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DPT 761 - Neuro Rehab II > Vestibular Examination > Flashcards

Vestibular Examination Flashcards

1
Q

What is one of the most common complaints that brings adults to a physician?

A

Dizziness.

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2
Q

What are the four common descriptions patients might use instead of ‘dizziness’?

A
  • vertigo
  • light-headedness
  • dysequilibrium
  • oscillopsia
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3
Q

What does vertigo indicate?

A

Vestibular involvement, either peripheral or central.

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4
Q

What is dysequilibrium?

A

A sensation of being off balance, which can be due to vestibular or non-vestibular causes.

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5
Q

What is oscillopsia?

A

An illusion of unstable vision, where stationary objects appear to move, especially with head movement.

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6
Q

What vestibular conditions might cause vertigo?

A
  • BPPV
  • Unilateral vestibular hypofunction (UVH)
  • Vestibular migraine
  • Meniere’s disease
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7
Q

What non-vestibular conditions might cause light-headedness?

A
  • orthostatic hypotension
  • hypoglycemia
  • anxiety
  • panic disorder
  • cardiac dysfunction
  • VBI
  • polypharmacy
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8
Q

What are the four ‘D’s that may indicate neurological involvement?

A
  • Dysarthria - difficult to pronounce words
  • Dysphagia - trouble swallowing
  • Diplopia - double vision
  • Drop Attacks - loss of consciousness
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9
Q

What is the Dizziness Handicap Inventory (DHI)?

A

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
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10
Q

Score range on the DHI

  • mild impact = ?
  • moderate = ?
  • severe impact = ?
A
  • mild impact = 0-35
  • moderate = 36-53
  • severe impact = 54 +
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11
Q

What is the purpose of the cranial nerve screening in a vestibular exam?

A

To rule out central nervous system involvement.

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12
Q

What is nystagmus?

A

Rapid, rhythmic, involuntary eye movements.

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13
Q

How is nystagmus named?

A

By the direction of the fast phase relative to the patient.

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14
Q

What does spontaneous nystagmus at rest indicate?

A

It can indicate a peripheral vestibular lesion, especially if horizontal.

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15
Q

How can you observe nystagmus more effectively?

A

Using infrared video goggles that prevent fixation and allow observation of eye movements.

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16
Q

What does direction-fixed nystagmus indicate?

A

Typically, a peripheral vestibular lesion.

  • Direction-fixed = always beating the same direction, regardless of where the patient looks
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17
Q

What does direction-changing nystagmus indicate?

A

A central vestibular pathology.

Direction-changing = changes direction while the patient is gazing forward, or while the patient looks around.

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18
Q

What is the ‘H’ test used for in the oculomotor exam?

A

To test extraocular range of motion and observe for pathological nystagmus.

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19
Q

What does abnormal smooth pursuit indicate?

A

It may indicate central dysfunction such as cerebellar or brainstem involvement.

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20
Q

What is the purpose of the head impulse test (HIT)?

A

To examine the VOR at high acceleration and identify vestibular hypofunction.

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21
Q

What does a positive head impulse test indicate?

A

Vestibular hypofunction on the side toward which the head is turned.

22
Q

What is the dynamic visual acuity test (DVAT)?

A

A test that compares static visual acuity with visual acuity during passive horizontal head movements.

23
Q

What does a greater than 3-line difference in dynamic versus static visual acuity suggest?

A

VOR loss and vestibular hypofunction.

24
Q

What is the significance of the Dix-Hallpike test in vestibular examination?

A

It is a positional test used to diagnose BPPV.

25
Q

What vestibular conditions might cause dysequilibrium?

A

Bilateral vestibular loss, chronic unilateral vestibular hypofunction, peripheral neuropathy, cerebellar/motor pathway involvement, LE weakness.

26
Q

What are some key symptoms of vestibular dysfunction?

A

Vertigo, tinnitus, pressure in the ears, difficulty concentrating, feeling disoriented, difficulty watching moving objects, blurred vision with movement.

27
Q

What is lateropulsion?

A

A tendency to lose balance laterally, often leaning or falling toward the side of vestibular weakness.

28
Q

What balance tests can be used in a vestibular examination?

A
  • Modified CTSIB
  • Romberg
  • Sharpened Romberg
  • Single leg stance
  • 4 Square Step Test
  • Functional Reach Test
  • Fukuda Stepping Test
29
Q

.

A

.

30
Q

What is the Fukuda Stepping Test used for?

A

To assess vestibular weakness by monitoring body rotation while the patient steps in place with eyes closed.

31
Q

What does a rotation greater than 30 degrees during the Fukuda Stepping Test suggest?

A
  • Possible vestibular weakness
  • Patients usually rotate/deviate to the side of the vestibular weakness
32
Q

What does the Dynamic Gait Index (DGI) assess?

A

The ability to modify gait during various walking tasks.

33
Q

What does a positive Dix-Hallpike test indicate?

A

Benign Paroxysmal Positional Vertigo (BPPV).

34
Q

What does the head impulse test (HIT) assess?

A

The function of the vestibulo-ocular reflex (VOR) at high accelerations.

35
Q

What does the Dynamic Visual Acuity Test (DVAT) assess?

A

The difference between static visual acuity and visual acuity during passive horizontal head movements.

36
Q

What might a greater than 3-line difference between static and dynamic visual acuity suggest?

A

VOR loss and vestibular hypofunction.

37
Q

What is the significance of a positive Romberg test in a vestibular examination?

A

It indicates a loss of proprioception or vestibular dysfunction.

38
Q

What might vertical nystagmus indicate?

A

Central vestibular system pathology.

39
Q

What does direction-fixed nystagmus suggest?

A

A peripheral vestibular lesion.

40
Q

What does direction-changing nystagmus suggest?

A

A central vestibular pathology.

41
Q

What does the ‘H’ test assess in a vestibular examination?

A

Extraocular range of motion and observation for pathological nystagmus.

42
Q

What does a positive Head Impulse Test indicate?

A

Vestibular hypofunction on the side being tested.

43
Q

What is dynamic visual acuity?

A

The clarity of vision during head movement, testing the VOR function.

44
Q

What is the purpose of the Dix-Hallpike test?

A

To diagnose BPPV by identifying positional nystagmus.

45
Q

What is VOR gain?

A

The ratio of eye velocity to head velocity, ideally 1:1 for normal function.

46
Q

What are corrective saccades during the head impulse test indicative of?

A

Vestibular hypofunction on the side being tested.

47
Q

What is a common symptom of BPPV?

A

Vertigo triggered by specific head positions.

48
Q

What does a decline in dynamic visual acuity indicate?

A

A loss of VOR function and possible vestibular hypofunction.

49
Q

What is the role of the vestibular nuclei?

A

Integration of sensory information from the vestibular system and coordination of motor output.

50
Q

What does spontaneous nystagmus at rest suggest?

A

Acute peripheral unilateral vestibular lesion or hypofunction.

51
Q

What does the Fukuda Stepping Test assess?

A

Spatial orientation and vestibular weakness.

DPT 761 - Neuro Rehab II (17 decks)

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