Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro 2 > Week 2 Vestibular Pathology > Flashcards

Week 2 Vestibular Pathology Flashcards

1
Q

What is Meniere’s disease and its mechanism?

A
  • chronic, incurable disorder characterized by recurrent, episodic bouts of vestibular symptoms
  • swelling in inner ear leads to increased pressure and damage within membranous labyrinth (hair cell death and dilation of otoliths)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Meniere’s disease clinical presentation and duration

A
  • periodic attacks - violent vertigo, oscillopsia, fluctuating unilateral tinnitus and hearing loss
  • sometimes have “aura” or warning signs
  • minutes up to 24 hours
  • otolithic crisis - drop attacks (conscious entire time, no pass out)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of patient population is Meniere’s Disease most prevalent?

A
  • 40s – 60s y/o but can develop at any age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 stages of progression for Meniere’s disease?

A
  • unpredictable attacks of vertigo
  • vertigo > tinnitus > hearing loss
  • hearing loss > balance difficulties > tinnitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is Meniere’s disease diagnosed? What are the steps?

A

diagnosis by exclusion
- 2 or more episodes of spontaneous vertigo of at least 20 min - 24 hours
- audiometrically documented hearing loss (audiogram)
- tinnitus or aural fullness
- exclusion of other causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What laboratory tests are done to a Meniere’s patient?

A

ENG/VNG
VEMP (alongside vHIT)
Posturography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does bilateral involvement occur with Meniere’s Disease?

A
  • 1 in 5 will progress to bilateral involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

conservative treatment for Meniere’s disease

A
  • diet restrictions - reduction in salt, chocolate, caffeine
  • medications - diuretics, vestibular and CNS suppressants to manage symptoms, steroids
  • Vestibular Rehab (VRT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T/F: A PT can treat a patient having a Meniere’s attack

A

false - there is nothing we can do

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When can a Meniere’s patient have PT?

A
  • not having frequent episodes, can provide symptom relief in between attacks
  • have common sequelae of BBPV
  • after surgical interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 3 surgical interventions used with Meniere’s disease?

A
  • intratympanic gentamicin
  • vestibular nerve section
  • labryinthectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is intratympanic gentamicin? What is a consequence?

A

antibiotic injected into inner ear and kills vestibular system on that side
- high risk of hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is vestibular nerve section? What is a consequence?

A

snip vestibular branch of vestibulocochlear nerve (CN 8)
- hearing is spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a labyrinthectomy? What is a consequence?

A

surgical removal of the labyrinth
- 100% hearing loss because cochlea is in labyrinth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What vestibular pathology is rare in kids and caused by an upper respiratory or GI infection? What is the most common preceding virus to this condition?

A

vestibular neuritis
- Herpes (HSV-Type 1) is the most common virus cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

mechanism of vestibular neuritis

A

viral infection of the vestibular branch of vestibulocochlear nerve or ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute vestibular neuritis clinical presentation and duration

A
  • spontaneous vertigo w/ N&V and imbalance
  • duration - days to months
  • normal hearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

chronic vestibular neuritis clinical presentation and duration

A
  • gradual recovery but can take months for all vestibular symptoms to resolve
  • some left with residual imbalance and oscillopsia with head movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

acute vestibular neuritis diagnosis

A
  • diagnosis by exclusion
  • vHIT/HIT - head impulse test - + test w/ symptoms that last longer than a few days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

chronic/severe vestibular neuritis diagnosis

A
  • rotary chair test
  • audiogram
  • VEMP
  • MRI
  • blood work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vestibular neuritis treatment

A
  • vestibular suppressants (don’t want to use for too long)
  • steroids + antivirals

Vestibular Rehab - vestibular adaption exercises to speed up recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Labyrinthitis mechanism and cause

A

Cause - viral or bacterial infection - most common is viral upper respiratory tract infection

Mechanism - inflammation within labyrinth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common cause of labyrinthitis in kids?

A

bacterial infection
- bacterial meningitis or ear infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Labyrinthitis clinical presentation

A
  • sudden onset of vertigo, N&V, disequilibrium that lasts days
  • HEARING LOSS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What can change diagnosis to Meniere’s disease?

A

recurrent labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which vestibular pathology that is commonly caused by a viral infection has hearing loss? Why?

A

labyrinthitis has hearing loss while neuritis does not
- labyrinthitis affects both branches of vestibulocochlear nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Labyrinthitis treatment

A
  • vestibular suppressants (not too long)
  • steroids + antivirals
    • antibiotic if evidence of a middle ear infection
  • VRT - adaption exercises to speed recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

acoustic neuroma mechanism

A

slow-growing tumors derived from Schwann cells of the vestibulocochlear nerve or internal auditory canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

acoustic neuroma clinical presentation. What are the most common first symtpoms?

A
  • gradual or sudden onset of tinnitus, hearing loss, vertigo, or disequilibrium
  • hearing loss and tinnitus are the most common first symptoms
  • can cause facial numbness and tingling due to compression on CN 5 and 7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

IF acoustic neuroma remains undiagnosed, what can occur?

