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Adv Neuro: Vestibular > Week 1 Highlights > Flashcards

Week 1 Highlights Flashcards

Oculomotor/Vestib Exam, BPPV, & other resources

1
Q

peripheral vs central nystagmus

pattern of mvmt

A

peripheral: horizontal
* mixed plane (torsional w/ horizontal or vertical component)

central: vertical or torsional
* single plane

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2
Q

peripheral vs central nystagmus

consistency of pattern

A

peripheral - doesn’t change

central - direction and pattern may change

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3
Q

peripheral vs central nystagmus

effect of gaze

A

peripheral
* fast phase always to same side
* inc w gaze toward direction of fast phase

central
* no change or fast phase reverses direction

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4
Q

peripheral vs central nystagmus

fatigability

A

peripheral - fatigues, adaptation

central - doesn’t fatigue

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5
Q

peripheral vs central nystagmus

duration

A

peripheral - varies depending on dx but usually short duration

central - can be longer duration or >1min

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6
Q

peripheral vs central nystagmus

unilateral vs bilateral

A

peripheral - always bilateral

central - can be unilateral or bilateral

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7
Q

peripheral vs central nystagmus

effect of fixation

A

peripheral - dec amplitude

central - no impact or inc amplitude

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8
Q

peripheral vs central nystagmus

onset tempo

A

peripheral - often sudden (minutes)

central - often more gradual (more than an hour)

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9
Q

peripheral vs central nystagmus

severity

A

peripheral - mod to severe

central - mild to mod

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9
Q

peripheral vs central nystagmus

symptom pattern

A

peripheral - intermittent
* tends to be more peripheral in nature

central - persistent sx
* either peripheral or central

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10
Q

peripheral vs central nystagmus

headache

A

peripheral - usually absent

central - often present

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11
Q

peripheral vs central nystagmus

course throughout the day

A

peripheral - worse in AM, improves as day proceeds

central - no impact

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12
Q

peripheral vs central nystagmus

positional

A

peripheral - often, depends on etiology

central - minimal impact
* presence of positional impact doesn’t r/o central etiology

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13
Q

peripheral vs central nystagmus

concomitant ear sx

A

peripheral - dec hearing or tinnitis = peripheral cause more likely

central - rare, U/L sudden onset
* could be seen in TIA, interanl auditory artery or AICA stroke

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14
Q

peripheral vs central nystagmus

concomitant neurologic sx

A

peripheral - any neuro complaint = peripheral less likely

central - any neuro complaint = central more likely
* esp diplopia, dysarthria, true ataxia

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15
Q

peripheral vs central nystagmus

gait instability

A

peripheral - tendency to fall to one side

central - tendency to fall to either side

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16
Q

peripheral vs central nystagmus

imbalance

A

peripheral - mild to mod

central - severe

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17
Q

peripheral vs central nystagmus

n/v

A

peripheral - severe

central - variable, may be minimal

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18
Q

acute vestibular syndrome

what is it
5 differential dx

A

acute persistent continuous dizziness lasting days to weeks and usually associated w n/v and intolerance to head motion

  1. vestib neuritis
  2. labyrinthitis
  3. post circulation stroke
  4. demyelinating dz
  5. post-traumatic vertigo
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19
Q

triggered episodic vestib syndrome

what is it
6 differential dx

A

episodic dizziness triggered by specific and obligate actions, usually a change in head or body position; episodes generally last <1min

  1. BPPV
  2. postural HTN
  3. perilymph fistula
  4. superior canal dehiscence syndrome
  5. vertebrobasilar insufficiency
  6. central paroxysmal positional vertigo
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20
Q

spontaneous episodic vestib syndrome

what is it
5 differential dx

A

episodic dizziness not triggered and can last minutes to hours

  1. vestib migraine
  2. meniere’s dz
  3. post circulation TIA
  4. med side effects
  5. anxiety or panic disorder
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21
Q

peripheral vs central nystagmus

symptom pattern

A

peripheral - intermittent
* tends to be more peripheral in nature

central - persistent sx
* either peripheral or central

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21
Q

chronic vestib syndrome

what is it
5 differential dx

A

dizziness lasting weeks to months or longer

  1. anxiety or panic disorder
  2. med side effects
  3. post-traumatic vertigo
  4. post fossa mass lesions
  5. cervicogenic vertigo (variable)
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22
Q

what does alexander’s law mean

A

when gaze is shifted in direction of fast phase, nystagmus will become more pronounced

