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Neuro Final > 22. Vestibular System > Flashcards

22. Vestibular System Flashcards

1
Q

what causes vestibular symptoms?

A

a mismatch of firing of the canal functional pairs

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1
Q

what is the most common peripheral vestibular dysfunction
which canal does this happen the most?

A

BPPV
PSCC

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2
Q

what is BPPV

A

otoconia become dislodged from utricle or saccule and are displacced in the SCC

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3
Q

BPPV:
the displaced _______ affect the flow of the _________ within the canal. leads to the defection of the ________, leading to a nerve signal and vertigo

A

the displaced otoconia affect the flow of the endolymph within the canal. leads to the defection of the cupula, leading to a nerve signal and vertigo

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4
Q

causes of BPPV

A

idiopathic, head trauma, inflammation, ischemia, pressure changes

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5
Q

risk factors for BPPV

A

age, female, VitD def, HTN, migraine, hyperlipidema

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6
Q

symptoms of BPPV

A

brief spells of vertigo with changes in head position against gravity

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7
Q

clear sign of BPPV

A

nystagmus is upbeat for PSCC

  • named by torsion or rotary component which indicates if it is R or L PSCC
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8
Q

which is more commom: cupulolithiasis or canalithiasis

A

canalithiasis

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9
Q

Cupulolithiasis:
otoconia fall off and adhere to _______, making cupula denser than surrounding
__________ onset of vertigo
__________ vertigo/nystagmus at provoking position

A

otoconia fall off and adhere to cupula, making it denser than surrounding
immediate onset of vertigo
persistent vertigo/nystagmus at provoking position

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10
Q

canalithiasis:
otoconia fall off otolith and are free floating in _____________ of PSCC
_______ onset of vertigo/nystagmus
___________ intensity of nystagmus/vertigo, diminishes after 1 minute of provocation

A

otoconia fall off otolith and are free floating in long arm of PSCC
latent onset of vertigo/nystagmus
fluctuating intensity of nystagmus/vertigo, diminishes after 1 minute of provocation

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11
Q

both nystagmus for cupulolithiasis and canalithiasis are

A

upbeat and rotary R/L for PSCC

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12
Q

inflammation of the inner ear

A

vestibular labyrinthitis

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13
Q

inflammation of the vestibular nerve

A

neuritis

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14
Q

which inflammatory vestibular issue has hearing loss?

A

labyrinthitis, and it has tinnitus

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15
Q

main cause of neuritis and labyrinthitis

A

viral infection (98%), also head trauma

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16
Q

symptoms of neuritis and labyrinthitis

A

sudden onset of vertigo/vomiting

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17
Q

how long does symptoms of neuritis and labyrinthitis last

A

3-7 days with residual balance and dizziness lasting 1-2 wks

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18
Q

what is the hallmark of neuritis and labyrinthitis?

A

direction fixed of nystagmus and if it occurs in 1st, 2nd. 3rd degrees of gaze

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19
Q

damage to inner ear or vestibular nerve that results in diminished or weaker neurological signal

A

peripheral vestibular hypofunction

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20
Q

causes of peripheral vestibular hypofunction

A

neuritis, labyrinthitis, meniere’s disease, acoustic neuroma, some medications

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21
Q

symptoms of peripheral vestibular hypofunction

A

affects VOR and VSR
postural and gait instability
movement dizziness, motion sensitivity, foggy headedness

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22
Q

what is tinnitus

A

ringing in the ear

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23
Q

before diagnosis of vestibular neuritis/labyrinthitis, what should you do first?

A

rule out central causes!

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24
Q

types of central vestibular dysfunction

A

stroke
tumor
MS lesions
degenerative neuro conditions
vestibular migraine
persistent postural positional dizziness
mal de debarquement
anything affecting central vestibular connection in brain or brainstem!

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25
Q

signs of vestibular dysfunction

A

nystagmus and oscillopsia

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26
Q

non voluntary rhythmic oscillations of eyes with clearly defined fast and slow components beating in opposite directions

A

nystagmus

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27
Q

physiologic nystagmus

A

induced by a normal stimuli

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28
Q

pathologic nystagmus

A

abnormal, appears with or without stimulation; 4 types

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29
Q

4 types of pathologic nystagmus

A

spontaneous
positional
gaze evoked
congenital

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30
Q

T or F: peripheral vestibular hypofunction is unilateral

A

F: can be unilateral or bilateral

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31
Q

spontaneous nystagmus

A

due to central or peripheral vestibular problempo

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32
Q

positional nystagmus

A

can be paroxysmal or static
2 types: torsional or downbeat

33
Q

torsional/rotary nystagmus points to what diagnosis?

A

peripheral (BPPV) or brainstem dysfunction

34
Q

downbeat/upbeat nystagmus points to what diagnosis?

A

central (cerebellar) dysfunction or peripheral (but not BPPV)

35
Q

gaze evoked nystagmus

A

eyes drift toward center, constant corrective saccades to reset gaze

36
Q

congenital nystagmus

A

since birth or infancy (types of central vestibular dysfunction)

37
Q

mal de debarquement

A

feeling like you’re moving even though you are still- perceptual issues

38
Q

what phase is nystagmus named for? what is the exception?

A

fast phase
exception is BPPV, named for direction or rotary torsion towards side of lesion

39
Q

nystagmus causes by peripheral will present as..

A

a mix of torsion vertically and rotary

40
Q

peripheral vestibular nystagmus slow phases is caused by

A

VOR

41
Q

periphreal vestibular nystagmus fast phase is caused

A

corrective saccades

42
Q

nystagmus caused by CNS lesions

A

smooth pursuit and saccades- points to cerebellum and brainstem lesions

43
Q

what can suppress nystagmus

A

if the patient can fixate on a target

44
Q

nystagmus is best examined by

A

Frenzel/ Infrared Goggles!

45
Q

central nystagmus looks like: (4 points)

A

directional changing
vertical
not affected by fixation
constant

46
Q

alexander’s law

A

peripheral vestibular issues
gaze towards fast phases increases intensity

47
Q

sensory for postural control involves

A

observing availability and accuracy of sensory info

48
Q

three sensory systems for postural control

A

vision
somatosensory
vestibular

49
Q

posture control, motor output is based on (3 things)

A

anticipatory mechanisms, automatic motor strategies, and motor pathways

50
Q

what is the fastest of the 3 senses

A

somatosensory system

51
Q

somatosensory system provides information about

A

support system via pressure receptors
body position and movement via muscle/joint receptors

52
Q

what are the 3 conscious proprioceptive senses

A

kinesthesia
joint position sense
sense of resistance

53
Q

functions of the vestibular system (3)

A

oculomotor control
gaze stability
VOR

54
Q

oculomotor control includes what 3 cranial nerves?

A

oculomotor, trochlear, abducens

55
Q

jobs of the CNS

A

provides CNS info
VOR
internal reference to determine appropriateness/accuracy of external sensory info
postural stability

56
Q

selection of sensory strategy for postural control depends on (3 things)

A

availability of information within individual
accuracy of info within environment
motor strategy used to control balance

57
Q

what are the components of the peripheral vestibular system

A

semi circular canals
otoliths

58
Q

what are the otolith organs

A

utricle
saccule

59
Q

what are the components of the central vestibular system

A

CN 8
vestibular nuclei
motor pathways
cerebellum

60
Q

which part of the vestibular system can we address as PTs?

A

peripheral

61
Q

movement that bends hair towards the kinocilium causes

A

activation

62
Q

movement that bends hair away from the kinocilium causes

A

deactivation

63
Q

T or F: activation of hair cells is gravity dependent

A

True

64
Q

T or F: semicircular canals sense angular velocity/speed

A

F: semicircular canals sense angular acceleration

65
Q

“YAW” axis
is what motion and includes what semicircular canal?

A

shaking head NO
horizontal canal

66
Q

“PITCH” axis
is what motion and includes what semicircular canals?

A

shaking head YES
posterior and anterior canals

67
Q

“ROLL” axis
is what motion and includes what semicircular canals?

A

rolling head side to side (ear to shoulder)
anterior and posterior canals

68
Q

if turning head to right:
endolymph moves ______
exciting the _____
hyperpolarizing the _____

A

endolymph moves left
exciting the right
hyperpolarizing the left

69
Q

ampulla at the base of canal contains _______ with hair cells

A

cupula

70
Q

utricle senses

A

horizontal movement

71
Q

saccule senses

A

vertical movement

72
Q

lateral vestibular nuclei are the origin of what tract

A

lateral vestibulospinal tract

73
Q

medial vestibular nuclei are the origin of what tract

A

medial vestibulospinal tract

74
Q

superior vestibular nuclei is the relay center for what

A

ocular reflexes

75
Q

inferior vestibular nuclei is the 2nd origin of what tract?

A

medial vestibulospinal tract

76
Q

cerebellum role in vestibular

A

monitors and fine tunes the vestibular reflexes

77
Q

maintains gaze stability during head motion thus controlling eye-head coordination

A

VOR

78
Q

maintains head and body equilibrium by facilitating or inhibiting skeletal muscle activity thus controlling coordination for balance

A

vestibulo spinal reflex

79
Q

reflex output to motor cells
signals head position on body; maintains gaze stability; taught as substitution for VOR when VOR absent

A

cervical ocular reflex COR

80
Q

input from otoliths; output to eye muscles
controls horizontal and vertical eye movements via linear VOR

A

otolith-ocular reflex

81
Q
A

Neuro Final (8 decks)

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