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Adv Neuro: Vestibular > Week 2 Highlights > Flashcards

Week 2 Highlights Flashcards

1
Q

what is the pathophys of meniere’s dz

A

inc hydraulic pressure w/i inner ear endolymphatic system

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2
Q

what are 7 sx experienced during a Meniere’s attack

A

fullness of ear
reduction in hearing
tinnitus
vertigo
postural imbalance
nystagmus
followed by n/v

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3
Q

what is the duration of meniere’s attack

A

> 20min to <24hrs

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4
Q

what is the symptomology s/p a meniere’s attack

A

gradual abatement of sx
s/p severe attack - exhaustion, sleep for hours
generally ambulatory w/i 72hrs
may have some postural unsteadiness for days-weeks then will return to normal

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5
Q

how can hearing be impacted after a meniere’s attack and long term

A

hearing can return to baseline or may have residual permanent sensorineural hearing loss (SNHL) w/ lower frequencies

long term decline inhearing is expected

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6
Q

what is our main focus when treating someone w meniere’s

A

education

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7
Q

what role does vestibular play in treating meniere’s dz

A

not the primary treatment

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8
Q

when could vestib rehab be useful in treating meniere’s (3)

A

s/p vestib ablation procedure
hypofunction present
impaired postural control

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9
Q

what is vestibular “prehab”, when is it implemented in meniere’s and why

A

vestibular rehab 2wks prior to planned vestibular ablation (ITG)

induce compensation pre-op
enhance post op recovery

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10
Q

what are 3 other disorders associated w vestib migraines

A

motion sensitivity
meniere’s
idiopathic BPPV

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11
Q

per IHS criteria, what is a migraine w/o aura

A

lasts 4-72hrs if not treated

must have 2:
* U/L location
* pulsatile quality
* * mod to severe intensity*
* * aggravated by exertion/stair negotiation*

must have 1:
* n/v
* photophobia
* phonophobia

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12
Q

what is the HINTS exam

A

stroke suspected if any of the following exist:
* normal head thrust
* direction changing nystagmus in eccentric gaze
* skew deviation (vertical ocular misalignment)

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13
Q

what are the vestibular connections to oculomotor nuclei

A

3 neuron arc from SCC:
* vestibular nuclei
* ascending tracts (b/l via MLF)
* oculomotor nuclei in brainstem (CN III, IV, IV)

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14
Q

what function do several vestibular connections have and where are the majority located

A

autonomic functions

in midbrain, pons, and medulla

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15
Q

what oculomotor deficit is commonly seen in advanced PD

A

slow hypometric saccades

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16
Q

what are some examples of vestibular interventions appropriate for a pt w advanced PD

A

work on saccades
occular function
incorporate visual exercises into training (ie during balance training)

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17
Q

what is the relationship b/w slow saccades and fall risk in PD

A

turning performance is impaired in PD and may be influenced by saccade dysfunction
* association b/w saccade function and turning performance may be indicative of the key role saccades plays in initiating proper turning kinematics

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18
Q

what is the pathophys of cerebellopontine angle lesions

A

compression of brainstem and CNVIII

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19
Q

what is are the 2 most prevalent etiologies of cerebellopontine angle lesions

A

acoustic neuroma
meningioma

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20
Q

how are cerebellopontine angle lesions dx (5)

A

hearing loss
ringing in ear

sometimes: dizziness, fullness, imbalance

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21
Q

what imaging would show cerebellopontine angle lesions

A

MRI w contrast

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22
Q

what is subjective visual vertical

A

ability to detect subjective tilt

23
Q

subjective visual vertical

impairments can be secondary to:

