Vestibular Impairment

Question 1

Anatomy

Answer 1

Peripheral Apparatus
- vestibular organ in inner ear
semicircular canals - rotational movement
otoliths (utricle and saccule) - lined movement
vestobular component of vestibulocochlear nerve

Central Vestibular System

• vestibular nuclei in brainstem
• brainstem pathways - vestibulocerebellar and vestibulospinal tracts

Question 2

Central Lesions

Answer 2

brainstem stroke (POCS)
trauma
swelling causes increased pressure on vestibular nuclei
tumours of brainstem

Question 3

Peripheral Lesions

Answer 3

traumatic dizziness
labyrinthitis 
vestibular neuritis 
Meniere's disease
acoustic neurona 
BPPV 
vertigo migraine

Question 4

Traumatic Dizziness

Answer 4

fracture through the labyrinth
BPPV
labyrinthine ocncussions
diving injuries

Question 5

Vestibular Neuritis

Answer 5

viral infection of inner ear/vestibular nerve
gradual onset
associated vertigo, nausea and vomiting
symptoms peak at 24 hours and can become chronic if not treated early and properly

Question 6

Labyrinthitis

Answer 6

bacterial infection of labyrinth inner ear
gradual onset
associated vertigo, nausea and vomiting
hearing loss

Question 7

Meniere’s Syndrome

Answer 7

disorder of inner ear as a result of fluctuating endolymph
causes hearing loss, tinnitus and vertigo
occurs in episodes
over time develop dysequilibrium, heraing loss, tinnitus and motion sensitivty

Question 8

Acoustic Neuroma

Answer 8

schannoma on the vestibular nerve

causes unilateral progressive hearing loss, tinnitus and equilibrium

Question 9

Benign Paroxysmal Positional Vertigo

Answer 9

dislodged otoconia into the semicircular canals
vertigo and nystagmus related to head position
attacks last up to 60 seconds then symptoms free

Question 10

Vestibular Assessment

Answer 10

history of symptoms

• quality of dizziness
• other symptoms associated with dizziness
• onset of symptoms
• duration of dizziness
• functional impact
• balance and falls

Oculomotor examination
smooth pursuit, saccades, head thrust, VOR, CN 3, 4 and 6

Sensory organisation
vestibular, vision, sensation

General neuro exam

Question 11

Rehab

Answer 11

requires accurate diagnosis and assessment
If BPPV = repositioning via Epley’s mannouevre

Oculomotor dysfunction - gaze stability exercises

dysequilibrium - balance re education
education

Dizziness with certain movements = habituation, get them to gradually do those mvoements more often to get used to them

Gait retraining

need to start early
avoid using vestibualr supressants

Question 12

Vestibular VS Non-Vestibular Symptoms

Answer 12

VESTIBULAR
dizziness - feel like world is spinning, motion sickness
caused by position change or head movement
associated nausea, vomiting, tinnitus and oscillopsia

NON-VESTIBULAR
dizziness - light headed, giddy, blacking out, dissociated from body
caused by stress, hyperventilation, cardiac arrhythmias
associated pallor, palpitations, syncope, perspiration

Question 13

Peripheral VS Central Vestibular Symptoms

Answer 13

PERIPHERAL 
severe nystagmus and vertigo 
mild imbalance 
likely to have hearing loss 
mild oscillopsia 
rarely have neurological symptoms 
rapid compensation 

CENTRAL 
moderate nystagmus and vertigo 
severe imbalance 
rare to have hearing loss 
severe oscillopsia 
have associated neurological impairments 
slow compensation

Question 14

Differentiate vestibular vs cerebellar nystagmus

Answer 14

Vesitibular - short duration, torsional, usually larger in one direction than the other
Cerebellar - continuous, smaller movement