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NEURO EXAM 2 > Lecture 19 Vestibular System > Flashcards

Lecture 19 Vestibular System Flashcards

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
signs of vestibular dysfunction
nystagmus and oscillopsia
26
non voluntary rhythmic oscillations of eyes with clearly defined fast and slow components beating in opposite directions
nystagmus
27
physiologic nystagmus
induced by a normal stimuli
28
pathologic nystagmus
abnormal, appears with or without stimulation; 4 types
29
4 types of pathologic nystagmus
spontaneous positional gaze evoked congenital
30
T or F: peripheral vestibular hypofunction is unilateral
F: can be unilateral or bilateral
31
spontaneous nystagmus
due to central or peripheral vestibular problempo
32
positional nystagmus
can be paroxysmal or static 2 types: torsional or downbeat
33
**torsional/rotary** nystagmus points to what diagnosis?
peripheral (BPPV) or brainstem dysfunction
34
**downbeat/upbeat** nystagmus points to what diagnosis?
central (cerebellar) dysfunction or peripheral (but not BPPV)
35
gaze evoked nystagmus
eyes drift toward center, constant corrective saccades to reset gaze
36
congenital nystagmus
since birth or infancy (types of central vestibular dysfunction)
37
mal de debarquement
feeling like you're moving even though you are still- perceptual issues
38
what phase is nystagmus named for? what is the exception?
fast phase exception is BPPV, named for direction or rotary torsion towards side of lesion
39
nystagmus causes by peripheral will present as..
a mix of torsion vertically and rotary
40
peripheral vestibular nystagmus slow phases is caused by
VOR
41
periphreal vestibular nystagmus fast phase is caused
corrective saccades
42
nystagmus caused by CNS lesions
smooth pursuit and saccades- points to cerebellum and brainstem lesions
43
what can suppress nystagmus
if the patient can fixate on a target
44
nystagmus is best examined by
Frenzel/ Infrared Goggles!
45
central nystagmus looks like: (5 points)
-directional changing -vertical -not affected by fixation -constant -Congenital or trauma induced
46
alexander's law
peripheral vestibular issues gaze towards fast phases increases intensity
47
sensory for postural control involves
observing availability and accuracy of sensory info
48
three sensory systems for postural control
vision somatosensory vestibular
49
posture control, motor output is based on (3 things)
anticipatory mechanisms, automatic motor strategies, and motor pathways
50
what is the fastest of the 3 senses
somatosensory system
51
somatosensory system provides information about
support system via pressure receptors body position and movement via muscle/joint receptors
52
what are the 3 conscious proprioceptive senses
kinesthesia joint position sense sense of resistance
53
functions of the vestibular system (3)
oculomotor control gaze stability VOR
54
oculomotor control includes what 3 cranial nerves?
oculomotor, trochlear, abducens
55
jobs of the CNS
provides CNS info VOR internal reference to determine appropriateness/accuracy of external sensory info postural stability
56
selection of sensory strategy for postural control depends on (3 things)
availability of information within individual accuracy of info within environment motor strategy used to control balance
57
what are the components of the peripheral vestibular system
semi circular canals otoliths
58
what are the otolith organs
utricle saccule
59
what are the components of the central vestibular system
CN 8 vestibular nuclei motor pathways cerebellum
60
which part of the vestibular system can we address as PTs?
peripheral
61
movement that bends hair towards the kinocilium causes
activation
62
movement that bends hair away from the kinocilium causes
deactivation
63
T or F: activation of hair cells is gravity dependent
True
64
T or F: semicircular canals sense angular velocity/speed
F: semicircular canals sense angular acceleration
65
"YAW" axis is what motion and includes what semicircular canal?
shaking head NO horizontal canal
66
"PITCH" axis is what motion and includes what semicircular canals?
shaking head YES posterior and anterior canals
67
"ROLL" axis is what motion and includes what semicircular canals?
rolling head side to side (ear to shoulder) anterior and posterior canals
68
if turning head to right: endolymph moves ______ exciting the _____ hyperpolarizing the _____
endolymph moves left exciting the right hyperpolarizing the left
69
ampulla at the base of canal contains _______ with hair cells
cupula
70
utricle senses
horizontal movement
71
saccule senses
vertical movement
72
lateral vestibular nuclei are the origin of what tract
lateral vestibulospinal tract
73
medial vestibular nuclei are the origin of what tract
medial vestibulospinal tract
74
superior vestibular nuclei is the relay center for what
ocular reflexes
75
inferior vestibular nuclei is the 2nd origin of what tract?
medial vestibulospinal tract
76
cerebellum role in vestibular
monitors and fine tunes the vestibular reflexes
77
maintains gaze stability during head motion thus controlling eye-head coordination
VOR
78
maintains head and body equilibrium by facilitating or inhibiting skeletal muscle activity thus controlling coordination for balance
vestibulo spinal reflex
79
reflex output to motor cells signals head position on body; maintains gaze stability; taught as substitution for VOR when VOR absent
cervical ocular reflex COR
80
input from otoliths; output to eye muscles controls horizontal and vertical eye movements via linear VOR
otolith-ocular reflex
81
82
what causes vestibular symptoms?
a mismatch of firing of the canal functional pairs

NEURO EXAM 2 (20 decks)

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