Week 2 Flashcards
brief overview of central vestibular pathology symptoms talked about in case history
milder in nature with gradual onset
*often associated with headache, visual changes or neurological deficits
brief overview of peripheral vestibular pathology symptoms talked about in case history
tends to be sudden onset, decreases with visual fixation, often accompanied by otologic symptoms (aural fullness, fluctuation on hearing, tinnitus)
*more likely to report nausea and vomiting
nystagmus with peripheral lesion
horizontal and torsional
inhibited by fixation
doesnt change with gaze
nystagmus with central lesion
purely vertical or horizontal
nor inhibited by fixation
direction changing with gaze
otologic symptoms with peripheral lesion?
hearing loss and tinnitus common
otologic symptoms with central lesion?
uncommon
latency after provocation with peripheral lesion
longer (>15 seconds)
latency after provocation with central lesion
short
fatigibility of peripheral lesion
yes
fatigability of central lesion
no
duration with peripheral lesion
variable
duration with central lesion
long
neurologic symptoms with peripheral lesion
no
neurologic symptoms with central lesion
yes
loss of consciousness with peripheral lesion
no
loss of consciousness with central lesion
possible
vertigo
an illusionary sense of movement or rotation
*can be pt spinning or the world spinning around them
presyncope
lightheadedness just prior to falling
- often pts report feeling like they are going to faint, but don’t actually
- *if they faint, its not a disorder of the ear
- need to look at heart, blood pressure, carotid artery blockage and do so quickly
orthostatic hypotension
- common cause of presyncope
- this is when someone either stands up too quickly or sits up too quickly from the supine position
- this happens in the young and old populations but see an increase with age (inadequate vascular supply, reduced reflex compensation)
how to diagnose orthostatic hypotension
blood pressure is taken laying, sitting, and standing
*if a sig changes (>20 systolic pressure) is notes then it is orthostatic hypotension
treating orthostatic hypotension
medication management: what medications could be causing the issue?
*counseling: pts should be urged to move slowly to allow the change in blood pressure to equalize
vasovagal attacks
- reduction of cardiac output by decreasing blood pressure and pulse rate
- maybe w/ sight of blood, or a frightening event, heat exposure, bowel movement
- dizziness, pallor, sweating, tingling hands, nausea
- pts may pass out
- EKG and medical eval often negative
- tilt table is important
treating vasovagal attacks
reevaluation of meds
education
counseling to reduce frusteration and anxiety
heart disorders (leading to dizziness)
- arrythmias
- heart disease acquired or congenital
- coronary artery disease
psychological disequilibrium
- anxiety induced, associated with panic attacks
- usually lasting 10-15 minutes
- accompanied by palpitations, parethesias, sweating, shortness or breath and dizziness
- hyperventilation
ocular disequilibrium
- visual abnormalities send incorrect messages to the brain about spacial positioning
- very common after changes in corrective lenses, or eye surgery
- pts will have to adjust to the change by returning to life and allowing compensation of the VOR
- motion sickness falls in this category
motion sickness
- occurs when there is a mismatch between vestib and visual systems
- this is also why reading a book in a car can make some people really sick
- Dramamine reduces the input of the vestib system and reduces conflicting message
pathologies that have short length dizziness
- BPPV
- perilymph fistula
- SSCD
- vascular insufficiency
- Chiari malformation
- Iatrogenic
pathologies that have a medium length dizziness
- meniere’s disease
- migraine
- metabolic
- syphilis
- panic attacks
- TIA
- Iatrogenic
pathologies that have a long length dizziness
- labyrinthitis
- temporal bone trauma
- stroke
- multiple sclerosis
- Iatrogenic (caused by medical treatment)
- autoimmune inner ear disease
static evaluation (bedside eval)
- assess for spontaneous nystagmus
- have pt look straight, right, left, up, and down with and without fixation (Fenzels lenses) look at eyes fro spontaneous or gaze nystagmus
- results:
- –horizontal nystagmus that is conjugate and without fixation= peripheral
- –vertical or torsional (rotary) and may be stronger in one eye than the other and with fixation= central
headshake test (bedside exam)
- a test of the VOR. have pt shake head back and forth in horizontal plane for 20-30 seconds. have stop abruptly and open eyes with frenzel’s lenses or infra red goggles
- Results:
- –horizontal nystagmus beats away from the lesion or beats towards the healthy ear (usually)
- –horizontal nystagmus beats toward the lesion after a delay or after the initial nystagmus sops
head thrust (bedside exam)
- a test of the VOR. the pt is asked to gaze steadily at a target in the room. move the pts head from side to side gently and then move briskly from one side to the other and hold while observing eyes position
- results:
- –eyes remain fixed on the target=normal
- –eyes make a compensatory movement after the head is stopped to fixate on the target=abnormal
- this test can indicate if the output of one or both labyrinths is depressed
dynamic visual acuity (bedside exam)
- a test of the VOR. have patient read a Snellen eye chart and establish visual acuity or static acuity. then rotate the pts head at 1-2 Hz horizontally and have them read the chart again
- results:
- –loss of one or two lines=normal
- –loss of three lines indicated a VOR deficit
saccades (bedside exam)
- have pt rapidly shift gaze from nose to finger or wiggle fingers on each side at varying distances
- results:
- –grossly abnormal responses can indicate cerebellar dysfunction
- –poor eyesight, unable to focus the fovea onto the target
smooth pursuit (tracking) (beside exam)
- have pt follow your finger as it moves slowly through their visual field
- results:
- –grossly abnormal responses can indicate cerebellar dysfunction
- –again, interpret with caution
Rhomberg (bedside exam)
- have the pt stand with feet together, eyes open and arms to the side or across the chest. then have pt close their eyes
- sharpened Rhomberg= have pt stand heel to toe with 1 foot in front and close eyes with arms at side or across chest, then close eyes
- results:
- -excessive sway (eyes closed)-peripheral lesion (usually to the side they lean)
- -excessive sway (eyes pen)- proprioceptive weakness
gait/tandem gait (beside exam)
- have pt walk heal-to-toe in a straight line
- tandem gait test- have patient walk heal-to-toe in a tight circle or figure eight
- results:
- –pt staggers or consistently leans to one side or the other=likely central
fakuda stepping (bedside exam)
- pt is asked to step (march) in place with eyes closed for 100 steps
- results:
- –rotation of the pt= peripheral lesion
- –less than a 45 degree rotation= normal
fistula test (beside exam)
- manual setting of temp or pneumatic otoscopy
* nystagmus and dizziness is indicative of a fistula
dysduadichokinesis (bedside exam)
- rapid alternating movements such as tapping foot to floor of touching thumb to each finger rapidly
- poor coordination of movements-cerebellar dysfunction
hyperventilating syndrome tsting
*have pt over breathe for 90 seconds and see if they can reproduce their symptoms
