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Small Animal Optho/Neuro > Vestibular Patient > Flashcards

Vestibular Patient Flashcards

1
Q

What is the physiologic function of the vestibulochoclear system?

A

Maintain posture and balance relative to the head, body and limbs, detects acceleration and deceleration and coordinates eye movement

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2
Q

List some of the structures involved?

A

Bulla, pons, medulla, horizonal canal, inner ear, vestibular apparatus, choclea

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3
Q

How do hair cells help detect motion?

A

movement pulls on the hair cells and changes the rate of fire

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4
Q

Explain the purpose of each of the folllowing structures:
Semicircular canals
Saccule
Utricle
Ampulla

A

Semicircular canals - x, y and z plane
Saccule - vertical acceleration
Utricle - horizonal acceleration
Ampulla - rotational movement

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5
Q

What parts of the brain are considered central vestibular?

A

medulla and cerebellum

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6
Q

The vestibulospinal track is the only ____ track. (Contralateral or ipsilateral)

A

Ipsilateral

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7
Q

What role does the vestibular system have in eye movement?

A

Physiologic nystagmus and oculocephalic reflex

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8
Q

What nerves run through the middle ear?

A

Cranial nerve 7: Facial Nerve
Sympathetic to eye

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9
Q

What are the signs of horners sysndrome?

A

Miosis, ptosis, enophthalmos, 3rd eyelid protrusion

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10
Q

What are some clinical signs of vestibular disease?

A

Abnormal posture, vestibular ataxia, strabismus, nystagmus

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11
Q

How is nausea related to the inner ear?

A

Chemoreceptor trigger zone and vomiting center right next door

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12
Q

What are some treatments for nausea?

A

-Antihistamines (Target vestibular nucleus
-Ondansetron (target seratonins in CTZ)
-Metoclpramise (target dopamine)
-Maropitant (targets on CTZ and vomit center Neurokinin-1)

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13
Q

What are the goals of the neurologic exam in reference to vestibular dysfunction?

A

Localize (central versus peripheral), establish differntial diagnosis, determine diagnostic procedure and prognosis

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14
Q

What is the consciousness level of peripheral vs central vestibular disease?

A

Peripheral: alert but disoriented

Central: alert, disoriented, obtunded, stupor or coma

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15
Q

What can a patient be obtunded and stuporous with central vestibular?

A

The RAS system is right next door so if the lesion is large enough it may be affected as well

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16
Q

What does the gait look like in a vestibular patient?

A

asymmetric input, head tils, circle, rolling, leading (toward lesion) and vestibular ataxia

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17
Q

When a patient loses balance and is found in the archer pose, where is the lesion?

A

flexed leg is where the lesion is located (Lose tone on side with injury)

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18
Q

Which gait says peripheral versus central?

A

Peripheral: vestibular ataxia and good strength

Central: vestibular ataxia and tetra or hemiparesis

19
Q

What are the key parts of the neuro exam that tell peripheral versus central?

A

Consciousness and postural reactions

20
Q

What is the postural reaction of peripheral versus central vestibular?

A

Peripheral: no deficit, good strength

Central: ipsilateral deficit and hemi/tetra paresis

21
Q

What is the common vestibular strabismus location?

A

Abnormal eye position, ventrolateral, resting or positionally induced

22
Q

What is the pathologic nystagmus?

A

spontaneous at rest, positional induced, rotary, horizonal (central or peripheral) or vertical (central), fast phase, jerk away from lesion

23
Q

What kind of nystagmus is associated with peripheral or central?

A

Peripheral: horizonal rotary or fast away

Central verticle or horizonal, change directions

24
Q

Cranial nerve deficits central vs peripheral?

A

Peripheral: no other than 7, sympathetic eye

Central 5-7, sympathetic rare

25
Describe the following for a central vestibular lesion: Mentation: Posture: Gait: Postural Reaction Deficit: CN: Nystagmus:
Mentation: Alert, obtunded, stupor or coma Posture: head tilt ipsilateral and can be contralateral Gait: Ataxia and para or tetra paresis Postural Reaction Deficit: Deficit on ipsilateral side CN: 5-7 (facial, vestibulo coclear) Nystagmus: vertical or horizonal, change direction
26
Describe the following for a peripheral vestibular lesion: Mentation: Posture: Gait: Postural Reaction Deficit: CN: Nystagmus:
Mentation: Alert, disoriented Posture: head tilt ipsilateral Gait: Ataxia, strong, Postural Reaction Deficit: None CN: Only 7 Nystagmus: Horizonal, rotary
27
What are the most common causes of Peripheral vestibular disease?
Otitis media/interna, polyp, PSOM, Idiopathic, ototoxic drug, hypothyroidism
28
After determining that it is peripheral how do you procede?
Otoscopic exam, rad bulla, CT (good bony), BAER, Myringotomy *Can progress to meningitis or abscess
29
What are some causes of otitis media?
Infectious: pseudomonas aeruginosa, staph pseudointermedius, ecoli or klebsiella Non-infectious: PSOM (secretory), glue ear, otitis with effusion
30
How is otitis media treated?
Topical (careful) oral - clavamox or batryl myringotomy TECA-Bo
31
Describe an myringotomy and its indications
Poke a hole in the middle ear to release fluid and pressure Chronic infections, intact tympanum, fluid or buldging membrane
32
What is a polyp, signs and how do you treat it?
Inflammatory disease - middle ear, nasopharync or combo Signs: upper airway breathing heavy Pull off
33
What are some common types of aural neoplasia?
Fibrosarcoma, chondrosarcoma, osteosarcoma, SSC Surgical resection or radiation
34
Who gets idiopathic vestibular disease, when and how long does it take to clear?
Adult cat and older dogs Acute remission 1-2 weeks Cuterebra?
35
What kinds of things are ototoxic?
Aminoglycosides (gentamicin, amikacin neomycin), polymixin, furosamide, NSAID, Chemo, chlorohex, detergent prpylen glycol
36
What is the prognosis for vestibular peripheral?
good if treat early and aggressive guarded if cancer or ototoxicity permancent head tilt, kcs, horner or facial paresis
37
What are some major causes of central vestibular disease?
Hypothyroid, neoplasm, thiamine deficiency, infectious, brainstem trauma, metronidazole, stroke
38
How do you approach diagnostics once you know it is central vestibular disease?
MRI, CSF tap, Reffer
39
Hypothyroidism can cause either?
peripheral: myoxomatous compression CN, polyneuropathy Central - infarce, cns demylination
40
What kind of intercranial neoplasia are common?
meningioma, chorid plexus, Treat rescetion or radiation
41
Thiamine Deficiency in central?
Signs: seizure, mentation, vestibular Cause: diet treat: balance diet
42
What about metronidazole toxicity?
>60mg/kg/day GABA treatment? Diazepam Lead other toxin
43
What about vascular cause?
Sigs: acute Cause: cterebra?, infarct, thrombocis, hypothroidism

Small Animal Optho/Neuro (13 decks)

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