A
  • gradual compression on CN 5 (trigneminal) or CN 7 (facial)
  • can cause pressure on brainstem or cerebellum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

acoustic neuroma diagnosis What is the gold standard?

A
  • MRI w/ contrast - gold standard
  • audiogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acoustic neuroma treatment

A
  • surgical removal
  • radiation
  • monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When can an acoustic neuroma patient begin vestibular rehab?

A

only once tumor has been fully resected
- patients tend to do well after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

perilymph fistula mechanism. What is the most likely cause?

A

mechanism - opening between middle and inner ear
- rupture in oval window of ear which leads to perilymph leaking into the middle ear

Most likely cause - head trauma
- direct blow to ear
- objects perforating ear drum
- rapid increases in intracranial pressure (weightlifting, childbirth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

perilymph fistula clinical presentation. When are symptoms worst?

A
  • sudden onset vertigo
  • motion imbalance
  • ear fullness
  • fluctuating hearing
  • severe headaches and N/V can occur

symptoms worsen with activity (or altitude/pressure change) and improve with rest
- symptoms are triggered

36
Q

What is a tell tell sign of perilymph fistula?

A

Tulio’s phenomenon - use of ones own voice or a musical instrument will cause dizziness

37
Q

perilymph fistula diagnosis

A
  • fistula test
  • Valsalva test
  • audiogram - to determine involved side
  • ENG/VNG
  • MRI - to rule out CNS
38
Q

What is a fistula test? What is a +?

A

push air into ear and record eye movement
- + sign = nystagmus
- - sign = no nystagmus

39
Q

What is a Valsalva test? What is a + sign?

A

patient holds breath while recording eyes

+ sign = nystagmus
- sign = no nystagmus

40
Q

perilymph fistula treatment

A
  • conservative management with smaller fistulas - rest and avoid lifting or activities that change ICP
  • surgical repair if > 6 months without healing - VRT after surgery
41
Q

When is surgery necessary for a perilymph fistula?

A

> 6 months without healing
- followed by VRT

42
Q

What vestibular pathology will not benefit from PT?

A

semicircular canal dehiscence

43
Q

Semicircular canal dehiscence mechanism

A
  • congenital (born this way) and worsens with age
  • bony labyrinth degrades overtime
  • gets worse after trauma (accelerates degrading)
44
Q

What is the most common type of semicircular canal dehiscence?

A

Superior/Anterior canal dehiscence (SCDC)

45
Q

semicircular canal dehiscence clinical presentation

A
  • transient vertigo (caused by coughing, loud noises and pressure changes)
  • pressure sensitivity
  • sound sensitivity - can hear what is in their body
  • imbalance
  • hearing loss, tinnitus, aural fullness
46
Q

What are some examples of internal sound sensitivity experienced with semicircular canal dehiscence?

A
  • heel strike with gait
  • eye movement
  • heartbeat
  • own voice
47
Q

What are some examples of external sound sensitivity experienced with semicircular canal dehiscence?

A
  • phone ring
  • music
  • cannot tolerate loud noises
48
Q

semicircular canal dehiscence diagnosis

A
  • Bone conduction sensitivity test (+ test when patient hears tuning fork on lateral malleoli)
  • test for tulio’s phenomena
  • valsalva test
  • CT scan
  • audiogram
49
Q

bilateral vestibular hypofunction causes

A
  • idiopathic
  • ototoxic agents (gentamycin, streptomycin)
  • chemo agents (cisplatnin)
  • autoimmune
  • other vestibular and neurodegenerative conditions
50
Q

bilateral vestibular hypofunction clinical presentation. What is the most common complaint?

A
  • severe oscillopsia, particularly during walking
  • imbalance
  • possible hearing loss
  • functional tasks become inefficient and exhausting
  • no vertigo - only will occur in loss is sequential in nature
51
Q

T/F: Bilateral vestibular hypofunction will have vertigo as a symptom

A

false - only will have vertigo if sequential in nature
- vertigo needs imbalance on 1 side

52
Q

bilateral vestibular hypofunction diagnosis. What is the gold standard?

A
  • rotary chair test - gold standard
    • Head impulse test BILATERALLY
    • dynamic visual acuity
    • caloric testing
53
Q

bilateral vestibular hypofunction treatment

A

VRT
- postural control
- gaze stabilization exercises
- residual impairment - imbalance in dark environments, driving at night, etc.

54
Q

T/F: Medications are typically not helpful for bilateral vestibular hypofunction

A

true
- vestibular suppressants often worsen symptoms because vestibular system is already suppressed

55
Q

What are the surgical interventions available for bilateral vestibular hypofunction patients?

A

there are NO surgical interventions available to restore vestibular function

56
Q

What is BPPV? What are the symptoms?

