Week 2

Question 1

brief overview of central vestibular pathology symptoms talked about in case history

Answer 1

milder in nature with gradual onset

*often associated with headache, visual changes or neurological deficits

Question 2

brief overview of peripheral vestibular pathology symptoms talked about in case history

Answer 2

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

Question 3

nystagmus with peripheral lesion

Answer 3

horizontal and torsional
inhibited by fixation
doesnt change with gaze

Question 4

nystagmus with central lesion

Answer 4

purely vertical or horizontal
nor inhibited by fixation
direction changing with gaze

Question 5

otologic symptoms with peripheral lesion?

Answer 5

hearing loss and tinnitus common

Question 6

otologic symptoms with central lesion?

Answer 6

uncommon

Question 7

latency after provocation with peripheral lesion

Answer 7

longer (>15 seconds)

Question 8

latency after provocation with central lesion

Answer 8

short

Question 9

fatigibility of peripheral lesion

Answer 9

yes

Question 10

fatigability of central lesion

Answer 10

no

Question 11

duration with peripheral lesion

Answer 11

variable

Question 12

duration with central lesion

Answer 12

long

Question 13

neurologic symptoms with peripheral lesion

Answer 13

no

Question 14

neurologic symptoms with central lesion

Answer 14

yes

Question 15

loss of consciousness with peripheral lesion

Answer 15

no

Question 16

loss of consciousness with central lesion

Answer 16

possible

Question 17

vertigo

Answer 17

an illusionary sense of movement or rotation

*can be pt spinning or the world spinning around them

Question 18

presyncope

Answer 18

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

Question 19

orthostatic hypotension

Answer 19

• 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)

Question 20

how to diagnose orthostatic hypotension

Answer 20

blood pressure is taken laying, sitting, and standing

*if a sig changes (>20 systolic pressure) is notes then it is orthostatic hypotension

Question 21

treating orthostatic hypotension

Answer 21

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

Question 22

vasovagal attacks

Answer 22

• 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

Question 23

treating vasovagal attacks

Answer 23

reevaluation of meds
education
counseling to reduce frusteration and anxiety

Question 24

heart disorders (leading to dizziness)

Answer 24

• arrythmias
• heart disease acquired or congenital
• coronary artery disease

Question 25

psychological disequilibrium

Answer 25

* anxiety induced, associated with panic attacks * usually lasting 10-15 minutes * accompanied by palpitations, parethesias, sweating, shortness or breath and dizziness * hyperventilation

Question 26

ocular disequilibrium

Answer 26

* 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

Question 27

motion sickness

Answer 27

* 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

Question 28

pathologies that have short length dizziness

Answer 28

* BPPV * perilymph fistula * SSCD * vascular insufficiency * Chiari malformation * Iatrogenic

Question 29

pathologies that have a medium length dizziness

Answer 29

* meniere's disease * migraine * metabolic * syphilis * panic attacks * TIA * Iatrogenic

Question 30

pathologies that have a long length dizziness

Answer 30

* labyrinthitis * temporal bone trauma * stroke * multiple sclerosis * Iatrogenic (caused by medical treatment) * autoimmune inner ear disease

Question 31

static evaluation (bedside eval)

Answer 31

* 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

Question 32

headshake test (bedside exam)

Answer 32

* 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

Question 33

head thrust (bedside exam)

Answer 33

* 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

Question 34

dynamic visual acuity (bedside exam)

Answer 34

* 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

Question 35

saccades (bedside exam)

Answer 35

* 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

Question 36

smooth pursuit (tracking) (beside exam)

Answer 36

* 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

Question 37

Rhomberg (bedside exam)

Answer 37

* 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

Question 38

gait/tandem gait (beside exam)

Answer 38

* 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

Question 39

fakuda stepping (bedside exam)

Answer 39

* 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

Question 40

fistula test (beside exam)

Answer 40

* manual setting of temp or pneumatic otoscopy | * nystagmus and dizziness is indicative of a fistula

Question 41

dysduadichokinesis (bedside exam)

Answer 41

* rapid alternating movements such as tapping foot to floor of touching thumb to each finger rapidly * poor coordination of movements-cerebellar dysfunction

Question 42

hyperventilating syndrome tsting

Answer 42

*have pt over breathe for 90 seconds and see if they can reproduce their symptoms