Vestibular Disorders

Question 1

What systems may be at fault when their is dizziness

Answer 1

cardiovascular, neurological, visual, psychogenic, cervicogenic, meds, vestibular

Question 2

What are 3 vestibular functions

Answer 2

Gaze stabilization
Postural stabilization
Resolution of sensory motor mismatch

Question 3

What does gaze stabilization do

Answer 3

Keeps objects in visual field clear with head movement

Question 4

What does postural stabilization do

Answer 4

Maintain balance and equilibrium

Question 5

What is the result of sensory motor mismatch

Answer 5

Sea sickness

Motion intolerance

Question 6

How many semicircular canals are there? Names?

Function

Answer 6

3 Horizontal, anterior, posterior

gaze/angular displacement of the head

Question 7

How do the semicircular canals detect angular displacement of theh ead

Answer 7

Movement of endolymph within the canals will deflect hair cells and excite or inhibit neurons (CNVIII)

Question 8

How many otoliths are there? names?

Answer 8

2

Utricle
Saccule

Question 9

Function of utricle

Answer 9

Detects horizontal plane motion

Question 10

Function of saccule

Answer 10

Detect sagittal plane motion

Question 11

Combined function of utricle and saccule

Answer 11

Detect acceleration and deceleration, gravitational pull = Postural

Question 12

What are 3 common vestibular S&S

Answer 12

• Vertigo
• Dizziness
• Oscillopsia

Question 13

What is vertigo?

Answer 13

the subjective experience of nystagmus (room spinning around you) - get it with BPPV * always vestibular in origin

Question 14

What is dizziness

Answer 14

discrepancy between R and L side, patient can’t work out where they are in space
- *non-specific, may or may not be vestibular in origin

Question 15

Is vertigo or dizziness always vestibular in origin

Answer 15

Vertigo

Question 16

What is oscillopsia

Answer 16

Blurred vision (Not diplopia)

Question 17

Which antibiotic effects the vestibular system

Answer 17

Gentomycin

Question 18

What does BPPV stand for

Answer 18

Benign paroxysmal positonal vertigo

Question 19

Of people with BPV, 90% present with crystals in the _____, 80% of these are ____

Answer 19

in Posterior SCC

80% canalithiasis (free floating in canal)

Question 20

BPPV S&S

Answer 20

brief (< 30 sec), delayed, transient vertigo with looking up/down, rolling to that side of bed, sit to supine;
+/- vertigo,
nystagmus,
vomiting

Question 21

BPPV AX

Answer 21

Dix Hallpike * look for down beating nystagmus

Question 22

Contraindications to Dix Hallpike

Answer 22

cervical spine instability, VBI, Arnold- Chiari malformation, acute whiplash, RA, prolapsed IV disc with radiculopathy, cervical myelopathy

Question 23

BPPV Rx

Answer 23

Modified Epley Maneuver*, Semont/Liberty maneuver, Brandt-Daroff - very good prognosis after first treatment

Question 24

What is improtant o do after Maneuvers to treat BPPV

Answer 24

keep head down at end of maneuver because you can put the crystal in the horizontal canal

Question 25

What is Meniers Disease

Answer 25

Over accumulation of endolymph

Question 26

What is the vestibulo occular reflex (VOR)

Answer 26

- reflex that moves your eyes in the opposite direction that your head is turning - allows for visual fixation*

Question 27

Is VOR deficient in UVL (unilateral vestibular loss) or BVL (Bilateral vestibular loss)

Answer 27

Both

Question 28

Causes of UVL

Answer 28

Infection, trauma, disease (Meniere’s Disease), surgery

Question 29

Acute S&S of UVL

Answer 29

- spontaneous nystagmus away from the affected ear - reduced VOR - vertigo (resolves in a few days) - dizziness - oscillopsia - imbalance - ?vomiting

Question 30

Chronic S&S of UVL

Answer 30

- dizziness, oscillopsia, imbalance | - symptoms worse after rapid head movements: depends on compensation

Question 31

UVL Ax

Answer 31

- head-thrust, dynamic visual acuity test, balance and gait assessment + Dix Hallpike

Question 32

UVL Rx

Answer 32

- exercises to resolve conflict and symptoms (adaptation exercises, balance, walking program, functional tasks) - education on impact of stress on symptoms - maintain general fitness - address falls risk, mobility aids - improve any balance deficits * 6-8 wks

Question 33

Is BVL always equal side to side

Answer 33

No can be unequal

Question 34

Is the dizziness and vertigo in BVL

Answer 34

No

Question 35

What normally causes BVL

Answer 35

Ototoxic drugs (gentamicin)

Question 36

BVL S&S

Answer 36

Decreased balance with eyes closed + Increase oscillopsia

Question 37

What are some general ototoxic meds

Answer 37

``` antibiotics (gentamicin) anticancer drugs env. chemicals loops diuretics aspirin ```

Question 38

Balance Ax

Answer 38

- static (Romberg - sharped Romberg (tandem stance)) - dynamic (reach arm forward - movement with eyes opened and closed) - composite tests (berg)

Question 39

Different Gait Ax

Answer 39

eyes open/closed head turns different surfaces negotiating objects

Question 40

Central vestibular disorders Causes

Answer 40

- stroke - TBI, MS - tumor - neurodegeneration - epilepsy

Question 41

Central vestibular disorder red flags:

Answer 41

direction changing nystagmus | inconsistency in test results

Question 42

Central vestibular disorders Dx

Answer 42

By a collection of occulomotor tests

Question 43

Central vestibular disorders Rx

Answer 43

Based on neuroplasticity - Exercises (habituation, substitution, balance, walking program, functional tasks 8-12 weeks

Question 44

2 types of motion sensitivity

Answer 44

1) sensitivity to head movement | 2) sensitivity of moving environment

Question 45

Motions sensitivity Rx

Answer 45

8--12 weeks of sensorimotor mismatch exercises

Question 46

Cervicogenic dizziness Dx

Answer 46

Disorder of exclusion

Question 47

Cervicogenic dizziness Rx

Answer 47

management of vestibular dysfunction - proprioception neck symptoms - Increase motor control and endurance (deep neck flexors)

Question 48

What is an acoustic neuroma? When is it most common? What does it cause?

Answer 48

- intracranial tumor of myelin around CN VIII | - common later in life 50-60 yrs causes central vestibular loss