A
  • Benign = not malignant
  • Paroxysmal = recurrent, sudden intensification of symptoms
  • Positional = placement dependent
  • Vertigo = false inner sensation of rotational movement

bursts of vertigo, lightheadedness, imbalance, and nausea precipitated by a change of position of the head

57
Q

What is the major symptom that BPPV patients complain of?

A

positional vertigo

58
Q

What is canalithiasis?

A

free-floating otoconia in SCC resulting in abnormal endolymphatic flow with the affected canal

59
Q

Canalithiasis clinical presentation

A
  • Latency - delay in onset of vertigo (1-40 seconds) after positional change
  • nystagmus appears after latency period with + vertigo
  • vertigo fluctuation while in position - vertigo typically disappears after 60 seconds
60
Q

What canal is mainly involved with canalithiasis? Why?

A

posterior and horizontal canals because otoconia usually settle in canal during sleep
- Want to ask if they are a side sleeper and if so what side? - usually indicates which side is involved

61
Q

What is cupulolithiasis?

A

otoconia get stuck in cupula (ampulla) of affected canal
- affected canal becomes gravity sensitive

62
Q

cupulolithiasis clinical presentation

A
  • immediate onset of vertigo during positional change
  • persistence of vertigo and nystagmus as long as patient is in the position
63
Q

Why do vertigo symptoms persist with cupulolithiasis and not canalithiasis?

A

in cupulolithiasis, otoconia are constantly pulling on hair cells in the cupula which is excitatory and otoconia eventually settle to lowest point of SCC in canalithiasis

64
Q

Slow phase VOR response in HEALTHY vestibular system: R horizontal canal

A

Left

65
Q

Slow phase VOR response in HEALTHY vestibular system: R anterior canal

A

Left torsion and up

66
Q

Slow phase VOR response in HEALTHY vestibular system: R posterior canal

A

left torsion and down

67
Q

Slow phase VOR response in HEALTHY vestibular system: left horizontal canal

A

right

68
Q

Slow phase VOR response in HEALTHY vestibular system: L anterior canal

A

right torsion and up

69
Q

Slow phase VOR response in HEALTHY vestibular system: L posterior canal

A

Right torsion and down

70
Q

T/F: Horizontal BBPV will have symptoms during head thrust test or shaking head no while stationary

A

false - otoconia aren’t moving in horizontal canal during head thrust

71
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: Right horizontal canal

A

slow = left

fast = Right beating nystagmus

72
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: Right anterior canal

A

slow = left torsion and up

fast = downward and right torsional nystagmus

73
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: right posterior canal

A

slow = left torsion and down

fast = upward and right torsional nystagmus

74
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: Left horizontal canal

A

slow = right

fast = left beating nystagmus

75
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: left anterior canal

A

slow = right torsion and up

fast = downward and left torsional nystagmus

76
Q

Slow and fast phase (nystagmus) VOR response in BBPV patients: left posterior canal

A

slow = right torsion and down

fast = upward and left torsional nystagmus

77
Q

Who is more likely to develop BPPV?

A

older women
- women > men
- 50% of people > 70 y/o will experience BPPV

78
Q

What are lifestyle effects of BPPV?

A
  • reduced independent ADLs
    • falls
  • depression
79
Q

What are some predisposing factors of BPPV?

A
  • age
  • head trauma
  • inner ear disease
  • genetics
  • osteopenia/osteoporosis
  • CV disease
  • diabetes
  • migraine
  • Vitamin D deficiency
  • sleeping position/prolonged immobility
80
Q

Patients with migraine commonly show vestibular system as ________

A

an aura

81
Q

What is the most common site for a TIA that will bring vestibular symptoms? What is the most common symptoms

A

vertebrobasilar artery TIA
- most common symptom is vertigo - intense that lasts minutes to hours

82
Q

What symptom distinguishes a PICA and AICA stroke?

A

hearing with AICA stroke

83
Q

What will cause a gradual degeneration of both spinal nerve roots and cerebellum?

A

spinocerebellar ataxias

84
Q

What could be a possible diagnosis if all other pathologies have been ruled out or don’t add up?

A

paraneoplastic disorders - undiagnosed cancer
- breast
- lung
- ovary
- uterine cancer

the immune system attacks cerebellum by mistake - thinks its Purkinje fibers are cancerous

85
Q

What is persistent postural-perceptual dizziness (PPPD or 3PD)? How are they treated?

A

patients have persistent vestibular symptoms (not made up) but are largely psychogenic in nature
- should never have just PT alone for treatment

86
Q

What are the 5 criteria for diagnosis of persistent postural-perceptual dizziness?

A

1) > or = of 1 symptoms of dizziness or unsteadiness present on most days for 3 months or longer

2) persistent symptoms without specific triggers, but exacerbated by upright position, active or passive motion, visual stimuli or complex visual patterns

3) precipitated by conditions that cause vertigo, unsteadiness, dizziness, or balance issues (vestibular issues, neuro pathology, medical or psychological distress)

4) symptoms cause significant distress or functional impairment

5) all other diagnoses ruled out

Neuro 2 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions