Vertigo/Dizziness Flashcards
(113 cards)
1
Q
Otolith Organs:
A
Utricle
Saccule
= linear sensory receptors
2
Q
Utricle:
A
detects horizontal linear acceleration (e.g., car moving forward)
lies in the same plan at horizontal SCC
3
Q
Saccule:
A
detects vertical linear acceleration (e.g., elevator)
lies in horizontal plane of SCC (next to the opening)
sensory epithelium = hair cells embedded in otolithic membrane + crystals (otoconia)
4
Q
Semicircular Canals (SCCs):
A
Detect rotational/angular acceleration
Work in push-pull pairs, arranged in orthogonal planes (right angles)
each canal forms a loop filled with endolymph
5
Q
SCC functional pairs:
A
Right & Left Horizontal Canals
Right Anterior ↔ Left Posterior
Left Anterior ↔ Right Posterior
6
Q
SCC Push-Pull System:
A
When one canal is excited (more firing), the paired one is inhibited (less firing).
Example: Turn head right → right horizontal canal excited, left inhibited
7
Q
anterior SCC =
A
(superior)
plane of motion: sagittal
detects rotation in: nodding head yes
flexion/extension
8
Q
poster SCC =
A
plane of motion: coronal
detects rotation in: tilting head towards shoulder
BPPV often affects the posterior canal (most gravity-dependent)
9
Q
horizontal SCC =
A
(lateral)
plane of motion: transverse
detects rotation in: turning head L/R
10
Q
The utricle is sensitive to a change in ___ movement
A
horizontal
11
Q
The saccule is sensitive to ___ acceleration
A
vertical
12
Q
Otolith Organs: Utricle and Saccule
Sensory receptors of linear acceleration such as ___ and translational motion ____
A
gravity
e.g. sit to stand, car de/acceleration
13
Q
Ampulla =
A
swollen base of each SCCC
contains crista ampullaris
inside = hair cells embedded in cupula = gel structure that moves with endolymph
14
Q
crista ampullaris =
A
sensory structure with hair cells and ampulla
15
Q
endolymph moves due to head rotation ->
A
deflects the cupula -> bends hair cells -> triggers firing of vestibular nerve (action potentials)
= motion sensor!! detects rotation and triggers VOR
16
Q
Three canals - positioned at roughly ___-degree angles to each other for ___ movement monitoring
A
90
3-D
17
Q
horizontal BPPV vs posterior BPPV
A
horizontal = less common, more intense
posterior = most common
18
Q
vestibular triad =
balance system (if one is impaired they rely more on others)
A
Vestibular
Vision
Somatosensory
19
Q
sensory input =
A
vestibular = equilibrium, spatial awareness, rotation, linear movement
visual = sight
proprioception = touch
20
Q
integration of input =
A
cerebellum = coordinates and regulates posture, movement, balance
cerebral cortex = contribute memory and higher level thinking
brainstem = integrates and sorts sensory information
21
Q
motor output =
A
VOR (vestibulo-ocular reflex)
motor impulse to control eye movement
motor impulses to make postural adjustments
22
Q
Vestibular Ocular Reflex =
A
maintains stability of an image on the fovea of the retina during rapid head movements
Uses a three-neuron arc connectivity pathway
23
Q
VOR generates rapid compensatory eye movements in the direction ___ the head rotation
A
opposite
24
Q
three-neuron arc =
A
peripheral sensory apparatus (set of motion sensors: the SCC & otolith organs)
central processing mechanism
motor output (which are the eye muscles)
25
Vestibular System =
parts of inner ear and brain that process sensory info involved with balance reactions and eye movements
26
Vestibular System in action (4 parts):
visual stability
balance
spatial orientation
autonomic
27
Balance System in action (3 parts):
gaze stability = coordinates eye movements
gait stability = keeps you upright and stable
spatial orientation = maintains sense of equilibrium
28
Overall incidence of dizziness, vertigo, and imbalance is ___
5-10%
29
Dizziness - ___% in patients older than 40 years
40
30
___% of people 65 and older have experienced dizziness
80
31
Dizziness - Falling incidence is ___% in people older than 65 years
25
32
Dizziness - ___% of US ED volumes (2-4 million people annually)
3-4
33
____ is the most common cause of dizziness in the ED, followed by ___
Benign paroxysmal positional vertigo (BPPV)
cerebellar stroke and vestibular neuritis
34
