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NEURO 2 > Vestibular pathology > Flashcards

Vestibular pathology Flashcards

1
Q

meniere’s
vertigo characteristics

A

Severe vertigo, can be preceded by aura (migraine)
Between attacks often asymptomatic
Those who are symptomatic between attacks have a wide assortment of S&S

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2
Q

meniere’s
onset

A

Sudden, spontaneous (unless identifiable trigger)

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3
Q

meniere’s
duration and frequency

A

Minutes to up to ~24 hours
Highly variable in frequency, ≥ 2 episodes

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4
Q

meniere’s
auditory involvement

A

YES
Ear fullness, fluctuating unilateral tinnitus and hearing loss

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5
Q

meniere’s
imbalance

A

YES
Can see OTOLITHIC CRISIS (”Drop attacks”)

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6
Q

meniere’s
other S/S

A

diarrhea, diaphoresis, tachycardia,
trembling, anxiety

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7
Q

3 stages of progression in meniere’s

A

unpredictable attacks of vertigo

vertigo> tinnitus> hearing loss

hearing loss> balance difficulties> tinnitus

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8
Q

lab testing for meniere’s

A

ENG/VNG
VEMP
posturography

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9
Q

neuritis

A

Viral infection of the vestibular branch of vestibulocochlear nerve or ganglion

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10
Q

labyrinthitis

A

Viral or bacterial inflammation within entire labyrinth

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11
Q

neuritis/labyrinthitis
vertigo characteristics

A

acute: severe

chronic: gradual reduction in symptoms. some resolve

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12
Q

neuritis/labyrinthitis
duration and frequency

A

acute: days to a week

chronic: weeks to months

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13
Q

neuritis/labyrinthitis
onset

A

sudden
spontaneous

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14
Q

neuritis/labyrinthitis
auditory involvement

A

neuritis– NO

labyrinthitis– YES

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15
Q

neuritis/labyrinthitis
imbalance

A

YES

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16
Q

neuritis/labyrinthitis
other S/Sx

A

Can be left with residual complaints of imbalance, persistent feelings of disorientation, or “haziness,” difficulty concentrating are all common

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17
Q

tests for acute neuritis/labyrinthitis

A

clinical exam
vHIT/HIT

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18
Q

tests for chronic neuritis/labyrinthitis

A

Rotary Chair Test
Audiogram
VEMP
MRI
Blood work

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19
Q

mechanism of acoustic neuroma/
vestibular schwannoma

A

slow growing tumor
age 30-60

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20
Q

acoustic neuroma
vertigo characteristics

A

usually secondary

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21
Q

acoustic neuroma
onset

A

usually gradual

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22
Q

acoustic neuroma
duration and frequency

A

constant

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23
Q

acoustic neuroma
auditory involvement

A

YES

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24
Q

acoustic neuroma
imbalance

A

if vertigo symptoms, YES

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25
Q

acoustic neuroma
other S/Sx

A

check for CN5 and 7 involvement
defer PT until after surgery

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26
Q

lab tests for acoustic neuroma

A

MRI is gold standard
audiogram

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27
Q

mechanism of perilymph fistula

A

opening between middle and inner ear

caused by rupture in the oval window of ear
leads to perilymph leaking into middle ear

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28
Q

causes of perilymph fistula

A

head trauma
usually a direct blow to ear

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29
Q

perilymph fistula
vertigo characteristics

A

worsens with activity, increased altitude, valsalva
improves with rest

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30
Q

perilymph fistula
onset

A

sudden
preceded by trauma

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31
Q

perilymph fistula
duration and frequency

A

dependent on activity
highly variable

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32
Q

perilymph fistula
auditory involvement

A

YES

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33
Q

perilymph fistula
imbalance

A

YES

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34
Q

perilymph fistula
other S/Sx

A

HA and motion intolerance

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35
Q

what tests are positive with perilymph fistula

A

fistula test
valsalva test

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36
Q

fistula test

A

puff in eyes to increase pressure
record eye movements

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37
Q

valsalva test

A

deep breath in, hold it
pretend to have BM
wait 10s and record eye movements

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38
Q

mechanism of semicircular canal dehiscence

A

fistula due to lack of temporal bone covering of anterior SCC

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39
Q

semicircular canal dehiscence
vertigo characteristics

A

precipitated by coughing, loud noises, pressure changes in ear

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40
Q

semicircular canal dehiscence
onset

A

sudden
spontaneous

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41
Q

semicircular canal dehiscence
duration and frequency

A

dependent on activity
highly variable

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42
Q

semicircular canal dehiscence
auditory involvement

A

YES

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43
Q

semicircular canal dehiscence
imbalance

A

YES

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44
Q

semicircular canal dehiscence
other S/Sx

A

internal and external sound sensitivity

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45
Q

what tests would be positive with semicircular canal dehiscence

A

tulio’s phenomenon (have patient talk louder)
valsalva test
bone sensitivity test (tuning fork to lateral malleoli)

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46
Q

bilateral vestibular hypofunction
vertigo characteristics

A

ONLY if loss is sequential in nature

47
Q

bilateral vestibular hypofunction
onset

A

dependent on cause

48
Q

bilateral vestibular hypofunction
duration and frequency

A

tends to be constant
worsened by head movements

49
Q

bilateral vestibular hypofunction
auditory involvement

A

dependent on cause
if ototoxicity– YES

50
Q

bilateral vestibular hypofunction
imbalance

A

YES

51
Q

bilateral vestibular hypofunction
other S/Sx

A

primary complaint is severe oscillopsia

52
Q

gold standard for bilateral vestibular hypofunction

A

rotary chair test

53
Q

Weber
sensorineural

A

louder in the good ear

54
Q

Weber
conductive

A

louder in the bad ear if congenital,
sounds the same if traumatic

55
Q

Rinne
sensorineural

A

can’t hear vibration on the bone or next to the ear

56
Q

Rinne
conductive

A

can hear vibration on mastoid process but not in the air

57
Q

sensorineural loss is dysfunction of

A

inner ear
damage to neurological structures

58
Q

conductive loss is dysfunction of

A

middle ear
something is physically in the way

59
Q

3 features of peripheral vestibular nystagmus

A

effect of fixation: nystagmus decreases

direction of fast phase: usually mixed (horizontal and torsional)

effect of gaze: nystagmus increases with gaze toward direction of quick phase

60
Q

3 features of central vestibular nystagmus

A

effect of fixation: nystagmus either does not change or it increases

direction of fast phase: usually single-plane horizontal (torsional or vertical)

effect of gaze: nystagmus either does not change or it reverses direction

61
Q

peripheral vestibulopathy

A

UNI directional
alexander’s law applies
present with acute lesion
rare for chronic lesions
decreases if fixation is available

62
Q

central dysfunction

A

changes direction
alexander’s law does NOT apply
seen in acute or chronic
increases or stays the same if fixation is available

63
Q

1st degree nystagmus

A

only present when gaze directed towards fast phase

64
Q

2nd degree nystagmus

A

present in primary gaze and when gaze directed towards fast phase

strongest when gaze directed towards fast phase

65
Q

3rd degree nystagmus

A

present in all gazes

strongest when gaze directed towards fast phase

66
Q

use of fixation blockers? :
look for spontaneous nystagmus

A

YES

67
Q

use of fixation blockers? :
assess dynamic visual acuity

A

NO

68
Q

use of fixation blockers? :
assess head impulse test

A

NO

69
Q

use of fixation blockers? :
assess head shaking nystagmus test

A

YES

70
Q

use of fixation blockers? :
look for skew eye deviation

A

NO

71
Q

use of fixation blockers? :
examine visual tracking and saccades

A

NO

72
Q

use of fixation blockers? :
look for eye movements elicited during maneuvers

A

YES

73
Q

use of fixation blockers? :
examine stance and gait

A

NO

74
Q

abnormal findings of VOR testing

A

corrective saccades
nystagmus

75
Q

abnormal findings of head thrust/head impulse test

A

corrective saccades// post-thrust nystagmus
normal with +vertigo sensation

76
Q

abnormal findings of head shake test

A

PVD: more than 3 beats of post head shaking nystagmus
CVD: vertical nystagmus

77
Q

abnormal findings of dynamic visual acuity

A

more than 3 line degradation

78
Q

abnormal findings of optokinetic nystagmus

A

asymmetrical response
direction of reduced motion leads to non-compensated vestibular condition

79
Q

abnormal findings of skew deviation

A

deviation of one eye while it is being covered
followed by refixation after uncovering it

80
Q

abnormal findings of VOR cancellation

A

+ corrective saccades ipsilateral to cerebellar lesion

81
Q

what is HINTS test

A

HI– head impulsive test
N– nystagmus observation
TS– test of skew

82
Q

concern for CNS– INFARCT

A

I– impulse
N– normal
F– fast phase nystagmus
A– alternating
R– refixation during
C– cover
T– test

83
Q

score for mild vestibular dysfunction

A

0-10

84
Q

score for moderate vestibular dysfunction

A

11-30

85
Q

score for severe vestibular dysfunction

A

31-100

86
Q

provoked S/SX of motion sensitivity quotient

A

episodic dizziness
pallor
diaphoresis
tiredness
salivation
nausea
vomiting
imbalance
vertigo
disorientation

87
Q

MCID for dizziness handicap inventory

A

18

88
Q

MCID for mini-best test

A

4

89
Q

MCID for BESS test

A

3points (3 errors)

90
Q

vestibular cut off for 4 square step test

A

> 12s
indicates risk for falls

91
Q

abnormal findings of romberg, sharpened romberg, and timed unipedal stance

A

unable to maintain balance
falls towards side of injury

92
Q

migraine characteristics

A

unilateral
tend to last 4-72 hours
pulsating sensation
aggravated by routine/activity
can have N/V

93
Q

3 causes of cerebellar degenerative disorders

A
  1. genetics/ congential
  2. alcoholism
  3. paraneoplastic disorders
94
Q

persistent postural-perceptual dizziness (PPPD or 3PD)

A

chronic dizziness with or without vertigo and fluctuating imbalance provoked by personal, social, or environmental stimuli

95
Q

3PD symptoms can present for

A

present for months but occur daily

96
Q

criteria for 3PD diagnosis

A
  1. > 1 symptom of dizziness or unsteadiness present on most days for 3 months or longer
  2. persistent symptoms without specific provocation, but are exacerbated by upright position, active or passive motion, and exposure to moving visual stimuli or complex visual patterns
  3. precipitated by conditions that cause vertigo, unsteadiness, dizziness, or problems with balance
  4. symptoms cause significant distress or functional impairment
  5. all other dx ruled out
97
Q

menieres interventions
conservative

A

diet restrictions: salt, chocolate, caffeine

medications: diuretics, vestibular and CNS suppressants, steroids

98
Q

menieres
vestibular rehabilitation therapy DOs and DONTs

A

do: for those that are symptomatic between attacks

don’t: not during attacks, no for those with frequent episodes

MOST APPROPRIATE– after surgical interventions

99
Q

intratympanic gentamicin

A

injects medication into membrane
medication kills off labyrinth

VERY high risk of hearing loss

100
Q

vestibular nerve section

A

takes vestibular branch of the vestibulocochlear nerve and cuts it out
**high risk because surgery has to open the brain

HEARING IS SPARED

101
Q

labyrinthectomy

A

labyrinth and cochlea taken out

100% HEARING LOSS

102
Q

neuritis and labyrinthitis
medications

A

neuritis: vestibular suppressants, steroids, and antivirals

labyrinthitis: treated with same meds but also antibiotic

103
Q

neuritis and labyrinthitis
vestibular rehabilitation

A

adaptation exercises speed up recovery

recovery can take up to 2 months but patients tend to do well

104
Q

acoustic neuroma interventions

A

surgical removal
radiation to shrink the tumor before
vestibular rehab ONLY once the tumor is fully resected

105
Q

what population is radiation preferred for in those with acoustic neuroma

A

elderly population
patients in poor health
bilateral neuroma
if affecting their only hearing ear

106
Q

perilymph fistula interventions

A

smaller= conservative (avoid lifting or increasing ICP)

surgery= occurs if 6months or more pass without healing

107
Q

exploratory tympanotomy

A

tries to patch fistula up with a graft
(usually a surgeons go-to)

108
Q

vestibular nerve section for perilymph fistula

A

clip out vestibular branch of vestibulocochlear nerve
these are the patients you work with due to their system imbalance

109
Q

do we treat perilymph fistulas

A

NO

110
Q

semicircular canal dehiscence
conservative intervention

A

avoid offending stimuli
- noise
- exertion

111
Q

semicircular canal dehiscence
surgical intervention

A

canal plugging
resurfacing surgery

112
Q

do we treat semicircular canal dehiscence before surgery

A

NO

113
Q

bilateral vestibular hypofunction
interventions

A

medications are not helpful

need for vestibular rehabilitation
- postural control
- gaze stabilization

**will ALWAYS have some type of residual impairment

114
Q
A

NEURO 2 (6 decks)

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