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Clinical Conditions II > Final - Vestibular Disorders > Flashcards

Final - Vestibular Disorders Flashcards

(72 cards)

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1
Q

Dizziness

A

The sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion (lightheadedness, nonspecific dizziness, not vertigo)

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2
Q

Presyncope

A

The sensation of impending loss of consciousness

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3
Q

Syncope

A

Transient loss of consciousness due to transient global cerebral hypo perfusion characterized by rapid onset, short duration, and spontaneous complete recovery

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4
Q

Vertigo

A

Sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement

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5
Q

Unsteadiness

A

The feeling of being unstable while seated, standing, or walking without a particular directional preference (disequilibrium or imbalance)

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6
Q

How are vestibular disorders diagnosed?

A
  1. history
  2. physical exam
  3. diagnostic testing if necessary
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7
Q

what are the types of vestibular disorders?

A

Unilateral vs Bilateral

Peripheral vs Central

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8
Q

Central Vestibular Disorder

A

In the cerebellum

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9
Q

TiTrATE

A

Triage: Identify dangerous causes (abnormal vital signs, altered mental status)
Timing: Determine the dizziness attack pattern (episodic, acute, chronic)
Triggers: Seek obvious triggers or exposures
Targeted Exam: Vestibular Exam
Testing: Further diagnostic testing when appropriate

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10
Q

Timing

A

onset, duration, and evolution of dizziness

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11
Q

Episodic timing

A

intermittent dizziness lasting seconds, minutes, or hours

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12
Q

Acute Timing

A

acute, persistent dizziness lasting days to weeks, sometimes with lingering sequelae
** Temporal evolution at onset and in first week most important

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13
Q

Chronic Timing

A

Lasting longer than 3-6 months

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14
Q

Positional Triggers

A

Head changes

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15
Q

Exposures

A

Head/neck trauma
Barotrauma
Toxin exposure
Medications

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16
Q

Benign Positional Vertigo

A

Seconds to few minutes

triggered by head position changes

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17
Q

Vestibular neuritis

A

hours to 2-3 days

spontaneous trigger

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18
Q

Meniere’s Disease

A

Minutes to 24 hours

Spontaneous triggers

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19
Q

Vestibular Migraine

A

Seconds to Weeks

Head changes/ spontaneous

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20
Q

Targeted Exam - Positional Testing

A

Supine Roll Test

Dix-Hallpike Test

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21
Q

4 key acute categories

A
  1. episodic vestibular syndromes: triggered or spontaneous

2. acute vestibular syndromes: post-exposure or spontaneous

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22
Q

BPPV

A
  • Timing: episodic lasting seconds
  • Triggers: rolling onto side, moving from sitting to lying, looking upward, “swimming sensation”
  • Targeted Exam: Dix-Hallpike Evaluation
  • Treatment: Employ maneuver/canalith repositioning procedure
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23
Q

BPPV Pathophysiology

A
  1. Cupulolithiasis: debris attached to cupula
  2. Canalithiasis: Debris within long arm (delay)
  3. Vestibulithiasis: debris within short arm (type 2)
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24
Q

