Vestibular Exam pt. 2 Flashcards
dizziness
non specific term
feelings of imbalance, spinning, lightheadedness
vertigo
what is it due to?
room is spinning
rotational or linear
imbalance of tonic neural activity to vestibular cortex
caused by peripheral or central damage
what is oscillopsia
just bouncy
gaze instability - illusionary sensation that stationary visual world is moving
only when eyes open
when can oscillopsia be seen
bilateral > unilateral
central vestibular dysfunction
what is disequilibrium
imbalance or unsteadiness while standing or walking
causes of disequilibrium
visual changes, vestibular dysfunction, proprioceptive deficits
neuromotor deficits, joint pain, psychological factors
lightheadedness
pre-syncope
brief decrease in blood flow to brain
motion sickness
induced passive locomotion OR motion in visual surroundings while standing still
episodic dizziness, tiredness, pallor, diaphoresis, salivation, N/V
what is motion sickness caused by
sensory mismatch between visual and vestibular systems
what is motion sickness common with
migraine disorders (60%)
red flags noted during subjective history:
severe HA
rapid hearing decline
dysarthria
incoordination
diplopia
decreased mentation
urinary incontinence
acute weakness
decreased consciousness
additional CN dysfunction
motion sensitivity quotient
position dependent clinical examination that evaluates symptom response
what are the S&S provoked in the motion sensitivity quotient
episodic dizziness, pallor, diaphoresis, tiredness, salivation, nausea, vomiting, imbalance, vertigo, disorientation
motion sensitivity quotient: mild vestibular dysfunction
0-10
motion sensitivity quotient: mod vestibular dysfunction
11-30
motion sensitivity quotient: severe vestibular dysfunction
31-100
dizziness handicap inventory
self assessment inventory designed to evaluate self-perceived handicap from dizziness
physical, emotional, functional
DHI cut offs
mild:
mod:
severe:
0-30
31-60
61-100
DHI MCID
18
smooth pursuit
voluntary
slow following a target
1-2Hz
saccades
voluntary
rapid repositioning of target
VOR
involuntary
eye position in relation to head movement
optokinetic
involuntary
perceives motion in visual field
supplements VOR to stabilize vision
nystagmus
abnormal visual finding
spontaneous nystagmus
peripheral vestibular imbalance nystagmus
congenital
central
nystagmus during nothing
gaze evoked nystagmus
has a trigger
head shaking, optokinetic, positional, calroic, pressure induced, sound induced
non-pathological nystagmus
end range nystagmus
does central nystagmus get worse with lights on
yes - too much info
does peripheral nystagmus get worse with lights on
no - lights off
can’t correct
effect of fixation on peripheral nystagmus
decreases
direction of gaze with peripheral nystagmus
usually mixed plane - horizontal and torsional
effect of gaze on peripheral nystagmus
increases with gaze directed towards quick phase
effect of fixation on central nystagmus
does not change or it increases
direction of gaze with central nystagmus
usually single plane horizontal - torsional or vertical
effect of gaze with central nystagmus
does not change or reverses direction
when do u use frenzel lenses or video infrared camera?
spontaneous nystagmus
head shaking test
eye movements during maneuvers
when do u not use frenzel lenses or video infrared camera?
dynamic visual activity
head impuse test
looking for skew deviations
examine visual tracking and saccades
examine stance and gait
