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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
Q

Describe the following for a central vestibular lesion:
Mentation:
Posture:
Gait:
Postural Reaction Deficit:
CN:
Nystagmus:

A

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
Q

Describe the following for a peripheral vestibular lesion:
Mentation:
Posture:
Gait:
Postural Reaction Deficit:
CN:
Nystagmus:

A

Mentation: Alert, disoriented
Posture: head tilt ipsilateral
Gait: Ataxia, strong,
Postural Reaction Deficit: None
CN: Only 7
Nystagmus: Horizonal, rotary

27
Q

What are the most common causes of Peripheral vestibular disease?

A

Otitis media/interna, polyp, PSOM, Idiopathic, ototoxic drug, hypothyroidism

28
Q

After determining that it is peripheral how do you procede?

A

Otoscopic exam, rad bulla, CT (good bony), BAER, Myringotomy

*Can progress to meningitis or abscess

29
Q

What are some causes of otitis media?

A

Infectious: pseudomonas aeruginosa, staph pseudointermedius, ecoli or klebsiella

Non-infectious: PSOM (secretory), glue ear, otitis with effusion

30
Q

How is otitis media treated?

A

Topical (careful)
oral - clavamox or batryl
myringotomy
TECA-Bo

31
Q

Describe an myringotomy and its indications

A

Poke a hole in the middle ear to release fluid and pressure

Chronic infections, intact tympanum, fluid or buldging membrane

32
Q

What is a polyp, signs and how do you treat it?

A

Inflammatory disease - middle ear, nasopharync or combo

Signs: upper airway breathing heavy

Pull off

33
Q

What are some common types of aural neoplasia?

A

Fibrosarcoma, chondrosarcoma, osteosarcoma, SSC

Surgical resection or radiation

34
Q

Who gets idiopathic vestibular disease, when and how long does it take to clear?

A

Adult cat and older dogs
Acute
remission 1-2 weeks
Cuterebra?

35
Q

What kinds of things are ototoxic?

A

Aminoglycosides (gentamicin, amikacin neomycin), polymixin, furosamide, NSAID, Chemo, chlorohex, detergent prpylen glycol

36
Q

What is the prognosis for vestibular peripheral?

A

good if treat early and aggressive
guarded if cancer or ototoxicity
permancent head tilt, kcs, horner or facial paresis

37
Q

What are some major causes of central vestibular disease?

A

Hypothyroid, neoplasm, thiamine deficiency, infectious, brainstem trauma, metronidazole, stroke

38
Q

How do you approach diagnostics once you know it is central vestibular disease?

A

MRI, CSF tap, Reffer

39
Q

Hypothyroidism can cause either?

A

peripheral: myoxomatous compression CN, polyneuropathy
Central - infarce, cns demylination

40
Q

What kind of intercranial neoplasia are common?

A

meningioma, chorid plexus,
Treat rescetion or radiation

41
Q

Thiamine Deficiency in central?

A

Signs: seizure, mentation, vestibular
Cause: diet
treat: balance diet

42
Q

What about metronidazole toxicity?

A

> 60mg/kg/day
GABA
treatment? Diazepam
Lead other toxin

43
Q

What about vascular cause?

A

Sigs: acute
Cause: cterebra?, infarct, thrombocis, hypothroidism

Small Animal Optho/Neuro (7 decks)

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