A

injury to otoliths or nerve connections

24
Q

what are 2 impairments that result from subjective visual vertical

A

causes sensory conflict
can’t be used to assess utricular function U/L

25
normal vs abnormal subjective visual vertical
normal: adjust illuminated rod to vertical w mean error of <2.5deg abnormal: >2.5 deg error noted in pts w central and peripheral path
26
what are 5 disorders that present with pathological subjective visual vertical
1. acute peripheral neuritis 2. wallenberg syndrome 3. internuclear opthalmoplegia 4. midbrain lesion 5. vestib neuronitis
27
how is abnormal subjective visual vertical defined in children
>2.13deg of deviation is significant (compared to >2deg using conventional testing)
28
what is internuclear opthalmoplegia and what are the 2 sx it is characterized by
specific gaze abnormality 1. impaired horizontal eye mvmts w weak ADD in affected eye 2. ABD nystagmus of contra eye
29
what is the pathophys of internuclear opthalmoplegia
localizing brainstem syndrome resulting from lesion in the MLF in dorsomedial brainstem tegmentum of either pons or midbrain
30
what is the most common etiology for B/L internuclear opthalmoplegia in a young adult
MS
31
what is the most common etiology for U/L internuclear opthalmoplegia in middle aged and elderly adults
brainstem infarction
32
what is PPPD
persistent sensations of rocking/swayign and/or non-vertigo type dizziness on most days for >3 months
33
what 3 primary complaints in PPPD
hypersensitivity to visual flow (ie grocery stores, windshield wipers, busy flooring, computer images/scrolling) head fullness perception of veering
34
what is the frequency of sx in PPPD
min of 15days for every 30 majority daily sx doesn't need to be continuous
35
what are aggravating factors for PPPD (3)
1. upright posture 2. busy environments (complexity and/or motion) 3. head or body mvmt (active or passive body motion w/o reguard to direction or position)
36
what are 2 nullifiers for PPPD
1. avoidance of provoking environments/triggers 2. lying down
37
how consistent is the severity of PPPD
fluctuates
38
what are 4 precipitating factors for PPPD
1. medical, psychosocial, or environmental event causing acute vestib sx or imbalance 2. coexisting vestib disorders 3. h/o vertigo 4. pre-existing anxiety disorder
39
what are psych or behavioral predisposing or coinciding factors for PPPD
* anxiety & depression * other psychiatric disorders * pre-existing anxiety * heightened anxiety w vestib problem * anxiety, cautiousness, neg expectation for recovery have greater chance of developing
40
how is PPPD dx
based on sx presentation: * tempo * aggravators * triggering events ## Footnote no specific test tests tend to be normal, may be (+) for other conditions no present neuro-otologic dysfunction no ongoing med etiology not a psychiatric condition
41
what improves the prognosis for PPPD
when migraine medically managed and psych care to address anxiety
42
# psych probs and pt w dizziness what is the challenge with getting a definitive dx
dizziness can lead to neg psych impact psych disorders can result in profound dizziness
43
how does the incidence of psych disorders as primary cause of dizziness change
declines w inc age
44
what are general associations seen b/w psych problems and pt w dizziness
* psych probs often coexist w balance disorders * common for anxiety to accompany vestib disorder * depression more common in those w migraines/HAs than those w/o * high prevalence of mood disorders and psych probs in pts w dizziness
45
what are general management strategies for psych problems and pts w dizziness
* recognize presence of disorder * discuss w pt the disorder when appropriate and depending on dx * provide reassurance * relate emotions/stress can cause same sx as vestib disorder * destigmatize by telling prevalence of disorder * refer pt for med mgmt, CBT, etc. * individualize HEP * assure continued PT involvement * wean inappropriate ADs
46
# psych probs and pt w dizziness at what point to you discuss the presence of one of the following disorders in the pt's POC: * anxiety * depression * CSD * PPPD * somatoform * factitious
anxiet/depression/CSD/PPPD = early somatoform - avoid in 1st visit factitious - defer unless deemed clinically appropriate * they don't want to get better
47
what is MdDS
central vestib (neuro) disorder ## Footnote *not a peripheral vestib (inner ear) disorder/dz
48
what are non-motion triggered MdDS (aka "rockers" or "spontaneous MdDS")
individuals w similar sx w/o preceding motiono exposure
49
what is a challenge w treating non-motion triggered MdDS
possibly more difficult to treat w habituation but still able to cure >50%
50
what is the pathogenesis of MdDS
pathogenesis and lesion site unknown no particular injury ## Footnote most agree it is a variant of motion sickness
51
what are possible etiologies of MdDS
* otolith dysfunction * d/t or exacerbated by anxiety/somatoform disorder * variant of migraine * processing error - inappropriate high weighting of somatosensory input for balance
52
what is a PT strategy for treating MdDS
work on pushing somatosensory reference back b/w vestib mechanism and somatosensory system
53
what is the Dai Protocol for in MdDS
established to address theory of Maladaption of VOR

Adv Neuro: Vestibular (6 decks)

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