VESTIBULAR SYSTEM Flashcards

(53 cards)

1
Q

What are the 3 main inputs of the vestibular system?

A

Visual, proprioceptive and vestibular (rotation and gravity) information

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2
Q

What are the outputs of the vestibular system?

A

Mainly reflexes to maintain a stable posture and stable gaze

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3
Q

Where is the vestibular organ located?

A

Posterior area of the inner ear called the labyrinth

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4
Q

Describe the structure of the vestibular organ

A

Utricle and saccule located in vestibule and joined together by conduit. Saccule also joined to cochlea by conduit.
Each ear also has 3 semicircular canals which have an ampulla on one side and are connected to the utricle

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5
Q

What are the 3 semi-circular canals called?

A

Anterior semi-circular canal
Lateral semi-circular canal
Posterior semi-circular canal

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6
Q

How is the labyrinth positioned in the skull?

A

Superior projection on base of skull

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7
Q

How is specific head movement distinguished by the vestibular organ?

A

The orientation of the semi-circular canals draws planes. A movement in each plane will stimulate the structures giving a map of how the head is moving.

The utricle, saccule and the 3 semi-circular canals gives 5 structures which work independently

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8
Q

What is the largest cilium on vestibular hair cells called?

A

Kinocilium

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9
Q

How is movement of the head sensed?

A

Movement of head causes movement of endolymph which shifts the hair cell’s cilia. The bigger the movement the bigger the depolarisation/hyperpolarisation

If stereocilia move towards the kinocilium the cell depolarises and vice versa.

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10
Q

Which organs of the vestibular organ are otolith organs?

A

Utricle and saccule

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11
Q

What are otoliths and what do they do?

A

Calcium carbonate crystals located on top of hair cells and gelatinous matrix. They help to deflect the hairs by adding weight

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12
Q

What does the maculae contain and where is it located?

A

Contains the hair cells, a gelatinous matrix and otoliths on top.

Horizontal in the utricle and vertical in the saccule

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13
Q

Where are the hair cells in the semi-circular canals located?

A

Ampulla - rest of the canal only has endolymph

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14
Q

Describe the structure of the ampullas

A

Hair cells located in the crista.
Cells surrounded by the cupula.

One end of ampulla leads to semi-circular canal and other end to the utricle

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15
Q

What sit the cupula?

A

Gel like substance surrounding the hair cells of the ampulla (canals) which helps with hair cell movement

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16
Q

Describe the planes formed by the canals

A

Anterior and posterior canals/planes form a 90 degree angle with the lateral canal/plane horizontal to them

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17
Q

Where do primary vestibular afferents from hair cells end/lead to?

A

Vestibular nuclei in the brainstem

Cerebellum for coordination and feedback

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18
Q

Where does the vestibular nuclei project to?

A

Spinal cord
Nuclei of the extraocular muscles (eye movement)
Cerebellum
Centres of cardiovascular + respiratory control

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19
Q

Where is the vestibular cortex located?

A

Not one specific area since many inputs and integrators involved spread over many cortical areas

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20
Q

What/where is the main processing centre of the vestibular system located?

A

Parietal lobe, in the Parieto-Insular Vestibular Cortex (PIVC)

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21
Q

What are then 3 functions of the vestibular system?

A

Detect and inform about head movements
Keep images fixed in retina during head movements
Postural control

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22
Q

How does the head know if it is not moving?

A

Hair cells have resting potential which gives a basal discharge to the nerve

23
Q

What causes otolith movement?

A

Linear acceleration and tilt

24
Q

What type of movement is the utricle sensitive to?

A

Horizontal movement e.g. travelator

maculae is horizontal

25
What type of movement is the saccule sensitive to?
Vertical movement e.g. lift | maculae is vertical
26
What are the semi-circular canals sensitive to?
Angular acceleration e.g. rotating head | Cupulla moves and displaces hair cells
27
What is the output signal on CN VIII (vestibulocochlear)?
Velocity
28
How are the semicircular canals/planes paired?
Horizontal canals on either side Posterior on one side and anterior on the other Anterior on one side and posterior on the other
29
How do the semi-circular canal/planes pairs work?
When one side is excited, the other is inhibited
30
How does the vestibulo-ocular reflex (VOR) work and its function?
Keeps images fixed in retina through connection between vestibular nuclei and oculomotor nuclei Eye movement in opposite direction to head movement but same velocity and amplitude
31
How does the vestibulo spinal reflex (VSR) work and its function?
Motor neurons to limb muscles (lateral tract) Motor neurons to neck and back muscles (medial tract) Postural control, avoidance of falls and compensatory body movement according to head position
32
List the things you can assess for the vestibular system
Anamnesis (history) Posture and gait Cerebellar function Eye movements
33
List the tests that can be carried out to investigate a patient's vestibular system
Caloric test Video head impulse test (vHIT) Vestibular evoked myogenic potential (VEMP) Rotational test
34
What is the caloric test?
Stimulate inner ear with different temperatures to generate eye movement. Allows for the test of vestibular organs independently
35
What is the vestibular evoked myogenic potential (VEMP)?
See if neck muscles have response if vestibular organ is stimulated
36
What imaging can you carry out to investigate a patient's vestibular system?
CT, MRI
37
What are the symptoms of balance disorder?
Dizziness, vertigo
38
What is the difference between dizziness and vertigo?
Dizziness is the feeling of light-headedness, unbalanced or wooziness. Vertigo is a specific form of dizziness where you experience spinning sensation
39
What are the two types of balance/vestibular disorders based off location and what is affected?
Peripheral vestibular disorders (labyrinth, CN VIII) | Central vestibular disorders (CNS e.g. brainstem/cerebellum)
40
Which location of balance/vestibular disorders is more common and easier to manage?
Peripheral vestibular disorders
41
List examples of peripheral vestibular disorders
Vestibular nephritis Benign paroxysmal positional vertigo (BPPV) Meniere's disease Unilateral/bilateral vestibular hypofunction
42
What is benign paroxysmal positional vertigo (BPPV)?
Otoliths in the ampulla of semi-circular canals causing exaggerated movement of cupula
43
What is meniere's disease?
Problem with the absorption of endolymph causing fluid build-up in inner ear which breaks the membrane
44
List examples of central vestibular disorders
Stroke Multiple sclerosis Tumours
45
What are the acute causes of balance/vestibular disorder?
Vestibular neuritis | Stroke
46
What are the intermittent causes of balance/vestibular disorder?
BPPV - only occurs when head is moved
47
What are the recurrent causes of balance/vestibular disorder?
Meniere's disease - membrane regenerates and cycle continues | Migraine
48
What are the progressive causes of balance/vestibular disorder?
``` Schwannoma vestibular (CN VIII) Degenerative conditions e.g. MS ```
49
What could dizziness also be a sign of?
``` Heart disorders Presyncopal episodes Orthostatic hypotension Anaemia Hypoglycaemia Psychological Gait disorders ```
50
List the different vestibular nuclei
Superior Lateral Medial Inferior
51
What nuclei does the vestibulospinal reflexes arise from and what is it’s function?
Lateral, medial and inferior vestibular nuclei Posture
52
What nuclei do vestibulocerebellar reflexes arise from and what is it’s function?
Superior, lateral, medial and inferior vestibular nuclei Coordination monitoring
53
What nuclei does the vestibulo-ocular reflex originate from and what is it’s function?
Superior, lateral, medial and inferior vestibular nuclei Eye and head movement