Exam 2: Vestibular Pathology Flashcards Preview

Bringman class fall 2015 > Exam 2: Vestibular Pathology > Flashcards

Flashcards in Exam 2: Vestibular Pathology Deck (49):
1

Four medical causes of Vertigo

● HYPOTENSION
● CARDIAC ARRYTHMIA

● CAD
● HYPERTENSION

2

Two other medical causes of vertigo besides cardiovascular causes:

• Infection
• Hypoglycemia

3

Five Neurological causes of vertigo

NEUROLOGICAL CAUSES

● STROKE AND TIA
● VERTIBROBASILAR MIGRAINE
● BASAL GANGLIA DYSFUNCTION

● CEREBELLAR
● SEIZURE

4

Six Otological Causes of Vertigo

OTOLOGIC CAUSES

  1. ● BPPV
  2. ● MENIERES DISEASE
  3. ● UNILATERAL VESTIBULAR DYSFUNCTION
  4. ● BILATERAL VESTIBULAR DYSFUNCTION
  5. ● MIDDLE EAR DYSFUNCTION
  6. ● FISTULA

5

In what age group is vertigo the most common reason to see MD?

over 75 years of age

6

What is the most common cause of dizziness?

cardiovascular

A image thumb
7

Things that can cause peripheral dizziness? (12?)

  1. Acute otitis media
  2. Serous otitis media
  3. Chronic otitis media
  4. Perilymph fistula
    • Trauma
  5. Post-stapedectomy
  6. Barotrauma (round window rupture)
  7. Labyrinthitis
    • Serous
    • Bacterial
    • Viral
    • Toxic  
  8. Meniere's disease
  9. Vestibular neuritis
  10. Benign positional vertigo
  11. Acoustic neuroma or
  12. other cerebellar-pontine angle tumor

8

Central Nervous System causes of dizziness (6)

  1. Stroke (cerebrovascular accident)
  2. Transient ischemic attacks
  3. Multiple sclerosis
  4. Neurosyphilis
  5. Meningitis or encephalitis
  6. Migraine

9

Cervical Causes of dizziness (5)

  1. Cervical arthritis
  2. Carotid artery stenosis
  3. Vertebral-basilar artery insufficiency
  4. Subclavian steal syndrome
  5. TMJ

10

skipping the rest of the reasons for dizzines

because I doubt she is going to test on that

11

8 Unilateral Peripheral Vestibular Problems

  1.  BPPV
  2. ACUTE UNILATERAL VESTIBULAR DEAFFERENTATION
  3. VESTIBULAR NEURITIS
  4. VESTIBULAR LABYRINTHITIS
  5. PERILYMPHATIC FISTULA
  6. ENDOLYMPHATIC HYDROPS
  7. MENIERES DISEASE
  8. ACOUSTIC NEUROMA

12

Six bilateral peripheral vestibular problems

  1. ● OTOTOXICITY
  2. ● INFECTION
  3. ● ACOUSTIC NEUROMA
  4. ● INNER EAR AUTOIMMUNE DISEASE
  5. ● MENIERES
  6. ● BPPV

13

Hearing, spared/impaired?

Vestibular Neuritis

spared

14

Hearing, spared/impaired?

Ramsey Hunt

Impaired

15

Hearing, spared/impaired?

Labrynthitis

Impaired

16

Hearing, spared/impaired?

Acoustic Neuroma

impaired

17

Hearing, spared/impaired?

Infarct: Anterior Vestibular Artery

spared

18

Hearing, spared/impaired?

Infarct: Labyrinthine Artery

Impaired

19

 

Hearing, spared/impaired?

MS at root entry zone

Spared

20

Hearing, spared/impaired?

Gentamicin ablation

Impaired

21

What is the mean age (and age range) of onset for BPPV?

● MEAN AGE AT ONSET 54 (RANGE 11 TO 84)

22

how many cases of BPPV are ideopathic?

about half

23

What are 5 potential causes of BPPV?

● IDEOPATHIC
● TRAUMA
● OCCLUSION OF THE INNER EAR VASCULATURE

● INACTIVITY
● BEDREST

24

What are the two main theories of BPPV?

● CUPULOLITHIASIS

● CANALITHIASIS

25

What is Cupulolithiasis?

●  DEBRIS FROM UTRICULAR MACULA SETTLES BY GRAVITY ON TO THE CUPULA OF THE SEMICIRCULAR CANAL

●  CUPULA THUS OBTAINS A HIGHER SPECIFIC GRAVITY THAN THE ENDOLYMPH AND BECOMES SENSITIVE TO GRAVITY DURING CHANGES IN HEAD POSITION

● SHOULD IMPLY A LONGER DURATION OF POSITIONAL NYSTAGMUS

● SIMILAR EVENT OCCURS WITH ETOH

26

What is Canalithiasis?

symptoms

characteristics

●  LOOSE PARTICLES DISPLACED INTO SCC WHICH WOULD INDUCE A MOVEMENT AWAY FROM THE AMPULLA, PULLS ON THE CUPULA AND EXCITES THE NEURONS

●  SHORT DURATION OF NYSTAGMUS WHEN SCC PLACED IN THE SAME PLANE WITH GRAVITY

Symptoms:

  1. ● BRIEF EPISODES OF VERTIGO INDUCED BY CHANGE IN HEAD POSITION
  2. ● USUALLY INVOLVES THE POSTERIOR SCC
  3. ● CONSISTENT TYPICAL CHARACTERISTICS

Characteristics

  1. POSITIONALLY INDUCED
  2. LATENCY IN THE ONSET OF SYMPTOMS
  3. MOST COMMONLY TORSIONAL NYSTAGMUS WITH THE SUPERIOR ASPECT OF THE EYE BEATING TOWARD THE AFFECTED EAR WHICH APPEARS WITH THE SAME LATENCY AS THE COMPLAINTS OF VERTIGO
  4. A CRESCENDO AND DECRESCENDO OF THE VERTIGO AND NYSTAGMUS WITH LASTS LESS THAN 60 SECONDS

27

REMEMBER THAT MOVEMENT __________ THE AMPULLA IS excitatory IN THE HORIZONTAL CANALS, BUT IN THE ANTERIOR AND POSTERIOR CANALS, MOVEMENT ________ FROM THE AMPULLA IS excitatory.

REMEMBER THAT MOVEMENT TOWARD THE AMPULLA IS EXCITATORY IN THE HORIZONTAL CANALS, BUT IN THE ANTERIOR AND POSTERIOR CANALS, MOVEMENT AWAY FROM THE AMPULLA IS EXCITATORY

28

8 surgeries affecting peripheral vestibular system

  1. ●  LABYRINTHECTOMY
  2. ●  CHEMICAL LABYRINTHECTOMY
  3. ●  VESTIBULAR NERVE SECTION
  4. ●  PERILYMPHATIC FISTULA REPAIR
  5. ●  POSTERIOR CANAL PARTITIONING
  6. ●  ACOUSTIC NEUROMA REMOVAL
  7. ●  CHOLESTEATOMA REMOVAL
  8. ●  ENDOLYMPHATIC SAC DECOMPRESSION PROCEEDURES

29

Characteristics of Vestibular Neuritis (5)

  1. USUALLY VIRAL
  2. DURING OR FOLLOWING AN UPPER RESPIRATORY INFECTION
  3. PEAK OF CASES IN WOMEN IN THE 4TH DECADE, MEN IN THEIR 60’S
  4. DIZZINESS NAUSEA AND VOMITING
  5. CALORIC TESTS IPSILATERAL HYPORESPONSIVENESS

30

Acute Vestibular Dafferentation (2)

● AFTER SURGICAL ABLATION
● ACUTE PHASE OF VESTIBULAR NEURITIS

31

characteristics of Perlymphatic Fistula (7-11)

  1. ASSOCIATED WITH
    • HEAD TRAUMA
    • BAROTRAUMA
    • SURGERY
    • PENETRATING INJURY
  2. LOUD POPPING SOUND
  3. SEVERE VERTIGO, HEARING LOSS, TINNITUS ● TULIO’S PHENOMENON
  4. FISTULA BETWEEN THE MIDDLE EAR AND THE PERILYMPH
  5. SNEEZING, COUGHING, STRAINING, NOSE BLOWING WILL REPRODUCE THE SYMPTOMS
  6. TREATED WITH BED REST
  7. REQUIRES IMMEDIATE SURGERY IF SNHL (Sensorineural hearing loss) IS PRESENT

32

Characteristics of Barotrauma (3)

● IMPLOSION ON DESCENT

● EXPLOSION ON ASCENT

● USUALLY INVOLVES RUPTURE OF UTRICLE AND SACCULE

 

(think of a diver)

33

Characteristics of Endolymphatic Hydrops (4)

  1. ●  INNER EAR FLUID CHEMISTRY SHOULD REMAIN CONSTANT
  2. ●  MALFUNCTION OF THE MECHANISMS WHICH MAINTAINS PRESSURE AND COMPOSITION CONSTANT
  3. ●  NERVE ENDINGS BECOME ABNORMALLY STIMUL ATED
  4. ●  AURAL FULLNESS, TINNUTUS, HEARING LOSS, VERTIGO

34

Characteristics of Meniere's Disease (5)

  1. ●  IDEOPATHIC SYNDROME OF ENDOLYMPHATIC HYDROPS
  2. ●  MALFUNCTION OF RESORPTIVE FUNCTION OF ENDOLYMPHATIC SAC
  3. ●  AURAL FULLNESS, DECREASED HEARING LOSS, TINNITUS, VERTIGO
  4. ●  SEVERE VERTIGO AND DYSEQUILIBRIUM 30 MIN TO 24 HOURS
  5. Pt may elect to destroy vestibular system on that side (often using Microwick Procedure - insert ototoxic substance)

35

what is the microwick procedure?

used to insert ototoxic substance into the inner ear to destroy the vestibular system

(sometimeis used in Menier's disease)

36

Characteristics of Ideopathic Vestibular Degeneration

  1. ●  OCCURS WITH AGING
  2. ●  COMMON IN PATIENTS WITH EARLY BALDING OR GRAYING
  3. ●  ESPECIALLY IS GRAYING OCCURRED BEFORE AGE 30

37

Characteristics of Acoustic Neuroma (5-9)

  1. ● MAY BE INHERITED TENDENCY
  2. ● TUMOR ON ACOUSTIC NERVE
  3. ● SYMPTOMS
    • ● PROGRESSIVE HEARING LOSS
    • ● TINNITUS IN ONE EAR 
  4. ● VESTIBULAR BRANCH COMPRESSION
    • ● IMBALANCE
    • ● VERTIGO
  5. ● MAY BE SLOW GROWING

38

Characteristics of Cholesteatoma (7)

  1. ●  CYST LIKE GROWTH
  2. ●  COMMONLY FORMS IN PTS WITH CHRONIC Middle EAR INFECTION OR PERFORATED EAR DRUM
  3. ●  BENIGN TUMOR OF MIDDLE EAR
  4. ●  ERODES THE BONE OF THE INNER EAR
  5. ●  HEARING LOSS
  6. ●  VERTIGO
  7. ●  FOUL DRAINAGE FROM THE EAR

39

Things that cause bilateral vestibular loss (8)

  1. ● OTOTOXIC DRUGS
  2. ● BILATATERAL MENIERES DISEASE
  3. ● AUTOIMMUNE DISEASE SJORGRENS
  4. ● SYPHILLIS
  5. ● BILATERAL ACOUSTIC NEUROMA
  6. ● INFECTION
  7. ● OTOSCLOSIS
  8. ● PAGETS DISEASE

40

Characteristics of Bilateral Vestibular Loss

  1. ●  IF EQUAL ON BOTH SIDES NO VERTIGO NYSTAGMUS OR SKEW DEVIATION
  2. ●  NO GAZE STABILIZATION WITH HEAD MOVEMENT
  3. ●  SEVERELY IMPAIRED GAIT
  4. ●  VISUALLY AND PROPRIOCEPTIVELY DEPENDENT

41

Ototoxic Drug Categories (6)

  1. Antibiotics (especially gentamicin)
  2. Anti-Neoplastic Drugs
  3. Loop Diuretics
  4. Anti-inflamatory drugs (includes ibuprophen)
  5. Anti-malarial drugs
  6. MISCELLANEOUS
    • heavy metals
    • industrial chemicals
    • arsenicals
    • lead
    • carbon monixide
    • mercury

42

characteristics of VBI

  1. ●  COMMON CAUSE OF VERTIGO IN THE ELDERLY
  2. ●  OCCURS SUDDENLY NO WARNING
  3. ●  LASTS SEVERAL MINUTES
  4. ●  OFTEN WITH NAUSEA AND VOMITING
  5. ●  HEADACHE IMPAIRED VISION CAN ALSO OCCUR

43

Draw Ms. Nancy's chart of how spells of vertigo differ between timing for BPPV, TIA, Menier's, Vestibular Neuritis, and Ototoxia.

A image thumb
44

Does Sudden onset suggest peripheral or CNS?

peripheral

CNS is usually gradual onset

45

Does intermittent symptoms usually suggest peripheral cause or CNS cause?

peripheral cause

CNS usually causes continuous symptoms

46

Peripheral etiology of dizziness (9)

  1. ● NEURITIS
  2. ● MENIERES
  3. ● BPPV
  4. ● BAROTRAUMA
  5. ● OTOTOXIA
  6. ● SURGERY
  7. ● TRAUMA
  8. ● ACOUSTIC NEUROMA
  9. ● OTOSCLEROSIS

47

Central etiology of dizziness (4)

  1. ● VERTIBROBASILAR INSUFFIENCY
  2. ● MIGRAINE
  3. ● LABYRININE, CEREBELLAR, BRAINSTEM INFARCTION
  4. ● TIA, STROKE

48

Medical etiology of dizziness (7)

  1. ●  HYPOTENSION
  2. ●  HYPERTENSION
  3. ●  CARDIAC ARRYTHMIA
  4. ●  CORONARY ARTERY DISEASE
  5. ●  INFECTION
  6. ●  MEDICATION
  7. ●  HYPOGLYCEMIA

49

Psychophysiologic etiology of dizziness: (4)

  1. ● ACUTE ANXIETY
  2. ● CHRONIC ANXIETY
  3. ● PANIC ATTACKS
  4. ● SECONDARY GAIN