Vestibular Examination Flashcards
What is one of the most common complaints that brings adults to a physician?
Dizziness.
What are the four common descriptions patients might use instead of ‘dizziness’?
- vertigo
- light-headedness
- dysequilibrium
- oscillopsia
What does vertigo indicate?
Vestibular involvement, either peripheral or central.
What is dysequilibrium?
A sensation of being off balance, which can be due to vestibular or non-vestibular causes.
What is oscillopsia?
An illusion of unstable vision, where stationary objects appear to move, especially with head movement.
What vestibular conditions might cause vertigo?
- BPPV
- Unilateral vestibular hypofunction (UVH)
- Vestibular migraine
- Meniere’s disease
What non-vestibular conditions might cause light-headedness?
- orthostatic hypotension
- hypoglycemia
- anxiety
- panic disorder
- cardiac dysfunction
- VBI
- polypharmacy
What are the four ‘D’s that may indicate neurological involvement?
- Dysarthria - difficult to pronounce words
- Dysphagia - trouble swallowing
- Diplopia - double vision
- Drop Attacks - loss of consciousness
What is the Dizziness Handicap Inventory (DHI)?
A 25-item self-report questionnaire that quantifies the impact of dizziness on a patient’s daily life.
- 0-35 = mild
- 36-53 = moderate
- 54+ = severe
Score range on the DHI
- mild impact = ?
- moderate = ?
- severe impact = ?
- mild impact = 0-35
- moderate = 36-53
- severe impact = 54 +
What is the purpose of the cranial nerve screening in a vestibular exam?
To rule out central nervous system involvement.
What is nystagmus?
Rapid, rhythmic, involuntary eye movements.
How is nystagmus named?
By the direction of the fast phase relative to the patient.
What does spontaneous nystagmus at rest indicate?
It can indicate a peripheral vestibular lesion, especially if horizontal.
How can you observe nystagmus more effectively?
Using infrared video goggles that prevent fixation and allow observation of eye movements.
What does direction-fixed nystagmus indicate?
Typically, a peripheral vestibular lesion.
- Direction-fixed = always beating the same direction, regardless of where the patient looks
What does direction-changing nystagmus indicate?
A central vestibular pathology.
Direction-changing = changes direction while the patient is gazing forward, or while the patient looks around.
What is the ‘H’ test used for in the oculomotor exam?
To test extraocular range of motion and observe for pathological nystagmus.
What does abnormal smooth pursuit indicate?
It may indicate central dysfunction such as cerebellar or brainstem involvement.
What is the purpose of the head impulse test (HIT)?
To examine the VOR at high acceleration and identify vestibular hypofunction.
What does a positive head impulse test indicate?
Vestibular hypofunction on the side toward which the head is turned.
What is the dynamic visual acuity test (DVAT)?
A test that compares static visual acuity with visual acuity during passive horizontal head movements.
What does a greater than 3-line difference in dynamic versus static visual acuity suggest?
VOR loss and vestibular hypofunction.
What is the significance of the Dix-Hallpike test in vestibular examination?
It is a positional test used to diagnose BPPV.
What vestibular conditions might cause dysequilibrium?
Bilateral vestibular loss, chronic unilateral vestibular hypofunction, peripheral neuropathy, cerebellar/motor pathway involvement, LE weakness.
What are some key symptoms of vestibular dysfunction?
Vertigo, tinnitus, pressure in the ears, difficulty concentrating, feeling disoriented, difficulty watching moving objects, blurred vision with movement.
What is lateropulsion?
A tendency to lose balance laterally, often leaning or falling toward the side of vestibular weakness.
What balance tests can be used in a vestibular examination?
- Modified CTSIB
- Romberg
- Sharpened Romberg
- Single leg stance
- 4 Square Step Test
- Functional Reach Test
- Fukuda Stepping Test
.
.
What is the Fukuda Stepping Test used for?
To assess vestibular weakness by monitoring body rotation while the patient steps in place with eyes closed.
What does a rotation greater than 30 degrees during the Fukuda Stepping Test suggest?
- Possible vestibular weakness
- Patients usually rotate/deviate to the side of the vestibular weakness
What does the Dynamic Gait Index (DGI) assess?
The ability to modify gait during various walking tasks.
What does a positive Dix-Hallpike test indicate?
Benign Paroxysmal Positional Vertigo (BPPV).
What does the head impulse test (HIT) assess?
The function of the vestibulo-ocular reflex (VOR) at high accelerations.
What does the Dynamic Visual Acuity Test (DVAT) assess?
The difference between static visual acuity and visual acuity during passive horizontal head movements.
What might a greater than 3-line difference between static and dynamic visual acuity suggest?
VOR loss and vestibular hypofunction.
What is the significance of a positive Romberg test in a vestibular examination?
It indicates a loss of proprioception or vestibular dysfunction.
What might vertical nystagmus indicate?
Central vestibular system pathology.
What does direction-fixed nystagmus suggest?
A peripheral vestibular lesion.
What does direction-changing nystagmus suggest?
A central vestibular pathology.
What does the ‘H’ test assess in a vestibular examination?
Extraocular range of motion and observation for pathological nystagmus.
What does a positive Head Impulse Test indicate?
Vestibular hypofunction on the side being tested.
What is dynamic visual acuity?
The clarity of vision during head movement, testing the VOR function.
What is the purpose of the Dix-Hallpike test?
To diagnose BPPV by identifying positional nystagmus.
What is VOR gain?
The ratio of eye velocity to head velocity, ideally 1:1 for normal function.
What are corrective saccades during the head impulse test indicative of?
Vestibular hypofunction on the side being tested.
What is a common symptom of BPPV?
Vertigo triggered by specific head positions.
What does a decline in dynamic visual acuity indicate?
A loss of VOR function and possible vestibular hypofunction.
What is the role of the vestibular nuclei?
Integration of sensory information from the vestibular system and coordination of motor output.
What does spontaneous nystagmus at rest suggest?
Acute peripheral unilateral vestibular lesion or hypofunction.
What does the Fukuda Stepping Test assess?
Spatial orientation and vestibular weakness.
