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Vestibular System Flashcards

1
Q

What are the four types of eye movements

A
  1. Saccades
  2. Vergence
  3. Smooth pursuit
  4. Vestibulo-ocular
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2
Q

In saccadic eye movements, what is the “motor error”

A

The difference between the initial and intended position of a target

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3
Q

Saccadic movements - when the intended target of fixation has moved, how long is the processing delay to then move the eye to the intended target

A

200ms

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4
Q

Are saccadic movements voluntary or reflexive ?

A

They can be both

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5
Q

What are the 3 sensory inputs

A

Vestibular, somatosensory and visual

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6
Q

What is the role of the cerebellum

A

It coordinates and regulates posture, movement and balance

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7
Q

What is the role of the cerebral cortex in movement

A

It contributes higher level of thinking and memory of movements (autonomy)

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8
Q

What is the role of the brainstem in movement

A

It integrates and sorts sensory information

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9
Q

What are the 3 motor outputs which feed into balance

A

Vestibulo-ocular reflex, and motor impulses for eye movements and postural adjustment

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10
Q

What are the two groups of receptors in the vestibular system and what are their roles

A

Angular rotation and velocity - semi-circular canals

Acceleration/deceleration (linear) - otoliths organs

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11
Q

What are the primary signs and symptoms of vestibular disorders (9)

A
  1. Vertigo
  2. Dizziness/light headedness
  3. Nausea/vomiting
  4. Oscillopsia
  5. Nystagmus
  6. Impaired balance
  7. Panic/anxiety
  8. Gait abnormalities
  9. Fatigue
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12
Q

What are the associated problems of vestibular signs and symptoms (6)

A 
Neck and back pain
Physical deconditioning
Agoraphobia
Hyperventilation
Falls
Hearing loss/tinnitus
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13
Q

List the 2 peripheral components of the vestibular system

A

Semi-circular canals

Vestibule (otoliths organs)

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14
Q

What are the 3 semicircular canals

A

Anterior, posterior, horizontal

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15
Q

What are the structures which make up the semicircular canals (2)

A

Bony (Osseous) labyrinth

Membranous labyrinth

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16
Q

What is the name of the fluid within the semicircular canals

A

Endolymph

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17
Q

What is the name of the area within the semicircular canal where fluid reacts with hair cells

A

Ampulla

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18
Q

What is the name of the structure which reacts to the forces of the endolymph and converts them into APs in hair cells

A

Capulla

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19
Q

Define Alexander’s law

A

Nystagmus is greater when patient looks in the direction of the fast phase

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20
Q

What number is the vestibulecochlear nerve

A

CN8

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21
Q

What are the 3 planes of rotation

A

Pitch (AP - nodding the head)
Roll (ML - touching ears to shoulders)
Yaw (head side to side - shaking head)

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22
Q

What separates the bony and membranous labyrinths

A

Perilymphatic fluid and supportive connective tissues

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23
Q

What are the 2 otoliths organs

A

Utricle

Saccule

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24
Q

What movement of the capula results in APs

A

Deflection

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25
Q

What is the name of the longest hair in semilunar canal hair cells

How does it affect APs

A 
Kinocilium
Movement towards (excitation)
Movement away (inhibition)
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26
Q

Which planes do the otoliths organs provide sensory information for?

A

Utricle - horizontal plane

Saccule - vertical plane

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27
Q

Which semicircular canals are parallel

A

Left anterior & right posterior

Right anterior & left posterior

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28
Q

True of false: Vergence movements are disconjugate

A

True

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29
Q

The basic function of Vestibulo-ocular movements are to what ?

A

Stabilise the eyes relative to the external world

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30
Q

What is the VOR

A

The automatic and coordinated movement of extraocular eye muscles of equal velocity and opposite direction to head movement

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31
Q

What is the formula for gain

A

Output/input
OR
eye movement/ head movement

32
Q

What is perfect gain

A

1 (eye movement = head movement)

33
Q

How does vestibular hypo-function affect VOR

A

Reduces gain (eye movement/head movement < 1)

34
Q

What is the difference between stereocilia in the ampulla versus utricle?

A

In the ampulla, they are only within the capula, and react to rotational or angular motion.

In the utricle, the stereocilia lay beneath otoliths (calcium carbonate crystals) and react to linear acceleration/deceleration.

35
Q

What are the main reflexes of the vestibular system and what do they do?

A

VOR - equivocal velocity and opposite direction of eye movements during head movements to maintain foveal focus on a target.
VSR - changes in muscle activity to optimise postural control and stability with head movements
VCR - Acts on neck muscles to stabilise the head during movements

36
Q

What are 3 causes of central vestibular pathologies

A

Vascular
Traumatic
De-myelination

37
Q

8 causes of peripheral vestibular pathology

A 
Benign positional paroxysmal vertigo (BPPV)
Unilateral hypofunction
Unilateral vestibular loss (UVL)
Bilateral vestibular loss (BVL)
Ménière’s disease
Fistula
Vestibular neuritis/labyrinthitis 
Vestibular schwannoma/neuroma
38
Q

What is BPPV and what are the two types and symptoms of each?