when gaze is shifted in direction of slow phase, nystagmus will diminish

23
what are the 3 degrees of nystagmus according to alexander's law
1st: nystagmus on intact side only 2nd: nystagmus to intact side and in central position 3rd: nystagmus in all 3 directions
24
when do you usually see 3rd degree nystagmus (per alexander's law)
acute stages w/ vestib neuritis and labyrinthitis
25
what is optokinetic nystagmus (OKN)
normal eye mvmt elicited by tracking of moving field
26
how does OKN present with distinct moving targets
OKN generally contains within it a smooth pursuit
27
what is the function of OKN
allows you to follow objects in motion while head remains stationary
28
how is OKN different from smooth pursuit
smooth pursuit - eye mvmt elicited by tracking a single distinct target OKN - tracking a moving field
29
# chronic vestib syndrome what is it 5 differential dx
dizziness lasting weeks to months or longer 1. anxiety or panic disorder 2. med side effects 3. post-traumatic vertigo 4. post fossa mass lesions 5. cervicogenic vertigo (variable)
29
# peripheral vs central nystagmus symptom pattern
**peripheral** - intermittent * tends to be more peripheral in nature **central** - persistent sx * either peripheral or central
29
what is the ocular tilt reaction (OTR)
triad comprising head tilt, conjugate ocular torsion, and hypotropia d/t skew deviation
30
how will a (+) OTR present
head tilt toward side of lower eye and ocular torsion in same direction w upper poles of eye rotating to lower eye
31
how will (+) OTR present in cerebellar lesions
ipsi or contra depending on structures involved
32
describe the course of the pathway responsible for OTR and how the location of the lesion will impact the (+) OTR presentation
crosses the midline above the abducens nucleus level and ascend into contralateral MLF 1. below lower pons = ipsi 2. more rostral = contra
33
how do you determine the side of the lesion in contraversive vs ipsiversive abnormal OTR
the lesion is ipsi or contralateral to the lowermost eye
34
what is the pathological ocular tilt reaction (OTR)
triad comprising head tilt, conjugate ocular torsion, and hypotropia d/t skew deviation
35
how will peripheral lesions impact all parts of the OTR ## Footnote peripheral - utricle, vestib n., medial and superior vestib nuclei
all tilt effects (perceptual, ocular motor, postural) are all ipsiversive ## Footnote ipsiversive = lesion is ipsilateral to the lowermost eye
36
what are examples of potential etiologies of eye mvmt abnormalities on pressure change
* abnormalities at craniocervical junction (ie arnold-chiari malformation) * disorders of inner ear - ie perilymphatic fistula, superior canal dehiscence (SCD) * middle ear problems with ossicular chain
37
what are 3 examples of pressure tests to use to sus out any eye mvmt abnormalities on a pressure change
1. tragal compression 2. valsalva 3. hyperventilation (1 breath/sec x40-60)
38
what is the key to dx a SCD etiology for an eye mvmt abnormality w pressure changes
thorough hx subjective c/o * sensitive to noise * can hear heartbeat * can hear eyeballs move
39
what is the most commonly involved SCC in BPPV
posterior
40
# BPPV post SCC nystagmus presentation
upbeating and torsional
41
# BPPV ant SCC nystagmus presentation
* downbeating and torsional * or just downbeating
42
# BPPV lat SCC nystagmus presentation
horizontal nystagmus (geo vs apogeo)
43
# BPPV lateral SCC nystagmus geotropic vs apogeotropic
**geotropic** -> ground loving * side of inc intensity = side of affected LC = *canalithiasis* * apogeotropic -> away from ground, to ceiling * side of lesser intensity = side of affected LC = *cupulolithiasis* ## Footnote in lateral SCC, will present with nystagmus sx during head rotation to both sides during *roll test*
44
# peripheral vs central nystagmus symptom pattern
**peripheral** - intermittent * tends to be more peripheral in nature **central** - persistent sx * either peripheral or central
45
how do you differentiate nystagmus in HC from nystagmus of cervicogenic origin
HC = BPPV, gravity dependent cervico = dependent on position of neck
46
a triggering mvmt like reaching for the top shelf would be indicative of BPPV in what canal
post SCC
47
a triggering mvmt reading would be indicative of BPPV in what canal
ant SCC
48
what pt pop is 3x more likely to develop BPPV
migrainers
49
having vertigo with what functional activity makes it 4.3xs more likely to have BPPV
vertigo w rolling in bed
50
describe excitation vs inhibition in vertical canals
flow of endolymph away from ampulla = excites nerve flow of endolymph toward ampulla = inhibits ## Footnote d/t position of kinocilium w/i ampulla
51
what is the primary treatment for BPPV
CRP
52
when is Meclizine prescribed and why? what is a consideration for PT with this?
prescribed during peripheral event to manage sx of vertigo and motion sickness * sedative effect on vestib system sedative effect --> beneficial to not take long term * if testing a pt, have them hold the med bc can suppress nystagmus ## Footnote no strong evidence to support use of meds in treatment of BPPV
53
# peripheral vs central nystagmus symptom pattern
**peripheral** - intermittent * tends to be more peripheral in nature **central** - persistent sx * either peripheral or central
53
what does research say about the efficacy of daily exercise like Brandt Daroffs or Self CRP
doesn't prevent recurrence of BPPV

Adv Neuro: Vestibular (6 decks)

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