BPV causes

A
  • Idiopathic 70-80%
  • Head Injury
  • Vascular
  • Viral Infection
  • Meniere’s Disease
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25
BPV Diagnosis
- History | - Positional Testing: Dix-Hallpike Evaluation or Supine Roll Test
26
Unilateral Peripheral Vestibular Deficit
1. Timing: acute onset, persistent, continuous dizziness (hours to weeks) 2. Triggers: Spontaneous 3. Targeted History: Nausea/vomiting, gait instability, head-motion intolerance 4. targeted exam: HINTS Evaluation (head impulse nystagmus test of skew)
27
Causes of Unilateral Peripheral Vestibular Deficit
- Vestibular Neuritis/Neuronitis - Labyrinthitis - Sudden Sensorineural Hearing Loss - Early Meniere's Disease - Fractured Temporal Bone - Stroke - Head Trauma
28
Vestibular Neuritis Cause
Viral Infection of CN VIII
29
Vestibular Neuritis Symptoms
- Severe vertigo (hours to days) - nausea/vomiting - NO HEARING LOSS****
30
Vestibular Neuritis Treatment
- Vestibular Suppressants/ Anti-Emetics/ Steroids | - Vestibular Rehabiliation
31
Labyrinthitis: Viral or Bacterial Infection of Inner Ear Symptoms
Sudden onset of: - severe vertigo (hours to days) - nausea/vomiting - ***unilateral profound sensorineural hearing loss**
32
Labyrinthitis: Viral or Bacterial Infection of Inner Ear Treatment
- Vestibular Suppressants/ Anti-Emetics/ Steroids | - Vestibular Rehabiliation
33
Unilateral Peripheral Vestibular Deficit: Head Injury TiTrATE
- Timing: Acute - Trigger: Trauma - Targeted History: blunt head trauma, whiplash history - Targeted Exam: HINTS evaluation, Head Evaluation, Radiographic EvaluationC
34
Common in patients with head injury
Vestibular Hypofunction - Without skill fracture: 28% - with skull fracture (not temporal bone): 50% - with skill fracture of temporal bone: 87-100%
35
Other causes of Unilateral Vestibular Hypofunction
- labyrinthectomy (Meniere's Disease) - Vestibular Neurectomy (Meniere's Disease) - Semicircular Canal Plugging (BPV, SSCD) - Acoustic Neuroma Resection
36
What is an acoustic neuroma
proliferation of the sheath producing Schwann cells of CN VIII
37
Symptoms of acoustic neuroma
- unilateral hearing loss - unilateral tinnitus - unsteadiness/ vertigo
38
acoustic neuroma treatment
- observation - microsurgery - radiosurgery
39
Symptoms of Unilateral Vestibular Deficit
- increased tone in the extensor muscles of contralateral side: inadequate postural response - Oscillopsia (objects appear to move when they are still)
40
Signs of Unilateral Vestibular Deficit
- Unidirectional horizontal spontaneous nystagmus --> fast phase toward healthy ear - Acute phase: up to 5 days after lesion (nystagmus seen with fixation) - Chronic phase: >5 days and up to 8 years (nystagmus suppressed by active fixation)
41
Tests of integrity of VOR
- Head Impulse Test | - Dynamic Visual Acuity Test/Dynamic Illegible E Test
42
Test for vestibular tone imbalance
Spontaneous nystagmus/ head shaking nystagmus
43
Postural imbalance Testing
- Modified Clinical Test of Sensory Interaction and Balance | - Dynamic Gait Index
44
Unilateral Peripheral Deficit Testing- Bithermal Caloric Testing
- Test of lateral SCC only - Cold/warm air or water - unilateral weakness - >25% difference between sides - measure of movements 0.003 Hz
45
Unilateral Peripheral Deficit: Testing - Video Head Impulse Test
- test of lateral and vertical SCCs | - measure movements 5-6 Hz
46
Vestibular Testing: cVEMP
saccule and inferior vestibular nerve
47
vestibular testing: oVEMP
utricle and superior vestibular nerve
48
Rotary Chair Testing
- head tiled forward 30 degrees: lateral canal in horizontal position - Uses: check for compensation from unilateral vestibular loss or to **check for bilateral vestibular weakness**
49
Does platform posturography tell you where the lesion is?
no | only tells you the vestibular loss pattern
50
Vestibular Testing Summary
- Caloric testing: lateral semicircular canal and sup vestibular nerve - vHIT: all canals - cVEMP: saccular function --> inf vestibular nerve - oVEMP: utricle function --> sup vestibular nerve - Rotary chair: lateral semicircular canal - platform posturography: objective eval of vest system
