Vestibular Exam

Question 1

what is the cardinal sign of vestibular dysfunction?

Answer 1

abnormal eye movements

Question 2

central vestib damage: impaired ____ and ____

Answer 2

smooth pursuits, saccades

Question 3

what type of abnormal eye movement do you see with peripheral vestib damage?

Answer 3

nystagmus

Question 4

caloric testing is the gold standard for diagnosing what?

Answer 4

unilateral peripheral vestibular hypofunction

Question 5

what does “COWS” mean when talking about caloric testing?

Answer 5

Cold irrigations generate nystagmus in the Opposite direction, Warm irrigations in the Same direction

Question 6

what is considered to be “significant asymmetry” with caloric testing?

Answer 6

> 25% difference in peak slow component eye movement velocities obtained bilaterally

Question 7

Vestibular Evoked Myogenic Potential (VEMP) testing measures ____ function

Answer 7

otholith

Question 8

what is the most common type of VEMP testing?

Answer 8

cVEMP

Question 9

describe the cVEMP

Answer 9

-measures saccule function via VST
-healthy response: reflexive contraction of ipsi SCM in response to sound

Question 10

describe the oVEMP

Answer 10

-measures utricle function via MLF
-healthy response: reflexive contraction of contra inferior oblique in response to air or bone conducted sound (eye elevation)

Question 11

what would be considered abnormal results during VEMP testing?

Answer 11

no muscular response to sound OR asymmetrical response L v R

Question 12

rotary chair test = gold standard for diagnosing what?

Answer 12

bilateral vestibular hypofunction (BVH)

Question 13

what is a healthy response during the rotary chair test?

Answer 13

nystagmus

Question 14

if someone has BVH, what will happen during the rotary chair test?

Answer 14

no VOR gain will be observed

Question 15

what is the TRUE major indicator of vestibular dysfunction?

Answer 15

vertigo

Question 16

T/F: vertigo can be experienced with eyes open or closed

Answer 16

true

Question 17

T/F: oscillopsia can be experienced with eyes open or closed

Answer 17

False! Oscillopsia is only experienced when the eyes are open

Question 18

what red flags should you look out for during a vestibular exam? (hint: RAIDS DUDAD)

Answer 18

Rapid hearing decline
Acute weakness
Incoordination
Dysarthria
Severe HA
Diplopia
Urinary incontinence
Dec mentation
Additional cranial nerve dysfunction
Dec consciousness

Question 19

Motion Sensitivity Quotient mild/mod/severe scores

Answer 19

Mild: 0-10
Moderate: 11-30
Severe: 31-100

Question 20

Dizziness Handicap Inventory mild/mod/severe scores

Answer 20

Mild: 0-30
Moderate: 31-60
Severe: 61-100

Question 21

Dizziness Handicap Inventory MCID

Answer 21

18

Question 22

what is the difference btw spontaneous and evoked nystagmus?

Answer 22

-spontaneous: occurs when pt is relaxing, typically seen w central injury or in the acute stages of peripheral injury
-evoked: specific trigger, central OR peripheral injury

Question 23

what are some common causes of up-beating nystagmus (hint: FCCWS)

Answer 23

Focal brainstem lesion (usually midline pontine)
Cerebellar lesions
Cancer
Wernicke’s Syndrome
Side effect of nicotine, alcohol intoxication

Question 24

what is the biggest single cause of down-beating nystagmus?

Answer 24

Chiari malformation (1/3 of cases)

Question 25

what are some other causes of down-beating nystagmus (hint: MC DID)?

Answer 25

MS
Cerebellar degenerations/injury
Demyelinating disease
Idiopathic
Drug toxicity (e.g. amiodarone)

Question 26

Down-beating nystagmus (esp on lateral gaze) is the cardinal sign of what?

Answer 26

paraneoplastic cerebellar degeneration syndrome

Question 27

what are some causes of pure torsional nystagmus?

Answer 27

-most common: lesions to medulla or cerebellar peduncles (i.e. Lateral Medullary Syndrome)
-also seen with midbrain lesions that impact oculomotor nuclei
-rare occasions: seen with SCDS