BPPV, the most common ___ disorder, causes approx. ___% of “dizziness” in people 65 and older
vestibular
50
35
Central Dizziness Causes =
CVA- Brainstem or cerebellar
TBI, DAI
MS
Migraine
Cervicogenic headache
Mal de Debarquement syndrome
Concussion
36
Peripheral Dizziness Causes =
Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular Neuritis
Labyrinthitis
Meniere’s Disease
Acoustic (vestibular) neuroma
Superior Canal Dehiscence or Fistula
37
Other Dizziness Causes =
Other medical conditions such as:
OH
VAI
hypoglycemia
stress/psychiatric
medications
38
Dizziness = umbrella term that can refer to:
Vertigo (spinning)
Lightheadedness
Disequilibrium
Pre-syncope
39
vertigo =
spinning
illusion of personal/ environmental movement
etiology: disturbance of vestibular function (central vs peripheral vertigo)
40
disequilibrium =
unsteadiness or feeling of falling with walking
disappears with sitting or lying down
etiology: spinal, peripheral n., cerebellar, impaired audio/visual acuity
41
presyncope =
near loss of consciousness
etiology: decreased cerebral perfusion, arrhythmias, valvular heart disease, vagal, hypotension
42
lightheadedness =
nonspecific dizziness/chronic subjective dizziness
43
oscillopsia =
rhythmic oscillation of your visual environment
etiology: often a consequence of central eye movement disorders or in response to motion due to bilateral vestibular failure
44
Peripheral Vestibular Disorders:
BPPV
Vestibular neuritis
Labyrinthitis
Meniere’s Disease
Acoustic Neuroma
Superior Canal Dehiscence
45
BPPV =
Brief, episodic vertigo with position changes (e.g., rolling over in bed)
cause = Otoconia displaced into SCC (usually posterior canal)
46
Vestibular Neuritis =
Acute vertigo, imbalance, nausea; no hearing loss
cause = Viral inflammation of the vestibular nerve
47
Labyrinthitis =
Like vestibular neuritis + hearing loss
cause = Viral or bacterial infection of the labyrinth
48
Meniere’s Disease =
Episodic vertigo, fluctuating hearing loss, tinnitus, ear fullness
cause = Abnormal endolymph fluid pressure in the inner ear
49
Acoustic Neuroma (Vestibular Schwannoma) =
Progressive hearing loss, imbalance; vertigo less common
cause = Benign tumor on CN VIII
50
Superior Canal Dehiscence =
Vertigo triggered by loud sounds or pressure
Bone defect in semicircular canal wall
51
Central Vestibular Disorders:
CVA (brainstem or cerebellum)
TBI / Concussion / DAI
MS
Vestibular Migraine
Mal de Debarquement Syndrome
52
CVA (brainstem or cerebellum) =
Sudden vertigo + other neuro signs (diplopia, dysarthria, weakness)
cause = Ischemic or hemorrhagic stroke
53
TBI / Concussion / DAI =
Dizziness, cognitive issues, headaches, light sensitivity
cause = Traumatic brain injury
54
MS =
May cause vertigo, imbalance, vision problems
cause = Demyelination of CNS tracts
55
Vestibular Migraine =
Episodic vertigo + migraine sx (photophobia, nausea, aura)
cause = Neurovascular disorder, not always with headache
56
Mal de Debarquement Syndrome =
Persistent rocking/swaying after cruise/travel
cause = Unknown; possibly central maladaptation
57
Other Vestibular Disorders:
Orthostatic Hypotension (OH)
Vertebral Artery Insufficiency (VAI)
Hypoglycemia
Cervicogenic Dizziness
Medications
Psychogenic (e.g. anxiety)
58
Orthostatic Hypotension (OH) =
Lightheadedness on standing
cause = BP drop with postural change
59
Vertebral Artery Insufficiency (VAI) =
Dizziness with neck extension/rotation
cause = Reduced blood flow to brainstem
60
Hypoglycemia =
Dizzy, confused, shaky
cause = Low blood sugar
61
Cervicogenic Dizziness =
Associated with neck pain, limited ROM
cause = Proprioceptive mismatch from neck dysfunction
62
Medications =
Sedatives, antihypertensives, antidepressants
cause = Drug-induced
63
Psychogenic (e.g. anxiety) =
Dizziness with normal exam, hyperventilation
cause = Panic, anxiety disorders
64
BBPV
Key Pathophysiology:
Dislodged otoconia (calcium carbonate crystals) from utricle into semicircular canals (usually posterior canal)
Causes abnormal endolymph flow → hair cell deflection during head movements
65
Vestibular Neuritis
Key Pathophysiology:
Viral inflammation of vestibular nerve (CN VIII)
Acute unilateral vestibular loss; no hearing involvement because cochlear nerve is spared
