Non-BPPV Vestibular Exam

Question 1

what are the oculomotor tests?

Answer 1

gaze evoked nystagmus
vergence
smooth pursuit
saccades

Question 2

what are the VOR tests?

Answer 2

head shake nystagmus test
head impulse test
dynamic visual acuity
VORx1
VORx2
VORc

Question 3

what does spontaneous nystagmus test determine?

Answer 3

peripheral (decreased w/ fixation) vs central (unaffected by fixation)

Question 4

+ spontaneous nystagmus test for central vestibular

Answer 4

no change in intensity
direction changing
not fatiguable

Question 5

(-) spontaneous nystagmus test for peripheral vestibular

Answer 5

nystagmus increases with Frenzels
unidirectional/fixed
fatiguable

Question 6

+ central sign for Gaze Evoked Nystagmus test

Answer 6

intensity of nystagmus increases with gaze in any direction
not fatigable

Question 7

+ peripheral sign (non-BPPV) for Gaze Evoked Nystagmus test

Answer 7

intensity of nystagmus increases when looking in direction of fast phase
fatigable

Question 8

how does 1st degree nystagmus present (GEN test)?

Answer 8

chronic; 1 wk
nystagmus present with gaze in all 3 directions
most intense when gaze towards healthy ear

Question 9

how does 2nd degree nystagmus present (GEN test)?

Answer 9

after few days
nystagmus present with gaze center and towards healthy ear

Question 10

how does 3rd degree nystagmus present (GEN test)?

Answer 10

1st day; acute lesion
nystagmus present in all directions
fastest towards healthy ear

Question 11

normal test for vergence

Answer 11

target at least 6 cm from nose before pt sees double

Question 12

abnormal test for vergence

Answer 12

deconjugate eye movement
diplopia before 6 cm
aversion reaction

Question 13

how far to hold target away for oculomotor testing?

Answer 13

12-18 inches

Question 14

how far to move target in each direction for smooth pursuit and saccade testing?

Answer 14

30 deg

Question 15

abnormal finding for smooth pursuit test?

Answer 15

saccadic intrusions
central sign

Question 16

abnormal test for saccades

Answer 16

over or under shooting
slow scan instead of quick jump

Question 17

VOR is driven at __ Hz

Answer 17

2 Hz (1 cycle = 120 bpm)

Question 18

amplitude of movement for VOR

Answer 18

60 deg (30 each direction)

Question 19

how should head be positioned for head shake test?

Answer 19

flexed 30 deg

Question 20

procedure for head shake test?

Answer 20

flex head to 30 deg
PASSIVELY shake QUICKLY (2 Hz) for 20 seconds
stop and look straight - observe for nystagmus

Question 21

abnormal head shake test

Answer 21

direction fixed nystagmus (>2 beats) towards intact side

Question 22

what is the most sensitive VOR test?

Answer 22

head impulse or head thrust test

Question 23

which Ewald Law is tested with head impulse/head thrust test?

Answer 23

2nd - vestibular nerve can increase firing with increasing intensities without compensatory saccade

Question 24

head impulse/head thrust test procedure

Answer 24

hold head 12-18” away
pitch head 30 deg
tell to focus on nose
PASSIVELY, SLOWLY move pt head side
quick, unexpected thrust

Question 25

which canal is stimulated in head impulse/head thrust test?

Answer 25

horizontal

Question 26

what is suspected? pt's eyes jump back to PT's nose during head impulse/head thrust test when quickly moved head to the R

Answer 26

right vestibular hypofunction

Question 27

abnormal DVA test for UNILATERAL vestibular hypofunction

Answer 27

3 or more line difference and dizziness

Question 28

abnormal DVA test for BILATERAL vestibular hypofunction

Answer 28

3 or more line difference + oscillopsia and postural instability (NO DIZZY)

Question 29

VOR x1 test procedure

Answer 29

pt actively moves head 20-30 deg at 120/240 bpm while keeping eyes on target held at 12-18 inches away at eye level

Question 30

abnormal VOR x1 test

Answer 30

target blurry or jumping unable to move head at 2 Hz

Question 31

VOR x2 test procedure

Answer 31

active head movement with target moving side to side as fast as can

Question 32

abnormal VOR x2 test

Answer 32

target blurry target jumping dizziness

Question 33

lesions where will cause inability to cancel VOR?

Answer 33

cerebellum - flocculus or paraflocculus

Question 34

which test assess visual-vestibular integration in CNS?

Answer 34

VOR cancellation