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PT 680 Clinical Medicine > Vestibular Anatomy, Pathology, and Test > Flashcards

Vestibular Anatomy, Pathology, and Test Flashcards

(85 cards)

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1
Q

what detects movement of endolymph

A

cupula

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2
Q

tilted slightly upward from horizontal and primarily detects forward and backward movement (walking)

A

utricle

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3
Q

tilted slightly off vertical and detects up and down movement primarily (sitting –> standing)

A

saccule

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4
Q

calcium carbonate crystals aka

A

otoconia

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5
Q

does the fast phase of nystagmus go toward active or inhibited side

A

active

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6
Q

where are cell bodies of the vestibular branch of CN 8 found

A

scarpa’s ganglion

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7
Q

what does the superior vestibular N communicate with

A

anterior and lateral SCC
utricle

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8
Q

what does the inferior vestibular N communicate with

A

posterior SCC
saccule

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9
Q

where does CN 8 exit and enter

A

exit: internal auditory canal with CN 7 and labyrinthine A
enter: brainstem at pontomedullary junction

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10
Q

what do the 4 vestibular nuclei in the brainstem have connections to

A

cerebellum
reticular activating system
CN 3, 4, 6

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11
Q

the vestibular nuclei on the two sides of the brainstem are connected to each other via _____ resulting in one combined message to CNS

A

commissural fibers

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12
Q

where does lateral vestibular nucleus receive information from and where does it project it to

A
  • from: maculae of utricle
  • to: lateral vestibulospinal tract
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13
Q

indirectly influences LMN that innervate antigravity extensors through vestibulospinal reflex (VSR)

A

lateral vestibular nucleus

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14
Q

where does the medial vestibular nucleus receive information from and where does it project it to

A
  • from: cristae ampullaris
  • to: medial vestibulospinal tract
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15
Q

indirectly influences LMN that stabilize the head through the vestibulocolic reflex (VCR)

A

medial vestibular nucleus

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16
Q

name for the cupulla and hair cells

A

cristae ampullaris

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17
Q

where does the superior vestibular nucleus receive information from and where does it project it to

A
  • from: cristae ampullaris
  • to: MLF
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18
Q

coordinates movement of eyes and head through vestibulo-ocular reflex (VOR)

A

superior vestibular nucleus

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19
Q

where does the inferior vestibular nucleus receive info from and where does it project to

A
  • from: cristae ampullaris and maculae in utricle
  • to: cerebellum
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20
Q

influences balance and postural awareness through the medial and lateral vestibulospinal tracts

A

inferior vestibular nucleus

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21
Q

what is a major recipient of information in and out of vestibular complex; primarily involved in adjust and maintaining calibration of VOR and static and dynamic posture via VSR

A

cerebellum

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22
Q

information from the vestibular complex is relayed where on cerebellum

A

cerebellar vermis aka flocculonodular region

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23
Q

lesions to cerebellum cause what

A

produce gait and truncal ataxia and nystagmus (central vestibular dysfunction)

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24
Q

allows SCC input (head velocity) to be used for orientation after head movement stops; after cupula stops being deflected, signals are still being interpreted as movement in vestibulocerebellum and vestibular nucleus

A

velocity storage –> could be why when you stop spinning and cupula returns to normal that you still see nystagmus and feel spinning