66
Labyrinthitis
Key Pathophysiology:
Viral or bacterial infection of the labyrinth (vestibular + cochlear apparatus)
Involves both balance and hearing → vertigo + hearing loss
67
Meniere's Disease
Key Pathophysiology:
Idiopathic endolymphatic hydrops (excess endolymph fluid in inner ear)
Recurrent attacks of vertigo, tinnitus, hearing loss due to pressure changes
68
Perilymph Fistula/Superior Canal Dehiscence
Key Pathophysiology:
Abnormal opening between inner ear and middle ear or thin bone overlying canal ruptures
Sound or pressure-induced vertigo due to inner ear fluid leak or abnormal pressure transmission
69
CVA
Key Pathophysiology:
Ischemia in PICA, AICA, basilar artery
Affects vestibular nuclei, cerebellum → vertigo with neuro signs (ataxia, diplopia, dysarthria)
70
MS
Key Pathophysiology:
Demyelination in CNS tracts (brainstem, cerebellar pathways)
Interrupts vestibular signal transmission; vertigo often one of many neuro symptoms
71
Vestibular Migraine
Key Pathophysiology:
Thought to be neurovascular dysregulation without structural damage
Central sensitivity to sensory input; episodic vertigo, photophobia, nausea ± headache
72
TBI
Key Pathophysiology:
Axonal shearing or impact affecting brainstem, cerebellum
Can disrupt vestibular processing centers or integration pathways
73
Tumors
Key Pathophysiology:
Compression of vestibular tracts/nuclei
Often gradual onset vertigo, imbalance, cranial nerve deficits
74
Central vs Peripheral Vertigo
Onset:
peripheral: Sudden
central: Gradual or sudden
75
Central vs Peripheral Vertigo
Hearing loss/tinnitus:
peripheral: Often present
central: Rare
76
Central vs Peripheral Vertigo
Nystagmus:
peripheral: Unidirectional, horizontal, suppresses with fixation
central: Vertical, direction-changing, doesn't suppress
77
Central vs Peripheral Vertigo
Balance Issues:
peripheral: Mild to moderate
central: Severe ataxia, unable to walk
78
Central vs Peripheral Vertigo
Other neuro signs:
peripheral: None
central: Often present (e.g., diplopia, dysarthria, limb ataxia)
79
Central vs Peripheral Vertigo
positional triggers:
peripheral: Common (BPPV)
central: Less common
80
Vestibular Rehabilitation Therapy (VRT) =
a customized exercise-based program designed to:
Reduce dizziness
Improve gaze and postural stability
Enhance functional mobility
Improve quality of life for people with vestibular disorders
81
PTs play role in ___ and ___ for people with vestibular dysfunction
diagnosis
treatment
82
Purpose is to alleviate ___ caused by vestibular disorders
both primary and secondary problems
83
___ exercise program
Evidence-based
84
Vestibular rehabilitation therapy (VRT) uses Activity/exercise-based treatment programs designed to promote
vestibular adaptation (modify responsivity, recalibrate)
vestibular substitution (alternative strategies/compensations)
85
Goals of VRT
reduce vertigo
enhance gaze stability
improve postural stability
improve activities of daily living, safety, QoL
86
Reduce vertigo/dizziness through ___ and ___ techniques
habituation
compensation
87
Enhance gaze stability through ___ exercises
gaze stabilization
(e.g., VOR x1, x2)
88
Improve postural stability & balance through balance training that challenges ____
visual/somatosensory reliance
89
Improve activities of daily living (ADLs), safety, and quality of life = Overall ___ is the ultimate rehab goal
functional independence
90
Vestibular Adaptation =
Focused on improving function of the impaired vestibular system
Based on neural plasticity
Uses error signals (like retinal slip) to retrain VOR gain
Example: VOR x1 and x2 exercises
91
Vestibular Adaptation is best for:
unilateral peripheral hypofunction
92
Vestibular Substitution =
Uses other systems (vision, proprioception) to compensate for vestibular loss
Example: Remembered targets, slow saccadic eye-head movements, enhanced use of visual cues during balance tasks
93
Vestibular Substitution is especially important in:
bilateral vestibular loss where adaptation isn’t possible
94
Habituation =
Repeated exposure to symptom-provoking movements/environments
Goal is to desensitize the brain to problematic stimuli
Example: Brandt-Daroff exercises, graded exposure to turning, lying down, etc.
95
Habituation is good for:
motion sensitivity, migraine-related vertigo, or post-concussion
96
CPG - Vestibular Rehab for Peripheral Vestibular Hypofunction
1) Gaze Stabilization Exercises (GSE)
2) VOR Adaptation Exercises
3) VOR Substitution Exercises
4) VSR Substitution Exercises
97
Gaze Stabilization Exercises (GSE) =
Improve the vestibulo-ocular reflex (VOR) to maintain visual focus during head movement.
Perform several times daily, start sitting → progress to standing, walking
Induce mild symptoms (goal is stimulation, not symptom avoidance)
98
VOR x1:
Head moves side-to-side or up/down while eyes stay fixed on a stable target.
Example: "Look at letter on wall while shaking head ‘no’ for 1 min.”
99
VOR x2:
Head and target move in opposite directions (harder).
Example: Holding a card in hand, move head and card side-to-side in opposite directions.
100
VOR Adaptation Exercises =
Recalibrate or adapt the VOR gain to respond better to head movements.
This overlaps with GSE but focuses on creating retinal slip to drive adaptation
Use target-based exercises that challenge the system enough to promote neuroplasticity
Usually involve small, fast head movements, fixed gaze, progressing difficulty
101
Retinal slip =
when the visual image moves on the retina instead of staying stable
This error signal prompts the brain to retrain the VOR
102
VOR Substitution Exercises =
Help the brain use alternative strategies when the VOR is too impaired to adapt (especially in bilateral loss).
Remembered targets
Predictive saccades
103
Remembered targets:
Look at target
Close eyes
Turn head
Open eyes and try to refocus on same spot
104
Predictive saccades:
Teach patient to move eyes first, then turn head (using voluntary eye movements to maintain visual stability)
105
VSR Substitution (Vestibulo-Spinal Reflex) =
Improve postural stability and balance using non-vestibular cues (vision and somatosensation).
Balance exercises on foam, uneven surfaces, with/without vision
Dynamic tasks like head turns while walking, changing BOS, dual-tasking
Progressions: sitting → standing → tandem → foam → compliant surfaces
106
What vestib rehab is best for:
Bilateral vestibular
hypofunction
Older adults with poor adaptation potential
VOR Substitution Exercises
107
What vestib rehab is best for:
unilateral vestibular loss
Gaze Stabilization Exercises (GSE)
108
What vestib rehab is best for:
Unilateral vestibular hypofunction where partial VOR function is still intact
VOR Adaptation Exercises
109
What vestib rehab is best for:
Anyone with balance deficits due to vestibular loss (uni or bilateral)
Fall prevention
VSR Substitution (Vestibulo-Spinal Reflex)
110
GSE
purpose -
best for -
example -
Improve gaze stability
Uni or bilateral
VOR x1, x2
111
VOR Adaptation
purpose -
best for -
example -
Retrain VOR gain
Unilateral
Head turns while focusing on letter
112
VOR Substitution
purpose -
best for -
example -
Compensate for VOR loss
Bilateral
Remembered targets
113
VSR Substitution
purpose -
best for -
example -
Improve posture/balance
Any vestibular loss
Balance with head turns on foam