A

Benign paroxysmal positional vertigo - The dislodging of otoconia from otolith organs which then causes excessive deflection of capula in semicircular canals leading to vertigo
Cupulolithiasis - immediate onset of vertigo held as long as the head is left in that position. Specifically, it is the adhering of otoconia to capula causing increased deflection (increased mass) leading to and increased vestibular reflex
Canalithiasis - latency of endolymph causing delayed onset of vertigo, nystagmus and changing intensities. Caused by free floating otoconia in long arm of semicircular canals leading to increased deflection

39
Q

What is vestibular neuritis/labyrinthitis

A 
Neuritis
Acute inflammation of CNVIII (vestibulocochlear) 
Postural imbalance
Nausea
No hearing loss, tinnitus

Labyrinthitis
Same presentation with addition of temporary hearing loss

40
Q

What is Ménière’s disease

A

Disorder of the inner ear function with 2 variants:
1. Vestibular
2. Cochlear
Typical attack: sensation of fullness of ear, tinnitus and reduction of unilateral hearing plus rotary vertigo and imbalance
Lasts several hours

41
Q

What is a vestibular schwannoma and symptoms

A

Non malignant tumour of the vestibular portion of CNVIII

Symptoms 
Progressive unilateral hearing loss
Aural fullness with tinnitus
Headaches (large tumours > 3cm)
Facial sensation loss, weakness with large tumours)
42
Q

Define ageotrophic and geotrophic nystagmus

A

Ageotrophic - opposite direction to gravity

Geotrophic - same direction as gravity

43
Q

Define upbeat and down beat

A

Nystagmus in an upwards or downward direction relative to the eye socket

44
Q

How can you tell the difference between canallulothiasis and capulolothiasis in the horizontal canal

A

Ageotrophic - capulothiasis

Geotrophic - canulothiasis

45
Q

Nystagmus decreasing when fixation is added, indicates what?

A

A peripherally caused vestibular nystagmus

46
Q

A peripheral Vestibular nystagmus will be effected by Gaze how?

A

The nystagmus will increase with gaze towards the direction of the quick phase

47
Q

Diagnosis driven treatment for BPPV

A

Canalith repositioning
Liberatory
Brandt-daroff
Appiani manoeuvres

48
Q

Unilateral hypofunction treatment

A

Adaptation, substitution (habituation)

49
Q

Treatment for motion sensitivity

A

Habituation

50
Q

Treatment for bilateral vestibular loss

A

Substitution, adaption

51
Q

Treatment for central vestibular dysfunction

A

Habituation

52
Q

What 2 things should be asked during vestibular subjective assessment

A

Nature of the symptoms (vertigo, dizziness, unsteadiness, headaches, falls, hearing loss)
Temporal quality of symptoms (when they come on, how long they last)

53
Q

What are 3 occulomotor assessmemts

A

VOR
DVA
peripheral canal testing (dix-hall pike and side-lying test - anterior/posterior; roll test - horizontal canal)

54
Q

If nystagmus does not decrease with fixation, what would this indicate?

A

Central vestibular nystagmus

55
Q

If nystagmus increased with gaze, what would this indicate?

A

Peripheral vestibular nystagmus

56
Q

What is a DVA assessment

A

Dynamic Visual acuity test compares the ability to read small letters in a static head position, compared to whilst using the VOR with head turning (at least 2 Hz)

57
Q

What does a gaze stability exercise consist of?

A

Challenging the eye to stay on a target during head movement

58
Q

An individual has prolonged episodes of vertigo, A head impulse test is performed and found to be positive, this is indicates what?

A

A peripheral vestibular dysfunction

59
Q

What are 3 self-reported outcome measures for vertigo

A

Dizziness handicap inventory DHI
Activities-specific balance confidence scale ABC
Motion sensitivity quotient MSQ

60
Q

Spontaneous and positional nystagmus is indicative of central or peripheral lesions

A

peripheral

61
Q

A patient presents with vertigo, examination reveals: A skew deviation, a normal Head impulse test, a gaze evoked nystagmus. Is the dysfunction likely to be central or peripheral?

A

Central

62
Q

List 2 common peripheral disorders presenting with acute dizziness

A
  1. Vestibular neuritis

2. Labrynthitis

63
Q

List 2 common disorders presenting with spells of dizziness for seconds

A
  1. BPPV

2. Orthostatic hypotension

64
Q

List 2 common disorders presenting with spells of dizziness for hours

A
  1. Meniere’s Disease

2. Motion sickness

65
Q

Explain how a unilateral peripheral lesion results in spontaneous nystagmus

A

Unopposed higher spontaneous neural activity, due to the unopposed activity of the SCC on the intact side

66
Q

Which positive tests indicate a central lesion

A
  1. smooth pursuit
  2. Saccades
  3. Skew deviation
  4. VOR cancellation
67
Q

Which tests may be indicative of peripheral vestibular dysfunction

A
  1. VOR - head thrust
  2. VOR - head shaking
  3. DVA
68
Q

Which type of BPPV has a latency of onset during testing

A

Canalisthiasis

69
Q

Which type of BPPV should settle within 60 seconds ?

A

Canalisthiasis

70
Q

Which type of BPPV has an immediate onset ?

A

Cupulolithiasis

71
Q

RPM - what manoeuvre could be used for an anterior or posterior Canalithiasis ?

A

Epley’s

72
Q

RPM - what manoeuvre could be used for an anterior or posterior Cupulolithiasis ?

A

Somount’s Liberatory

73
Q

RPM - what manoeuvre could be used for a Horizontal Canalithiasis ?

A

BBQ Roll

74
Q

RPM - what manoeuvre could be used for a Horizontal Cupulolithiasis ?

A

Casani’s

75
Q

Differentiating symptoms between Vestibular neuritis and Labrynthitis

A

Labrynthitis presents with temporary hearing loss

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