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Neuro II > Vestibular Examination > Flashcards

Vestibular Examination Flashcards

1
Q

Vestibular hypofunction can be due to…

A

Otolith involvement or semicircular canal involvement

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2
Q

Otolith involvement

A

Impaired orientation to static head position and linear acceleration/deceleration

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3
Q

What are the symptoms associated with otolith involvement?

A

Motion sickness, visual impairments, imbalance, nausea/vomiting

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4
Q

Semicircular canal involvement

A

impaired VOR

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5
Q

What signs and symptoms are associated with semicircular involvement?

A

Nystagmus, imbalance, nausea/vomiting

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6
Q

Nystagmus

A

repetitive, to-and-fro movement of the eyes characterized by a fast and slow phase.

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7
Q

What are the different pathological and non-pathological eye movements that can be observed during a vestibular examination?

A
  • Smooth pursuit
  • Saccades
  • VOR
  • Optokinetic
  • Nystagmus
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8
Q

What is the primary diagnostic indicator used in identifying most peripheral and central vestibular lesions?

A

Nystagmus

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9
Q

What is the primary symptom associated with the presence of nystagmus?

A

VERTIGO

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10
Q

What are the three types of nystagmus and how, in general, do they differ?

A
  • Spontaneous: occurs at rest
  • Evoked nystagmus: occurs with trigger
  • Non-pathological nystagmus: end-range eye movements
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11
Q

An audiogram assesses

A

for auditory asymmetry, significant difference in threshold hearing levels between ears (retrocochlear pathology or ear canal + tympanic membrane integrity)

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12
Q

Retrocochlear pathology

A

unilateral sensorinueral loss, impaired speech recognition d/t damage of cranial nerve VIII or CNS structures

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13
Q

Ear canal and Tympanic Membrane Integrity Pathology

A

Conductive Hearing Loss (variety of causes)

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14
Q

Electronystagmography (ENG)

A

electrodes are placed around the eye to measure VOR via muscular activation

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15
Q

Videonystagmography (VNG)

A

Utilizes video goggles to monitor eye movements and VOR

More common than ENG

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16
Q

What is the gold standard to assess for unilateral peripheral vestibular hypofunction?

A

Caloric Testing

17
Q

Caloric Testing

A

evaluates integirty of unilateral vestibular apparatus (horizontal canal comparative exam)

18
Q

Explain how caloric testing works

A

Cold irrigations generate nystagmus in the Opposite direction,
Warm irrigations generate nystagmus in the Same direction

Normally

19
Q

What is indicative of a (+) caloric test for peripheral vestibular hypofunction?

A

Significant asymmetry in nystagmus amplitude (>25% difference in peak slow components eye movement)

Cold in involved ear - HUGE nystagmus towards contralateral ear; warm in involved ear, decreased response of nystagmus OR switches to ipsilateral ear

20
Q

Vestibular Evoked Myogenic Potential (VEMP)

A

Measures otolith function via muscle reflex in neck or eye with electrodes.

21
Q

cVEMP

A

measures saccule function via VST

Measurement of reflexvie SCM ipsilaterally in reponse to sound

22
Q

oVEMP

A

measures utricle function via MLF

Measurement of reflexive inferior oblique contralaterally to air or bone conducted sound.

23
Q

Abnormal VEMP Results

A
  • No muscular response to sound
  • Asymmetrical response R vs L
24
Q

What is the gold standard for diagnosis of bilateral vestibular hypofunction (BVH)?

A

Rotational Chair Test

25
Q

Rotational Chair Test

A

Normally creates nystagmus, with bilateral vestibular hypofunction: NO VOR gain observed (eyes go with head)

26
Q

What are the red flags to screen for in the subjective history?

A
  • Severe headache
  • Rapid hearing decline
  • Dysarthria, dysphagia, aphasia
  • Incoordination
  • Diplopia
  • Cognitive changes
  • Urinary incontinence
  • Acute weakness
  • Decreased consciousness
  • Any other Neuro S&S
27
Q

Dizziness

A

NON-specific term emcompassing imbalance, spinning, lightheadedness

28
Q

Disequilibrium

A

Imbalance or unsteadiness while standing or walking

29
Q

Oscillopsia

A

“bouncing vision”, gaze-instability

BILATERAL > unilateral vestibulopathy, only experienced when eyes are open.

30
Q

Lightheadedness

A

Brief decrease in blood flow to brain

31
Q

Motion Sickness

A

episodic dizziness, tiredness, pallor, diaphoresis, salivation, N/V induced by passive locomotion OR motion in visual surroundings while standing still

Sensory mismatch between visual and vestibular systems

32
Q

VERTIGO

A

False sense of environmental motion (“room is spinning”), rotational or linear, due to imbalance of tonic neural activity to vestibular cortex: NYSTAGMUS

Neuro II (17 decks)

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