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Neuroscience Block 2 > Vestibular System > Flashcards

Vestibular System Flashcards

1
Q

Vestibulo-ocular vs vestibulo-spinal reflex

A
  • VO: when move head, helps EYES so don’t feel sick

- VS: helps maintain balance

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2
Q

vertigo: most common

A

BPPV

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3
Q

vertigo: lasts only seconds

A

BPPV

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4
Q

In BPPV, where does otoconia usually get discharged? where do they ultimately come to rest?

A
  • posterior SSC

- lateral to cupula

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5
Q

vertigo: superior oblique on same side and superior rectus on opposite side affected –> eye spinning

A

BPPV

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6
Q

vertigo: characterized by vertigo and nystagmus that is associated with changes in head position

A

BPPV

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7
Q

vertigo: can follow head trauma, prolonged periods of bed rest, or unusual positions (ex. hair dresser getting hair washed)

A

BPPV

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8
Q

vertigo: idiopathic

A

BPPV

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9
Q

vertigo: most commonly occurs when turning over in bed, getting out of bed ( ), and when reaching up on a shelf with extension of neck ( )

A

BBPV

  • malutinal vertigo
  • top shelf vertigo
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10
Q

BPPV: a change in head position that promotes movement of the otoconia (away from/towards) the cupula establishes a gravity sensitive current, whereby hair cells within the cupula move (away from/towards) the kinocilium and (away from/toward) the utricle or ampulla

A
  • away
  • toward
  • away
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11
Q

BPPV: for the vertical canals, movement produces depolarization and irritative response in the ( )

A

vestibular nerve

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12
Q

the nystagmus seen in BPPV is a form of ( ) nystagmus

A

peripheral

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13
Q

peripheral nystagmus (like in BPPV) are characterized by ( ) movements of the eyes in association with ( ) components that are often dysconjugate

A
  • torsional

- upbeat or horizontal

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14
Q

peripheral form of nystagmus can be provoked by performance of the ( )

A

Hallpike-Dix maneuver

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15
Q

central nystagmus is characterized by eye movements that are often seen to be purely ( )

A

horzizontal, vertical, or torsional

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16
Q

BPPV: once nystagmus done after Epley maneuver, patient is instructed to do what?

A

sleep upright for 48 hours and to avoid sleeping on the proactive side for a total of 5 nights

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17
Q

Epley: complete circle movement of head gradually moves otoconia from long arm of posterior semicircular canal into the ( ), where it is dispersed

A

vestibule

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18
Q

vertiggo: second most common

A

Vestibular Neuritis

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19
Q

vertigo: aka acute peripheral vestibulopathy

A

vestibular neuritis

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20
Q

vertigo: inflammation occurs in nerve itself and not generally within vestibular ganglion

A

vesitbular neuritis

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21
Q

vertigo: patients develop severe rotational vertigo, often with nausea and vomitting

A

vestibular neuritis

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22
Q

vestibular neuritis: fast phase toward ( ) ear; slow phase toward ( ) ear

A

normal; abnormal

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23
Q

vertigo: last 2-3 days but up to weeks for full recovery

A

vestibular neuritis

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24
Q

what is vestibular neuritis often preceded by?

A

upper respiratory tract infection

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25
Q

how is vestibular neuritis treated?

A

meclizine or “zepam”s

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26
Q

vertigo: associated with hearing loss, tinnitus, and ear pressure/fullness

A

Meneire’s syndrome

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27
Q

vertigo: sudden falls after abrupt interruption in vestibulospinal tract followed by loss of postural tone in large antigravity muscles

A

Meniere’s syndrome

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28
Q

vertigo: lasts 2-24 hours

A

Meneire’s syndrome

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29
Q

in Meniere’s, do they lose high or low frequencies first?

A

low

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30
Q

Pike’s Peak

A

Meneire’s

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31
Q

vertigo: inner ear fluid imbalance on ECOG

A

meneire’s

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32
Q

vertigo: development of excessive endolymph within the labyrinth

A

meneiere’s

33
Q

in meneire’s, periodic microruptures in layrinthine sac allow mixing of potassium rich ( ) with ( )

A

endolymph; perilymph

34
Q

meneire’s: which nerve is located within the periymh and becomes hyperpolarized when exposed to endolymph?

A

8th nerve

35
Q

how is meneire’s treated?

A

salt restriction, use of dieuretic agents, and weight loss (things that help you lose water)

36
Q

how is ACUTE meneire’s treated?

A

vestibular suppresstants combined with antiemetics

37
Q

phobic postural vertigo is a common cause of what?

A

dizziness

38
Q

vertigo: patients complain of a subjective balance disturbance despite normal balance testing

A

phobic postural vertigo

39
Q

vertigo: complaints include unsteadiness which is often associated with anxiety and vegetative symptoms

A

phobic postural

40
Q

vertigo: associated with pereceptual stimuli (malls, bridges, stiars, social situations, etc)

A

phobic postural

41
Q

OCD!

