - vomiting - headache
vert - both nausea - both oscillopsia = central not peripheral dyseq = both, central more severe vom = maybe both HA = central yes
50
what nerve is associated with oscillopsia
CN 8 = vestibulocochlear
51
list of peripheral vestibular disorders
BPPV Vestibular neuritis acoustic neuroma meniere's disease ototoxicity
52
central causes of vestibular disorders
stroke MS neoplasm
53
of the peripheral causes of vestibular disorder, what can a PT diagnose
BPPV others are medical diagnoses that result in vestibular hypofunction
54
what does BPPV stand for?
benign paroxysmal positional vertigo
55
cause of BPPV
otoconia in otolith organs become loose, clump together and then move into SCC
56
how is BPPV described
episodic, intense vertigo related to change in head position
57
which SCC is otoconia most likely to go into
posterior due to gravity
58
pathophys of BPPV
otoconia moving into SCC causes endolymph to move - cascade of events cause the brain to interpret movement of the head and causes sensation of spinning
59
time related to BPPV episodes of vertigo
<60 seconds
60
what is vestibular neuritis
viral infection preceeding vestibular symptoms will travel to vestibular nerve
61
explain timeline of symptoms associated with vestibular neuritis
sudden onset of vestibular symptoms that lasts 1-2 days then residual symptoms will resist with head motion
62
signs of vestibular neuritis
nystagmus abnormal VOR
63
medical treatment of vestibular neuritis
anti-emetics, histamines, cholinergics steroids
64
prognosis of vestibular neuritis
over 6 wks to 3 months may have persistent symptoms
65
what is an acoustic neuroma
benign tumor within schwann cells of vestibular nerve sheath
66
s/s of acoustic neuroma? which is different?
dizziness and dysequilibrium -- hearing loss is a differentiator
67
how to diagnose acoustic neuroma? what about treatment?
MRI surgery
68
what causes meniere's disease
malabsorption of endolymph fluid -- increased fluid volume
69
s/s of meniere's disease - any differentiators
fullness feeling in ear TINNITUS fluctuating vertigo HEARING LOSS imbalance caps are differentiators
70
diagnosis / treatment of meniere's
MD confirmation via s/s and audiogram medical treatment - diuretics, diet (NA restriction) could have surgery to prevent fluid buildup / ablation of vestibular nerve
71
when is PT appropriate in meniere's disease progression
acute = not appropriate vestib rehab after
72
when considering s/s of peripheral vestibular disorders, explain timing of symptoms
meniere and bppv = episodic neuroma = come upon slowly neuritis = very fast onset
73
ototoxicity targets the
cochlea and/or hair cells
74
what is the differentiator of ototoxicity
bilateral permanent damage
75
strokes involving the ____ and/or ____ via these arteries will cause _____ vestibular hypofunction
brainstem and or cerebellum Basilar - AICA Vertebral - PICA central
76
for central disorders, when is PT appropriate? what is indicated?
once medically stable VR, postural control and gait interventions
77
what is VNG and ENG? what is the point
video or electro nystagmography capture nystagmus associated with vestibular dysfunction to determine CNS or PNS cause
78
what is CDP? what is the point?
computerized dynamic posturgraphy -- assess ability to remain posture under various environmental conditions -- evaluate somatosensory and visual influences on posture and equilibrium
79
what in a general sense does CDP assess vs ENG/VNG
CDP - one's ability to integrate various sensory inputs to maintain postural control V/ENG - CNS or PNS cause of vestibular disorders
80
differential in testing the central vestibular system vs peripheral vestibular system
both include: oculomotor exam / postural control CNS includes = red flags PNS includes = VOR
81
how is vestibular rehabilitation designed
must produce an error signal in order for brain to adapt / compensate
82
explain acute vestibular rehabilitation and symptom reproduction
must exacerbate symptoms then allow for system to return to baseline progressively challenges the vestibular system to improve its ability
83
canalithiasis vs cupulolithiasis
canal = otoconia displacement from macula into SCC cupulo = otoconia adhere to cupula -- more intense and for >60 seconds

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