51
Unilateral Vestibular Deficit: Goals of Treatment
- increase gain of central vestibular system to improve function of VOR - improve postural control
52
Bilateral Vestibular Deficit: Ototoxic Medications
- Aminoglycosides - Neoplastics - Loop Diuretics - Quinine - IV Erythromycin
53
Bilareal Vestibular Deficit: SxS
- Vertigo: if none, symmetric loss; if yes, asymmetric loss - Nystagmus: if none, symmetric loss; if yes, asymmetric loss - Oscillopsia - Postural imbalance
54
Bilateral Vestibular Deficit: Bedside Testing
- Gain of VOR: dynamic visual acuity test - Postural Imbalance: Modified Clinical Test of Sensory Interaction and Balance, Dynamic Gait Index or Functional Gait Assessment
55
Bilateral Vestibular Deficit: Treatment
- Stop ototoxic medication - stop vestibular suppressants - vestibular rehabilitation
56
Vestibular Rehabilitation Goals for Bilateral Vestibular Deficit
- Increase gain of central vestibular system - Improve static & dynamic postural control in many sensory environments - Strategies to facilitate compensation: teach substitution and avoidance strategies
57
Do fluctuation vestibular deficits response to vestibular rehabilitation?
no
58
Fluctuating Vestibular Conditions: Meniere's Disease
1. episodic, spontaneous 2. sensorineural hearing loss 3. ? tinnitus 4. ? aural fullness
59
Fluctuating Vestibular Conditions: Meniere's Disease Rx
- Acute vertigo --> treat symptomatically - Long term management --> low sodium, diuretics, betahistine - Intratympanic Steroids - Surgical Management: endolymphatic shunt, vestibular nerve section, labyrinthectomy
60
Fluctuating Vestibular Conditions: Perilymphatic Fistula
- Timing: Acute vestibular syndrome - Trigger: Traumatic - Targeted History/Exam: Barotrauma, blast injury, weight lifting, spontaneous
61
Fluctuating Vestibular Conditions: Perilymphatic Fistula Symptoms
- Hearing Loss - Tinnitus - Vertigo - Disequilibrium - Worse w/ coughing, nose blowing, etc
62
Fluctuating Vestibular Conditions: Perilymphatic Fistula Rx
- Bedrest - Diuretic: acetazolamide - Surgical Exploration/ Repair
63
Fluctuating Vestibular Conditions: Superior Semicircular Canal Dehiscence Symptoms
- Dizziness/ chronic disequilibrium (sound or pressure induced) - pulse- synchronous oscillopsia - hyperacusis - low-frequency conductive hearing loss - pulsatile tinnitus - brain fog/fatigue - osculophonia (hearing eyes move)
64
Fluctuating Vestibular Conditions: Superior Semicircular Canal Dehiscence Diagnosis
cVEMP | CT Temporal Bones
65
Fluctuating Vestibular Conditions: Superior Semicircular Canal Dehiscence Treatment
- Tympanostomy tube | - Surgical plugging of canal
66
Vascular Lesions to the Central Vestibular System TiTrATE
- Timing: Acute onset continuous lasting days to weeks - Triggers: Spontaneous - Targeted Hx/Exam: Continuous dizziness/vertigo head motion intolerance gait instability/nystagmus HINTS exam MRI brain
67
Head Impulse Nystagmus Test of Skew (HINTS)
3 step bedside examination for acute vestibular syndrome: - head impulse test - nystagmus - test of skew
68
What's does the HINTS test do?
differentiates between peripheral and central dysfunction
69
Stroke is suspected if any one of the three following exist: (HINTS)
- normal head impulse test - direction changes nystagmus - skew deviation (100% desensitize and 96% specific)
70
Causes of lesions of the central vestibular system
- vascular: vertebro-basilar - head trauma - brain tumors - cerebelar degeneration
71
Lesions of the Central Vestibular System: Nystagmus
- Vertical (up or down beating) - Sustained gaze evoked nystagmus: inability to maintain stable conjugate eye deviation away from the primary position - Central positional nystagmus: may mimic benign positional nystagmus
72
Exam findings of central vestibular system lesion
- gait/ limb ataxia - ocular tilt - lateropulsion - dysmetria

Clinical Conditions II (11 decks)

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