A

phobic postural

42
Q

vertigo: 2/3 of patients will have complaints of dizziness at some point during disease

A

vertebrobasilar insufficiency

43
Q

vertigo: 15-20% of patients with completed posterior circulation strokes will have had antecedent isolated attacks of dizziness

A

vertebrobasilar insufficiency

44
Q

vertigo: sound drunk/slurring words

A

vertebrobasilar insufficiency

45
Q

vertigo: ischemia within brain stem, cerebellum, or to inner ear labyrinth secondary to disease within the branches of the basilar artery

A

vertebrobasilar insufficiency

46
Q

vertigo: typical attackes generally last on the order of minutes

A

vertebrobasilar insufficiency

47
Q

when vertebrobasilar ischemia affects the brainstem and cerebellum, a broad diversity of associated neurological manifestations can occur such as:

A
  • diplopia
  • sensory changes
  • ataxia
  • dysarthic speech
  • facial pain
  • Horner’s syndrome
  • weakness
  • postural abnormalities
48
Q

which vertigo is life threatening?

A

vertebrobasilar insufficiency

49
Q

which are taking over conventional angiography as gold standard for assessing the anatomy of posterior vaculature (for vertebrobasilar insufficiency)?

A

MR angiography and MRI

50
Q

alocohol changes the specific ( ) of endolymph within the cupula and can lead to nystagmus and vestibulopathy

A

gravity

51
Q

alocohol have major effect on cerebellar function that can lead to ( )

A
  • ataxia
  • speech changes
  • postural instability
  • nystagmus
52
Q

drug-induced vertigo: produce orthostatic hypotension

A

antihypertensive meds

53
Q

drug-induced vertigo: produce cerebellar dysfunction

A

anticonvulsant agents

54
Q

drug-induced vertigo: damage vestibular hair cells bilaterally, leading to gait instability and oscillopsia

A

antibiotics

55
Q

one of the most ototoxic agents is ( ), which can produce profound vestibular dysfunction in some patients

A

gentamicin

56
Q

patients with ( ) often have neurologic accompaniments. What are the most common? second most common?

A

migrane headache; visual distortions; vestibulopathy (typically vertigo)

57
Q

in up to ( )% of patients with vestibular migraine, vertigo occurs completely independent of headage

A

30%

58
Q

vertigo: connect perilymph with outside world

A

perilymphatic fistula

59
Q

where do perilymphatic fistulas occur?

A

bw middle and inner ear at the oval or round windows

60
Q

vertigo: causes include knocking brain, valsalva maneuver, vigorous exercise, stapes surgery, barotrauma, erosive lesions in petrous bone, inflammatory conditions such as syphilis and congenital conditions

A

perlympahtic fistula

61
Q

vertigo: often develop hearing loss similar to Meneire’s

A

perlymphatic fistula

62
Q

vertigo: hyperventilation-induced

A

perilymphatic fistula

63
Q

vertigo: diagnostic- blow (insufflation) in ear –> vertigo

A

perilymphatic fistula

64
Q

vertigo: patients with vertigo/nystagmus can be induced by what?

A

tragal compressions or swallowing

65
Q

vertigo: treated with be rest, fluid hydration, keeping head elevated, avoid straining

A

perilymphatic fistula

66
Q

vertigo is generally produced when injury occurs to ( )

A

one vestibular apparatus while the other remains intact (asymmetric involvement)

67
Q

in peripheral vestibular dysfunction, slow phase goes toward lesioned eye bc?

A

the normal eye’s vestibular function is increased relative to abnormal eye

68
Q

lightheadedness rasises concern about ( ), the mechanism of which most often involved ( )

A
  • presyncope

- diffuse cerebral ischemia

69
Q

orthostatic hypotension, cardia arrhythmias, certain metabolic derangements (like hypoglycemia, use of drugs with anticholinergic activity, and autoimmune dysfunction) can lead to what?

A

presyncope

70
Q

what most commonly refers to the inability to maintain normal ambulation and upright posture?

A

disequilibrium

71
Q

vegetative symptoms

A

diaphoresis (sweating), nausea, and vomiting

72
Q

vegetative symptoms are often related to instability in ( ) located within floor of 4th ventricle (close to ventral vestibular apparatus)

A

autonomic centers

73
Q

spatial disorientation: abnormalities are likely related to faulty sensory vestibular processing within the ( )

A

cortical vestibular areas

74
Q

vestibular system has ( ), which travel through the brain stem to ( ) nuclues of thalamus on route to ultimate cortical traget projections

A
  • ascending pathways

- contralateral ventral posterior lateral

75
Q

what are accepted indications for performing brain imaging in patients with onset vertigo?

A

intracranial structural abnormalities (tumors and chiari malformation)

76
Q

some patients who develop steriotypic paroysmal episodes of vertigo suffer from ( )

A

microvascular compression syndrome

77
Q

vestibular seizures involve discharges from ( ) that produce symtpoms of vertigo and on occasion perception of environmental tilt

A

primary vestibular cortical zones

78
Q

up to 20% of ( ) patients will experience vertigo at some time during illness

A

MS

79
Q

when vertigo occurs secondary to inflammatory demylination due to MS, the lesions most commonly localize to the root entry zone od ( ) at the lateral pons, or at the level of the vestibular nucleus within medulla

A

CN 8

Neuroscience Block 2 (6 decks)

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