Lecture 8: Vestibular Dysfunction Flashcards
(42 cards)
What is important to rule out before testing for BPPV?
VBI
What are sx of VBI?
5D 3N 1A
dizziness, diplopia, dysarthria, dysphagia, drop attacks
nausea, nystagmus, numbness of face
ataxic gait
What can be causes of VBI?
an occlusion cause by bone spurs, OA instability
What is Unilateral vestibular loss caused by?
aka peripheral hypofunction
vestibular neuritis, labrynthitis, viral or bacteria infection, acoustic neuroma, temporal bone fx or trauma, aging
What is PP of UVH?
vertigo crisis- sudden onset of vertigo, N/V and imbalance that warrants ER visit
sx lasting 24-72 hours
gradual return to baseline with some vertigo and imbalance
What is UVH neuritis?
inflammation of superior portion of vestibular nerve- the branch associated with balance resulting in vertigo but NOT hearing loss
What is UVH neuronitis?
damage specifically to sensory neurons of vestibular ganglia similar sx to neuritis
What is UVH labyrinthitis?
inflammation of labyrinth and affects both branches of CN 8 resulting in vertigo and hearing loss
What are key diagnostic features of a UVH?
horizontal nystagmus, postural instability, positive head thrust and reduced caloric response on ENG
What is medical tx for UVH?
- vestibular suppressant (meclizine)
- vestibular rehab to improve sx
- treat underlying cause
What is chronic UVH?
“recurrent vestibulopathy”
pp with multiple episodes of vertigo
sx vary from 5 minutes to 24 hours (no hearing loss)
Sx not always brought on by head turns
What is likely cause of chronic UVH?
decrease of afferent discharge in the vestibular nerve likely due to a virus
What is the most common cause of bilateral vestibular loss?
ototoxicity from antibiotics most likely gentamicin
Why is bilateral loss common in elders?
due to a normal decrease in the number of hair cells and vestibular neurons along with drop in the ability of vestibular system to compensate
Why is knowing elders lose vestibular function important to PT?
highlighting need to incorporate vestibular assessment when working with geriatrics
What is PP of bilateral VH?
imbalance especially when eyes closed or in dark, oscillopsia (blurring of eyes)
if complete loss- no vertigo, N/V
if incomplete- sx of vertigo but less severe of UVH
What is Meniere’s disease?
development of endolymph hydrops in the cochlea creating malabsorption of endolymph and an increase in pressure
What is PP of Meniere’s?
same as UVH but also with aural fullness and tinnitus (ringing of ears) and reversible hearing loss
Is vestibular rehab appropriate for Meziere’s?
No bc their sx will resolve in between episodes
use vest suppressants, diuretics, lifestyle mods
Where is likely location of a CNS vestibular pathology?
involves vestibular nuclear complex of cerebellum
What are common diagnosis with CNS vest problem?
brainstem strokes, head trauma, migraine related vestibulopathy, MS, cerebellar degradation
What is the main problem associated with CNS issues?
integration and processing of sensory input from vestibular, visual and somatosensory systems are impaired
What is clinical PP of CVD of CNS?
lateropulsion (while standing), ocular tilt, vertigo, N/V, ataxia, vertical deviation of perceived straight ahead, past pointing, vertical nystagmus, impaired smooth pursuits or saccades, concomitant D’s
What are 6 Concomitant D’s of CVD?
diplopia, dysarthria, dysmetria, dysphagia, dizziness, drop attacks