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25
list the final destination areas of vestibular input
- brainstem complex (for reflex responses) - thalamus --> partietal lobe and insular cortex - 2 descending extra-pyramidal tracts (medial and lateral vestibulospinal tracts) - hippocampus (for spatial mapping)
26
what arteries supply the vestibular system
All major A - vertebral, basilar, PICA, AICA, labyrinthine, anterior vestibular, posterior vestibular A
27
what does the anterior vestibular A supply
anterior and lateral SCC utricle
28
what does the posterior vestibular A supply
posterior SCC saccule
29
what artery supplies the peripheral vestibular system
anterior inferior cerebral artery (AICA)
30
what reflex allows us to visually fixate
vestibulo-ocular (VOR)
31
maintains image stationary on retina (high speeds) during head movements
VOR
32
what is the only reflex that works at high speeds
VOR
33
without the VOR, images would blur --> what is another name for blurred vision
oscillopsia
34
what is vestibular gain of VOR
1:1 eye movement : head velocity
35
equal but opposite head and eye relationship
vestibular phase VOR
36
what is the bundle of axons that carry information to CN 3, 4, and 6
medial longitudinal fasciculus (MLF)
37
what vestibular nucleus controls VOR
superior vestibular nucleus
38
occurs when visual, somatosensory, and vestibular systems work appropriately and seamlessly, normal postural control engages and balance occurs subconsciously; somatosensory and visual cues are compared with vestibular cues to produce compensatory oculomotor and postural responses
sensorimotor integration
39
is the process of the CNS continuously determining/adjusting the percentage of input needed from each of the 3 sensory system (visual, somatosensory, vestibular) to remain upright
sensory reweighting
40
neurologic conditions that occur with vestibular system
neuritis/labyrinthitis/vestibulopathy (peripheral vestibular deficit) central vestibular dysfunction (TBI, stroke, MS, PD)
41
mechanical condition with vestibular system
Benign paroxysmal positional vertigo
42
structural conditions with vestibular system
- superior canal dehiscence - perilymphatic fistula
43
space occupying lesion with vestibular system
vestibular schwannoma/acustic neuroma
44
occurs due to damage directly to CN 8
peripheral vestibular lesion
45
peripheral vestibular lesion s/s
hearing loss, tinnitus, imbalance, episodic sx with movement
46
describe the nystagmus associated with peripheral lesion to vestibular system
- nystagmus does not change direction - nystagmus amplitude increases when looking toward fast phase (alexander's law) - nystagmus decreases with visual fixation
47
amplitude of nystagmus increases when looking toward fast phase
Alexander's law --> peripheral lesion sx
48
UVL
unilateral vestibular lesion complete/incomplete
49
what are the causes of peripheral vestibular lesions
viral herpes simplex virus, EBV, mumps, rubella
50
what nerve is affected with labyrinthitis and state presentation
vestibulocohlear N hearing affected
51
what nerve is affected with neuronitis/neuritis and presentation
superior vestibular N hearing NOT affected
52
neuronitis or labyrinthitis
vestibulopathy
53
what can we dx peripheral vestibular lesions as as a PT
hypofunction
54
UVL clinical manifestion
- URI/gastritis 2 weeks before sx develop - sudden onset vertigo, spontaneous horizontal nystagmus, nausea, vomiting --> can last several days - after acute sx, c/o disequilibrium, dizziness lasting with quick head movements - causes vestibular hypofunction on affected side - brain readjusts firing rate in 2 weeks and sx resolve
55
what can be used and is very effective is sx do not resolve by brain with UVL
vestibular rehabilitation therapy (VRT)
56
BVL
bilateral vestibular lesion complete/incomplete
57
most common cause of BVL
ototoxicity - caused by medications
58
what is the most common medication that causes BVL and why
gentamicin damages vestibular hair cells, spares hearing
59
clinical manifestation of BVL
- severe disequilibrium - c/o visual blurring with head movement (oscillopsia) - NO vertigo (dizziness) - may be complete (both vestibular N not working, will not get dizzy bc no imbalance in firing rate) or incomplete (both sides not working but imbalance in firing rate) - if incomplete, will learn to substitute with use of visual and somatosensory input
60
what would spontaneous nystagmus indicate for pathology
acute U/L vestibular loss or brainstem/cerebellum abnormality
61
what would no spontaneous nystagmus, but loss of VOR indicate for pathology
chronic vestibular hypofunction
62
what would impaired visual tracking indicate for pathology
brainstem abnormality
63
what would nystagmus and vertigo only elicited during movement indicate for pathology
BPPV peripheral hypofunction rarely central positional vertigo or nystagmus PLF hypermobile stapes Meniere's
64
what would skew eye deviation indicate for pathology
disruption of central and peripheral utricle pathways (otolith organs)
65
what would imbalance while standing and walking indicate for pathology
anything vestibular related
66
differentiate between central vs peripheral vertigo based on the effect of fixation
- peripheral: nystagmus decreases - central: nystagmus either does not change or may increase
67
differentiate between central vs peripheral vertigo based on effect of gaze
- peripheral: nystagmus increases toward side of fast phase (alexander's law) - central: nystagmus may not change or reverse direction
68
mechanisms of recovery for vestibular system
spontaneous adaptation habituation substitution
69
episodic positional vertigo caused by calcium carbonate crystals (otoconia) deflecting cupula
benign paraxysmal positional vertigo
70
main sx of BPPV
room spinning sensation that lasts 5-90s
71
what is the most common peripheral vertigo
BPPV
72
1/3 of pt spontaneously have sx resolution after _____ and _____% recur
3 weeks 40%
73
what type of problem is BPPV
MECHANICAL
74
otoconia breaks loose from utricle and falls into SCC
BPPV
75
most to least affected SCC with BPPV
posterior horizontal anterior
76
what does BPPV typically occur secondary to
head trauma or neuronitis - migraine-induced ischemia, dehydration, more common as you age
77
list some causes for BPPV
- 50% idiopathic (age) - head trauma (whiplash, TBI) - viral neuronitis (superior vestibular N) - VBI
78
describe canalithiasis BPPV
- free floating crystals deflect cupula - can have latency - sx typically 5-60s
79
describe cupulolithiasis
- crystals adhere to cupula - turns SCC into gravity sensor - sx can be immediate - sx typically last 60-90s (longer)
80
what time of day are sx worse for BPPV
most symptomatic in AM
81
pts to screen for BPPV for
- if pt does not lay flat at night - anyone over 65 y/o who have balance problems - many people will avoid positions causing dizziness - BELIEVE NO ONE
82
what direction nystagmus does posterior BPPV cause
upward/torsional
83
what direction nystagmus does horizontal BPPV cause
lateral
84
what direction nystagmus does anterior BPPV cause
downward/torsional nystagmus
85
how to describe nystagmus associated with horizontal canal
- geotropic: toward ground (canalithiasis) - ageotropic: toward the ceiling (cupulolithiasis

PT 680 Clinical Medicine (18 decks)

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