Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Adult Neuro > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

(60 cards)

Start Studying
1
Q

Vestibular system is a key _____ receptor

A

sensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

VS is sensitive to:

A
  1. head movement
  2. head position
  3. effect of gravity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Function of VS

A
  1. detect movement
  2. maintain gaze stability during motion
  3. maintain balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When not functioning properly, what other systems compensate and what is the main impairment

A

Visual and SS compensate (body must learn this)

balance is an issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the peripheral parts of VS?

A

Labyrinth! = 3 SC canals and otolith (saccule + utricle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of movement/position does the otolith (saccule and utricle) respond to?

A

static positions

linear acceleration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of movement/position do the semicircular canals respond to?

A

Angular head movements
Anterior = head nod (tilt in sagital plane)
Posterior = head tilt (tilt in frontal plane)
Horizontal = head turns (tilt in transverse plane)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pathway of information transmission from SC canals –> brain?

A

endolymph in SC canal moves –> hair cells moved in opposite direction –> sends info to cortex –> stabilizes eyes to target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Push-Pull Phenomenon

A

Activation of SC canal on one side inhibits SC canal on other side
*i.e. head turn to right = activation R horizontal SC canal (don’t move eyes here) + inhibition of L horizontal SC canal (turn eyes that way)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Central structures of VS

A
  1. cochlea nerve and vestibular nerve (inflammation/injury to one can cause issues with the other)
  2. Facial nerve (issues here can cause issues in chochlea or vestibular nerve)
  3. Cerebellum (inhibition or facillitation of VOR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lesion in central v peripheral structures (recovery time)

A

longer recovery time for central lesions- pt must learn compensation strategies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Corrective saccade

A

eyes correct themselves to reorient to center (occurs in healthy system)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Saccade

A

voluntary corrective movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Smooth pursuit

A

slow saccades - voluntary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nystagmus

A

involuntary; quick corrective movement of the eyes back to the center

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Retinal Slip

A

image slips from person’s eyes; they are unable to process changes to a moving image (see it as more than 1 object in front of you)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Vestibulo-Occular Reflex (VOR), purpose, types/what senses it

A

purpose: hold images steady on retina with head movement
Angular VOR: sensed by SCC
Linear VOR: sensed by otolith
Ocular Tilt Reflex: sensed by utricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nystagmus- what side is the lesion on

A

typically the side with a quicker nystagmus is the side of the lesion (direction of the fast phase)
*evaluate during tonic and dynamic system- central lesions have nystagmus in both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tonic System deficit

A

nystagmus present without movement (at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dynamic system deficit

A

nystagmus with movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is considered a “Central lesion” v “Peripheral lesion”

A 
central = everything past internal auditory canal (disorders of the CNS)
Peripheral = everything before internal auditory canal (SCC and otolith)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Peripheral lesion symptoms

A
  1. Dizziness with positional changes
  2. hearing loss, tinnitus
  3. balance problems
  4. symptoms with head movement during gait
  5. acute nystagmus
  6. nystagmus only present chronically if they have NOT learned to compensate
  7. oscillopsia- jumping of objects in visual field (can’t focus, feel like its moving up and down)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Central Lesion Symptoms

A
  1. constant dizziness
  2. Downbeating nystagmus (but present with anterior SCC deficit- differentiate whether it is present at rest)
  3. Cerebellar signs/sx (ataxia/imbalance)
  4. Associated head injuries/cervical injuries
  5. Horner’s Dyndrome
  6. swallowing difficulty
  7. Sensory changes
    • babinski, clonus, changes in DTRs
  9. Impaired balance and gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms common in peripheral and central lesions

