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Neruo 1 - Test 3 > Central Vestibular System & Peripheral System Disorders- Lecture 12 > Flashcards

Central Vestibular System & Peripheral System Disorders- Lecture 12 Flashcards

1
Q

vestibular nuclei complex

A

primary processor of vestibular input

connects incoming afferent info and motor output neurons

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2
Q

what does the vestibular nuclei complex have

A

4 major nuclei in the pons

extends into the medulla

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3
Q

what does the vestibular nuclei complex process

A

vestibular sensory input and extra vestibular proprioceptive, visual, tactile and auditory info

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4
Q

cerebellum

A

monitors vestibular performance and readjusts the central processing

major recipient of vestibular info from the nuclei

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5
Q

what do both the cerebellum and nuclei process

A

info in association with somatosensory, proprioceptive and visual input

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6
Q

vertebrobasilar arterial system

A

provides supply for both the peripheral and central vestibular system

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7
Q

when might clinical syndromes with vestibular components appear

A

after occlusions of the basilar artery and its branches

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8
Q

VSR

A

vestibular spinal reflex

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9
Q

vestibular spinal reflex

A

adjusts posture when the head is moved

anticipates a loss of balance and adjusts posture to maintain balance

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10
Q

abnormal VSR

A

difficulty with static or dynamic balance and the feeling of being off balance

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11
Q

age related changes with the vestibular system

A

increased difficulty with eyes closed activities

decreased ability to detect head position and motion

reduced number of receptor cells

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12
Q

BPPV

A

benign paroxysmal positional vertigo

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13
Q

what is BPPV

A

positional vertigo of short duration (up to one minute) which occurs when the pt lie down, sits up, rolls over in bed, looks up or bends over

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14
Q

what is BPPV caused by

A

otoconia from the otolith that have become misplaced within the semicircular canals

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15
Q

Hallpike-Dix position

A

20-30 degrees of cervical extension

45 degrees of rotation

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16
Q

what does the Hallpike-Dix position elicit

A

symptoms of vertigo within 1-40 secs

not lasting more than 60 sec

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17
Q

why does BPPV occur

A

head trauma

degeneration of the vestibular system

following ear surgery

dental work

virus

idiopathic

link to vitamin D deficiency

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18
Q

what will be seen in the dix hallpike position with BPPV

A

torsional nystagmus

pt’s will habituate with repetition

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19
Q

what else can BPPV be seen in

A

roll test position

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20
Q

roll test position

A

pt supine

30 degrees of flexion and 45 degrees of rotation

nystagmus will not be torsional

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21
Q

how can BPPV resolve

A

w/o treatment

usually b/w 6 mo-1 yr

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22
Q

how can BPPV be treated

A

epley/CRt within 1-3 visits

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23
Q

labyrinthitis

A

inflammation of the labyrinth including cochlea

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24
Q

what is labyrinthitis d/t

A

upper respiratory infection

flu

bacterial or viral infection occurring up to 2 weeks prior to onset of symptoms

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25
Q

acute symptoms of labyrinthitis

A

sudden onset of vertigo lasting days w/ nausea and vomiting common

pt may be bed ridden or hospitalized secondary to severe symptoms

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26
Q

labyrinthitis med

A

antivert or meclizine

may be used initially to surpress the vestibular system

decrease vertigo

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27
Q

when should meds be stopped –> labyrinthitis

A

prior to coming to therapy in order for compensation to occur

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28
Q

chronic sx –> labyrinthitis

A

imbalance and dizziness

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29
Q

when are symptoms worse –> labyrinthitis

A

head movement

busy visual stimuli

stress

fatigue

weather changes

altitude changes

illness

30
Q

pts that recover on their own –> labyrinthitis

A

80%

31
Q

pts that need treatment –> labyrinthitis

A

prolonged

vestibular rehab can speed up compensation

32
Q

vestibular neuritis

A

inflammation of the vestibular nerve

33
Q

sx of vestibular neuritis

A

same as labyrinthitis except hearing is spared

34
Q

acoustic neuroma

A

slow growing benign tumor on CN8

overtime will compress on structures adjacent to it

35
Q

first sx of acoustic neuroma

A

hearing loss

tinnitus

decreased vestibular fxn with impaired balance

36
Q

acoustic neuroma has

A

no dizziness

CNS is able to gradually adapt in response to slow onset of sx and slow growing tumor

37
Q

what is recommended for acoustic neuroma

A

surgery to remove tumor

risk of facial palsy and/or permanent hearing loss

38
Q

gamma knife procedure –> acoustic neuroma

A

used for smaller tumors

39
Q

stereotactic radiotherapy –> acoustic neuroma

A

used for small tumors

40
Q

how do pts recover –> acoustic neuroma

A

without tx

vestibular rehab is successful for those who seek treatment

41
Q

meniere’s/endolymphatic hydrops is caused by

A

alteration in production, flow, absorption or reabsorption of the inner ear fluids

42
Q

underlying origin of meniere’s/endolymphatic hydrops

A

unknown

may be influenced by infection, abnormal response of the immune system or genetic tendency

43
Q

sx of meniere’s/endolymphatic hydrops

A

vertigo lasting 20 min-12 hrs

sensory neural hearing loss

nausea

vomiting

diarrhea

44
Q

sensory neural hearing loss

A

predominantly low frequency

tinnitus or fullness in ears

45
Q

when do pts have episodes –> meniere’s/endolymphatic hydrops

A

one episode every hew years to weekly or daily episodes

46
Q

what occurs after an episode –> meniere’s/endolymphatic hydrops

A

may or may not be residual sx

overtime residual sx may worsen –> become symptoms were able to treat

47
Q

when does rehab become ineffective –> meniere’s/endolymphatic hydrops

A

no sx in between episodesq

48
Q

tx for meniere’s/endolymphatic hydrops

A

diet changes

various surgeries

gentamycin injections

endolymphatic shunt

49
Q

endolymphatic shunt

A

tube inserted into endolymphatic sac to facilitate drainage

50
Q

superior canal dehiscence

A

thinning or opening in the bone overlying the superior (anterior) semicircular canal

51
Q

symptoms of SCD

A

vertigo

oscillopsia caused by loud noise and activities that increase intracranial pressure

sensitivity to sound

fatigue

fullness in the ear

52
Q

what does SCD create

A

a third area affected by pressure

fluid w/in the canal is moved by stimuli from pressure or sound

53
Q

what is SCD caused by

A

developmental abnormality of thin, fragile bone over the superior canal

54
Q

when do symptoms present SCD

A

following trauma or slow erosion of the bone over time

55
Q

how is SCD diagnosed

A

CT

symptoms

clinical exam

56
Q

how is SCD treated

A

surgery to reface the bone or plugging of the canal

57
Q

perilymphatic fistula

A

rare condition

a tear or defect in the oval or round window that separates the inner and middle ear

changes in pressure that affect the middle ear will also affect the inner ear

58
Q

when does perilymphatic fistula occur

A

following trauma or following rapid changes of intracranial or atmospheric pressure

59
Q

sx perilymphatic fistula

A

vertigo

nausea

imbalance

60
Q

when do symptoms increase perilymphatic fistula

A

pressure changes or altitude

exertion

61
Q

tx perilymphatic fistula

A

strict bed rest or surgery

do not get better with therapy

62
Q

ototoxicity

A

damage to hair cells of inner ear

63
Q

what causes ototoxicity

A

drugs –> primarily gentamicin and other “mycin” drugs

esp if meds are delivered by IV for greater than 6 days

64
Q

pt may not have –> ototoxicity

A

total loss of vestibular fxn

65
Q

sx ototoxicity

A

imbalance

ataxia

oscillopsia

gaze instability with decreased or absent VOR

66
Q

sx will be worse w/ –> ototoxicity

A

increased loss of hair cells

67
Q

when will a pt have vertigo –> ototoxicity

A

damage is asymmetrical

68
Q

vestibular rehab –> ototoxicity

A

focused on strengthening residual fxn or on substitution if there is total bilateral loss

69
Q

TBI/head trauma can cause

A

both central and peripheral problems

70
Q

sx –>TBI/head trauma

A

dependent on the area involved and the severity of central or peripheral injury

71
Q

sx could include –> TBI/head trauma

A

dizziness, vertigo, imbalance, headache, migraine, short term memory deficit and motion sensitivity

72
Q

vestibular rehab –> TBI/head trauma

A

prolonged

Neruo 1 - Test 3 (12 decks)

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