Vestibular Pathology Flashcards
1
Q
PNS Conditions
A
- BPPV
- Hypofunctioning conditions
— Vestibular neuritis/labyrinthitis
— BL vestibular hypofunction - Meniere’s Disease/endolymphatic hydrops
- Perilymphatic fistula
2
Q
CNS Conditions
A
- Vestibular Migraine
- PPPD
- Head trauma
- Brainstem stroke/VBI
- Cerebellar disorders/MS
3
Q
Non nervous system disorders
A
Cervicogenic dizziness
4
Q
A
5
Q
BPPV
A
- Most common cause of peripheral vertigo
- Otoconia in utricle become loose and fall off macula and drop into canal (usually posterior 85-95%)
- > 50Y
- Roomspinning vertigo 30s-2min
- Positional triggers
6
Q
Canalithiasis
A
- Horizontal BPPV
- Otoconia in endolymph
- Symptoms and nystagmus transient
- Tx: BBQ roll, appiani maneuver
7
Q
Cupulolithiasis
A
- Horizontal BPPV
- Otoconia stuck in cupula
- Symptoms and nystagmus persistent
- Tx: Cassani maneuver
8
Q
Posterior canal BPPV
A
- Vertical and torsional nystagmus
- Short duration < 1 min
- Test: Dix Hallpike
- Tx: Canal repositioning maneuver
9
Q
Unilateral hypofunction: vestibular neuritis
A
- Acute unilateral vestibulopathy, 2nd most common peripheral vertigo
- Typically d/t virus or trauma/surgery
- Resulting inflammation = hypofunction of CNVIII
- Can involve cochlear branch and impact hearing
10
Q
Unilateral hypofunction: Pathophysiology
A
- CNS normally receives symmetrical feedback from both nerves
- Acute asymmetry causes vertigo, nausea and spontaneous nystagmus
- Spontaneous rebalancing reduces symptoms within 14 days (neuroplasticity by cerebellum)
11
Q
Vestibular neuritis clinical presentation
A
- Room spinning dizziness
- Symptoms last 3-4 days w imbalance and nausea
- Spontaneous and gaze holding nystagmus acutely, and will beat to the more neurally intact side
- Testing: head impulse test, dynamic visual acuity
12
Q
Ménière’s disease
A
- Recurring vertigo d/t abnormally large amounts of endolymph in the inner ear
- Unclear cause, maybe poor circulation, virus, allergies, autoimmunity, migraine, genetics
- 40-60Y
- Triggered by stress, fatigue, atmospheric pressure change, certain foods (sodium)
13
Q
Meniere’s Disease Clinical Presentation
A
- Episodic vertigo, fluctuating hearing loss, ear fullness, tinnitus, spontaneous nystagmus
- Early: episodic, intense vertigo
- Chronic: imbalance due to dysfunction, hearing loss may become permanent
- No testing, clinical Dx
- Tx: low sodium, diuretics, steroids, gentamycin injection, nerve section if needed
14
Q
Perilymphatic fistula
A
- loss of separation bw middle and inner ear d/t fistula at round and oval windows
- usually d/t blow to the head or surgery
- imbalance, positional vertigo, nystagmus and hearing loss, worse with strain/valsalva
- Tx: bed rest, hope it heals or sx, NO PT
15
Q
Bilateral vestibular disorders
A
- caused by ototoxic chemicals/meds (antibiotics), advanced Ménière’s disease, autoimmune ear conditions
- may have hearing loss or vertigo
- imbalance, worse in dark, oscillopsia (no gaze stabilization)
16
Q
Central vestibular system components
A
-vestibular nuclei
-cerebellum
-reticular activating system (RF)
-midbrain (eye mvmts)
-higher cortical centers
17
Q
Vestibular Migraine
A
- Vertigo, self motion, nausea, migraine symptoms
- may be spontaneous, position change, visual stim, hormone fluctuation, barometric pressure change, poor sleep, stress, dietary
- lasts 5 min - 72 hrs, or can be brief
18
Q
Vestibular Migraine Pathophysiology
A
- Similar to migraine where chemicals involved in TVS also present within central vestib centers, which are connected to nociceptive centers in the brainstem
- Evidence that hyperactivity increase vestibular sensitivity, as well as altered sensory processing within higher cortical centers
19
Q
Vestibular Migraine Clinical Presentation
A
- Headache or migraines, photo or phonophobia, may have dizziness with or without headache, self motion more common than vertigo but vertigo may be spontaneous and last seconds up to 3 days
- May be hypersensitive to oculomotor/vestibular exam and demonstrate imbalance. May have nystagmus.
20
Q
Arterial supply to vestibular system
A
- Vertebral a: 2 vertebral arteries join to form basilar artery to supply brainstem and cerebellum
- Vertebral a dissection = dizziness/vertigo, headache, neck pain
21
Q
Brainstem/cerebellar stroke
A
Cerebellum is supplied by 3 major arteries on each side (AICA, PICA, SCA)
- Most common syndrome is PICA/Wallenberg: vertigo, nausea, hoarseness, dysphagia
22
Q
3PD
A
- Chronic maladaptation to vestibular dysfunction, medical or psychological event that triggered symptoms
- Non-spinning vertigo, self motion, imbalance, lightheaded, mild dissociation
- Visual (action movie, reading, grocery store), active (walking, car, change in pace or position), or mixed
- Tx: vestibular rehab, CBT, serotonergic meds
23
Q
Cervicogenic dizziness
A
- Non specific altered orientation in space and disequilibrium originating from abnormal afferent activity from the neck
- pts very likely to have neck pain at rest, w mvmt and to palpation, limited ROM
- imbalance, dizziness in head, disorientation, HA
- abnormal cervical proprioception