A
  1. Spinning/vertigo (worsened with 3D shapes)
  2. Vomitting
  3. Nausea
  4. Headache
  5. dizziness
  6. impaired balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Acoustic Neuroma (vestibular schwannoma)
*will be walking more to one side than the other* benign tumor, begins on vestibular portion of acoustic n. other symptoms: hearing and balance, tinnitus, disequilibrium, vertigo (all caused by compression of CN VIII) if grows enough- expansion to cerebellopontine angle (near brainstem and CNVII)
26
Peripheral Pathologies
1. Benign Paroxysmal Positional Vertigo (BPPV) 2. Cervicogenic Vertigo 3. Labrynthitis (inflammation of inner ear) 4. Perilymph Fistula 5. Meniere's Disease (inflammation of inner ear)
27
Benign Paroxysmal Positional Vertigo (BPPV): Cause
Free floating otoconia Otoconia belon in utricle; they dislodge and enter SCC disruption of endolymph mvt --> false info sent to brain *can occur spontaneously or following head trauma/labrynthitis
28
Benign Paroxysmal Positional Vertigo (BPPV): main symptom
vertigo with POSITIONAL changes
29
Benign Paroxysmal Positional Vertigo (BPPV): Diagnosis
onset of nystagmus and vertigo only when moved in plane of SCC 1. horizontal nytagmus --> horizontal SCC 2. Downwards nystagmus --> anterior SCC 3. Upwards nystagmus --> posterior SCC
30
Benign Paroxysmal Positional Vertigo (BPPV): Evaluation
Gold standard = Dix Hallpike test Anterior + posterior SCC = sidelying test Horizontal SCC = horizontal roll test
31
Benign Paroxysmal Positional Vertigo (BPPV): Treatment
Canalith Repositioning Maneuver --> helps remove otoconia Rotate head to affected ear --> lower into supine with head off the table Turn head to other side , then further so parallel to floor, then rapidly further so face is almost to the floor return to upright and head to normal
32
Cervicogenic Vertigo: Cause
occurs in pt with longstanding vertigo cervical spine receptors not firing as much--> turning head in limited motion for long time when they finally turn their head further, exposure to visual field they haven't seen in a long time (makes them even dizzier)
33
Perilymph Fistula
holes in the oval or round window- endolymph enters into air-filled middle ear (not much you can do for this pt)
34
Central Pathologies
1. CVA 2. MS 3. BL Vestibulopathy (inflammation of neurons by toxic substances)- hard to get better, not reversible 4. head injury
35
Dix Hallpike Test
gold standard for BPPV (posterior canal of side tested and anterior of opposite side) CANNOT be performed if VBI or stenosis side of dysfunction = side head is turned to
36
Dynamic Visual Acuity Test
assessment of gaze stability | no reliability established in pts with TBI
37
Saccadic Testing
Smooth pursuits: pt scans the room, want eyes and head to have same ROM Saccadic: pt looks back and forth from your fingers without head mvt
38
VOR testing
letter held at arms length from pt- maintain vision on letter with side-side head turns looking for when they have retinal slip (trying to induce this)
39
VOR cancellation testing
want head and eyes to turn in same direction at same velocity head mvt side-side while looking at pen (pen is moving with their head- movement is fast, about 2Hz)
40
Subjective Visual Vertigo testing (SVV)
Ability to identify whether an object is upright with SVV- head is tilted -- can't identify verticle *correct their head to midline! (better BL visual input)
41
Head Thrust Test
slowly turning their head from side-side, quickly move the head back to midline --> looks for the corrective saccade (+) test = eyes lagging when head is thrust back to midline
42
Fukuda Step Test
pt marches with high knees and eyes closed (looking for sideways deviations) involved side = side of deviation not good interrater reliability (distance deviated not always measured), not always positive in only vestibular dysfunctions
43
Sidelying Test
testing anterior and posterior SCC sitting at EOB -- rotate 45 degrees AWAY from side to be tested quickly bring head into CL sidelying (rotate to L, SL to R) pt reports vertigo, observe for nystagmus repeat to other side
44
Horizontal Roll Test
testing horizontal SCC pt in supine -- head flexed 20deg -- quick head rotation pt reports vertigo, observe for nystagmus slow return of head to midline, quick roll to other side
45
Sensory Organization Test: Purpose, administration
purpose: assess effective use of visual, vestibular, and proprioceptive information (how the body organizes information between the systems) Pt stands on moving board with visual frame (that moves) in front of them
46
SOT: categories/conditions
1. eyes open, fixed surface, fixed visual surround 2. Eyes closed, fixed surface, fixed visual surround 3. Eyes open, fixed surface, sway visual surround 4. Eyes open, sway surface, fixed visual surround 5. eyes closed, sway surface 6. eyes open, sway surface, sway visual surround * vestibular dysfunction, usual fall in categories 5 and 6
47
Activities Specific Balance Confidence Scale and Dizziness Handicap Inventory (pros and cons)
pros: good psychometric properties Cons: limited research in vestibular population
48
Referral back to physician
1. new onset UMN s/s 2. swallowing difficulties 3. sensory changes 4. changes in pupillary size/ptosis 5. loss of consciousness 6. new onset LOB 7. fluctuating hearing loss 8. visual field cut 9. memory loss
49
UL v BL vestibular hypofunction (prognostic differences, inital system they rely on)
``` UL = better prognosis, expect recovery, initially rely on SS cues BL = poorer/longer recovery time, requires compensation, initially rely on visual cues ```
50
Acoustic Neuroma Treatment
can teach VOR to these pts- hope is for some return | a lot of rememberance issues
51
Central lesions: focus of treatment
balance issues
52
Examples of Compensation strategies
using the unaffected side to help them | avoiding putting themselves in positions of known balance compromise
53
Treatment: Adaptation
teaching VOR exercise- hope is that practice will help them get better aim: reduce retinal slip, decrease symptoms, improve postural stability
54
Treatment: Habituation
a series of progressively more complex repeated movements designed to provoke symptoms (will make them dizzy)
55
Treatment: Substituation
use of alternative strategies to replace lost or compromised function (using SS and visual systems to help)
56
Vestibular Eval: Steps
1. Check vision (glasses, distance for dbl vision, skew deviations) 2. Check the cranial nerves ("H") 3. Check for visual field cut (PT and pt cover eye, introduce finger from periphery) 4. Check smooth puruit 5. VOR testing (horizontal and vertical) 6. VOR cancellation testing 7. Head thrust 8. Reading test
57
When are skew deviations seen
with cerebellar and brainstem strokes - skew deviation present on same side
58
Checking for skew deviations
pt with eyes closed, ask them to open and look at your finger when eyes open, one will be higher or lower
59
Reading Test
Read with head in midline, record # of lines able to read Read while turning head side-side, record # of lines able to read Compare the 2 numbers (+) test = more than 2 lines of difference
60
Checking for visual field cut: implications of periphery loss v nasal field loss
``` periphery = pituitary lesion Nasal = optic chiasm ```

Adult Neuro (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions