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S6- Neuro 2 > Week 1- Vestibular Dysfunction: Examination > Flashcards

Week 1- Vestibular Dysfunction: Examination Flashcards

1
Q

PART 1: PATIENT REFERRAL AND LAB TESTING

A

PART 1: PATIENT REFERRAL AND LAB TESTING

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2
Q

Misdiagnosis is VERY common and is often referred for ________.

A

-Dizziness

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3
Q

What lab tests can be performed to help with diagnosing and treating vestibular patients?

A
  • Audiogram
  • ENG/VNG, Caloric testing
  • Vestibular Evoked Myogenic Potential (VEMP) testing
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4
Q

What are the 3 main things that audiograms will give us information on?

A
  • Auditory Asymmetry
  • Retrocochlear Pathology
  • Ear Canal and Tympanic Membrane integrity
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5
Q

Audiograms are largely used with vestibular patients for what reason?

A

-Used as screening tool to rule out any auditory pathology that may mimic vestibular pathology.

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6
Q
  • Auditory asymmetry indicates the possibility of __________ vestibular or __________ _______ pathology.
  • What are some examples?
A
  • Peripheral Vestibular or Auditory Nerve Pathology

- Meniere’s Disease, Acoustic Neuroma, Perilymph Fistula, Labyrinthitis

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7
Q
  • Retrocochlear pathology refers to site of lesion at the CN ____, ____________ angle, or CN ____ nerve root.
  • Retrocochlear pathology presents with unilateral __________ hearing loss and impaired ______ recognition.
  • What are some examples?
A
  • CN VIII, cerebellopontine angle, or CN VIII nerve root
  • sensorineural, speech
  • Acoustic Neuroma, MS, variety of brainstem lesions
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8
Q

ENG and VNGs aren’t done as commonly as audiograms but specifically looks at the integrity of what?

A

-VOR integrity

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9
Q

What is the difference between ENG and VNG?

A

The way they measure VORs. ENG looks at muscular activity of extraoccular movements while VNG measures eye movement.

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10
Q
  • ENGs and VNGs also allow us to look at what subtest?

- What is this?

A
  • Caloric Testing

- Cold water is squirted into ear canal to evaluate integrity of unilateral vestibular apparatus.

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11
Q

Caloric testing is a comparative exam of what canal?

A

-Horizontal Canal

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12
Q

Describe what happens with caloric testing of the L ear normally.

A
  • Elicits cooling effect on canal which affects endolymph inside which reduces activity of said canal.
  • By inhibiting our L ear the brain thinks the head is moving to the right.
  • VOR kicks in gear and moves eyes left but recognizes that the head isn’t moving and corrects back to right. (NYSTAGMUS)
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13
Q

What happens when warm water is used with caloric testing of the L ear normally?

A

-Warm water excites that side and will cause the opposite response.

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14
Q

What is a good way to remember caloric testing?

A

COWS

-COLD irrigations generate nystagmus in OPPOSITE direction, WARM irrigations in the SAME direction function bilaterally

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15
Q

What will we see with caloric testing with vestibular pathologies involving horizontal canal?

A

Blunted response unilaterally

-Significant Asymmetry = ~25% difference in peak slow component eye movement velocities obtained bilaterally.

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16
Q

What are Vestibular Evoked Myogenic Potentials (VEMP)?

A

-Short latency muscle reflexes typically recorded from the neck (cVEMP) or eye (oVEMP) muscles with surface electrodes in response to loud sounds.

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17
Q

What does cVEMP evaluate the integrity of?

A

-Otoliths (specifically saccule)

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18
Q

What muscle does the saccule project down to specifically?

A

-Sternocleidomastoid (SCM)

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19
Q

How does abnormal saccule function present when performing cVEMP?

A
  • No muscular response (relaxation) to sound

- Asymmetrical response R vs L

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20
Q

How does structural abnormality present when performing cVEMP?

A

-Evoked response from softer sound waves (as sound turns down, SCM stays inhibited)

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21
Q

PART 2: SUBJECTIVE INTERVIEW

A

PART 2: SUBJECTIVE INTERVIEW

22
Q

What do we want to do first in the systems review when assessing for vestibular dysfunction?

A

-Rule out other causes of vestibular-like symptoms.

23
Q

More than 80% of the information needed to identify a specific vestibular diagnosis is made when?

A

-Subjective History/Patient Interview

24
Q

What are (4) things that you can ask during a subjective history to help narrow down “Dizziness” diagnosis?

A
  • Type of dizziness/ description of symptoms
  • Triggers/ Relieving Factors
  • Onset/Duration
  • Frequency

-And other associated symptoms

25
Q

_________ presents with a false sense of self-motion, can be rotational or linear, is due to imbalances of toxic neural activity to vestibular cortex, and can be caused by peripheral or central vestibular damage.

A

-Vertigo

26
Q

___________ presents with gaze instability and illusionary sensation that a stational visual world is moving, and can be seen with bilateral>unilateral vestibulopathy and central vestibular dysfunction.

A

-Oscillopsia

27
Q

____________ presents with imbalance or unsteadiness while standing or walking. Common causes are visual changes, vestibular dysfunction, and proprioceptive deficits.

A

-Disequilibrium

28
Q

____________ is also referred to as pre-syncope and is caused from brief decrease in blood flow to the brain.

A

-Lightheadedness

29
Q

____________ is episodic dizziness, tiredness, pallor, diaphoresis, salivation, and N/V. It is induced by passive locomotion (car) OR motion in visual surroundings while standing still. It is caused by sensory mismatch between visual and vestibular system.

A

Motion Sickness

30
Q

What are the RED FLAGS with vestibular pathologies? (9)

A
  • Severe headache
  • Rapid hearing decline
  • Dysarthria
  • Discoordination
  • Diplopia
  • Decreased mentation & Urinary Incontinence
  • Acute weakness
  • Decreased consciousness
  • Additional Cranial Nerve Dysfunction
31
Q

PART 3: NYSTAGMUS AND OUTCOME MEASURES

A

PART 3: NYSTAGMUS AND OUTCOME MEASURES

32
Q

What are the (4) main components of the vestibular examination?

A
  • Auditory Screen
  • Gaze Stabilization Assessment
  • Cervical Dizziness Tests
  • Balance and Postural Control Assessment
33
Q

What is one of the most common S/Sx of vestibular dysfunction?

A

-Gaze Stability

34
Q

What are some things to look at when assessing Gaze Stability? (9)

A
  • Spontaneous Nystagmus
  • Evoked Nystagmus
  • Smooth Pursuit
  • Saccades
  • Optokinetics
  • Dynamic Visual Acuity
  • Head Impulse Test
  • Head Shake Test
  • Skew Deviation
35
Q
  • What is smooth pursuit?
  • What is saccades?
  • What is VOR?
  • What is optokinetic?
  • What is nystagmus?
A
  • Smooth Pursuit = Voluntary slow following of a target.
  • Saccades = Voluntary rapid repositioning of target.
  • VOR = Involuntary eye stabilization in relation to head movement.
  • Optokinetic = Involuntary, perceives motion in visual field, and supplements VOR to stabilize vision.
  • Nystagmus = Involuntary eye movement which may cause the eye to rapidly move from side to side, up and down, or in a circle, and may slightly blur vision.
36
Q

________ is an abnormal visual finding that can occur spontaneously.

A

-Nystagmus

37
Q
  • Nystagmus is a repetitive, to- and fro- movement of the eyes characterized by a _____ and _____ phase of movement.
  • It is caused by imbalance between vestibular apparatus signaling and defined by the direction of the _____ phase of movement.
A
  • fast and slow

- fast

38
Q
  • Nystagmus is the ________ diagnostic indicator used in identifying most peripheral and central vestibular lesions.
  • It can be ___________ and can lead to vertigo, oscillopsia, and/or abnormal head positioning.
A
  • primary

- asymptamotic

39
Q

Are vertical and horizontal nystagmus the only forms?

A

No, can sometimes see torsional nystagmus.

40
Q

What are the 2 major ways we classify nystagmus?

A
  • Spontaneous

- Evoked

41
Q

What is the 5% of nystagmus that may be normal?

A

When bringing to end range and hanging there, can see some nystagmus in normal.

42
Q

____________ Nystagmus is the onset of nystagmus without any cognitive, visual or vestibular stimulus and occurs in the absence of any purposeful eye or head motion.
-How does this happen?

A
  • Spontaneous
  • When one side is not working correctly it will present as inhibited and cause an imbalance (Ex: R side inhibited, reflex thinks head is moving to L, eyes correct and go R).
43
Q

What are the (3) primary things that define peripheral spontaneous nystagmus?

A
  • Mixed horizontal/torsional (same direction).
  • Presents with acute lesions, rarely w/ chronic stable lesions.
  • More prominent with fixation removed.
44
Q

What are the (3) primary things that define central spontaneous nystagmus?

A
  • Vertical/torsional.
  • Acute or chronic.
  • More prominent w/ fixation present.
45
Q
  • How do we test for fixation removed/present?

- What do we do if we don’t have these items?

A

-Visual fixation blockers.
(Frenzel Lenses, Video Infrared Goggles)
-Private treatment room w/ lights off and shining light into patients eyes.

46
Q

What are 2 outcome measures used?

A
  • Motion Sensitivity Quotient

- Dizziness Handicap Inventory

47
Q
  • What is Motion Sensitivity Quotient (MSQ)?

- With this, symptoms are scored off of ________ and ________.

A
  • Objective examination tool bringing patient through 16 potential provocative head/body movements that can elicit motion sensitivity.
  • intensity and duration
48
Q

What is the scoring for MSQ?

A
  • Mild Vestibular Dysfunction = 0-10
  • Modderate Vestibular Dysfunction = 11-30
  • Severe Vestibular Dysfunction = 31-100
49
Q
  • Dizziness Handicap Inventory is a 25-item self-assessment designed to evaluate ______-__________ handicap from dizziness.
  • It is on a 0-100 scale with _______ scores indicating higher perceived handicap.
  • What are the 3 subscales of questions?
A
  • self-perceived
  • higher
  • physical, emotional, functional
50
Q
  • What is the scoring for the Dizziness Handicap Inventory?

- What is the MCID?

A
  • Mild = 0-30
  • Moderate = 31-60
  • Severe = 61-100

-MCID = 18

S6- Neuro 2 (18 decks)

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