Vestibular/Cerebellar Disorders-chapter 16 (exam 2)
Do central vestibular pathologies or peripheral vestibular pathologies have abnormal smooth persuit/saccades?
central
What is the most common nonherditary cause of cerebellar damage?
MS
What are the abnormal test conditions in the seonsory organization test with visual dependence?
2, 3, 5, 6
What is the most common cause of BPPV in people <50 years?
a head injury
What 3 arteries supply blood to the cerebellum?
anterior, inferior, and posterior inferior cerebellar artery
What means hearing function?
audiometru
What tests are used to assess otolith function and central pathways that convey gravitational information?
subjective visual vertical and subjective visual horizontal
What is illusion of movement, most commonly described as a feeling tht they are spinning or the room is?
vertigo
Are vestibular exercises reccomended during actue attacks of Meniere's disease?
no
Can you cure cerebellar damage?
no
What is the cause of BPPV in people over 50 years?
not really known
What do paitents report when they get PLF?
a pop in the ear
What are the abnormal test conditions in the seonsory organization test with general sensory selection?
3, 4, 5, 6
What are the abnormal test conditions in the seonsory organization test with visual preference?
3, 6
Who most commonly get vestibular neuritis?
30-60 years (women in 4th decade, men in sixth decade)
What are the abnormal test conditions in the seonsory organization test with support surface dependence?
4, 5, 6
What are the abnormal test conditions in the seonsory organization test with vestibular dysfunction or loss?
5, 6
What percent of people with a TBI have vertigo that persists for years?
50-75%
What is used as the treatment for horizontal BPPV?
BBQ roll maneuver
What is the most common peripheral vestibular disorder and is the cause of about 50% of dizziness in older people?
BPPV
What is a disorder of the inner ear that is also known as idiopathic endolymphatic hydrops?
Meniere's disease
What is it called when vestibular symptoms are induced by auditory stimili?
Tullio's phenomenon
What peripheral vestibular disorders experience nausea?
UVH, BPPV, meneires, PLF
What peripheral vestibular disorders experience nystagmus?
UVH, BPPV, meniere's, perilymphatic fistula
What peripheral vestibular disorders experience vertigo?
UVH, BPPV, meniere's, perilymphatic fistula
What peripheral vestibular disorders experience postural imbalance?
UVH, BVH, BPPV, menieres, PLF
What disease has the longest/shortest duration of vertigo?
UVH/PLF
What is vertebrobasilar insifficency synonymous of?
a TBI in the vestibular system
What tool is usefull for determining the patient's perception of his ability to balance?
activites-specific balance confidence scale
What are the main causes of cervicogenic dizziness?
altered proprioceptive signals from the upper cervical spine, caused by disorders to C1-C3 and VBI
What strategy is used for small pertubations?
ankle
What is the treatment for PLF?
bed rest with head elevated for 5-10 days
What is most commonly caused by ototoxicity from taking certain classes of antibiotics?
bilateral vestibular hyporfunction (BVH)
What is considered the gold standard for identifying peripheral UVH?
caloric test
What are the 3 main maneuvers to treat posterior and anterior BPPV?
canalith repositioning maneuver, liberatory maneuver, brandt-daroff maneuver
What is the most common form of BPPV?
canalithiasis in the posterior SCC
What is used as the treatment for cupuloliithiasis BPPV?
casani maneuver
Do central vestibular pathologies or peripheral vestibular pathologies have inability to stand/walk with sudden onset?
central
Do central vestibular pathologies or peripheral vestibular pathologies have severe oscillopsia?
central
Do central vestibular pathologies or peripheral vestibular pathologies have vertucal nystagmus?
central
What disease is defined as dizziness arising from the cervical spine?
cervicogenic dizziness
What provides information about motor control or balance function under varying environmental conditions?
computerized dynamic posturography (CDP)
What do central vestibular disorders usually involve?
damage to vestibular nuclei, the cerebellum, and the brainstem, including vestibular pathways within the brainstem that mediate vestibular reflexes
What does imbalance from head turns result from?
decreased activation of the vestibulospinal reflex on the affected side
What is a feeling that a person is off balance?
disequilibrium
What are the most prominant symptoms of BVH?
disequillibrium, severe postural instability with resultant gait ataxia, and oscillopsia with head movement
Are ankle strategies proximal to distal or distal to proximal?
distal to proximal
What is the gold-standard for diagnosing BPPV?
dix-hallpike maneuver
What tool can assess a person's perception of the effects of a balance problem and the emotional, physical, or functional adjustemnts that he or she makes?
dizziness handicap inventory
What is a battery of eye movement tests that look for signs of vestibular dysfunction or neurological problems?
electronustagmography (ENG)
How do you assess spontaneous nystagmus?
have pt fixate on a stationary target and observe for nystagmus
How do you assess for gaze-holding nystagmus?
have pt gaze at target places 20-30 degrees left/right of center for 20 seconds and observed for gaze-evoked nystagmus
How do you assess for saccades?
have pt look back and forth between 2 outstretched fingers heald 12 inches apart in the horizontal and vertical planes; observe for latency of onset, speed, accuracy, and conjugate movement
What is PLF caused by?
head trauma, excessive pressure changes, extremely loud noises
What drugs can hasten recovery of vestibular neuritis?
high-dose steroids
What strategy is used for large pertubations?
hip
What do peripheral vestibular disorders usually involve?
inner ear vestibular structures and/or the vestibular nerve
How do you assess for smooth persuit?
keep head stationary while following a finger with eyes as you slowly move the finger from left to right, up/down
What is an inflammatory disorder of membranous labrynth, typically caused by viral and bacterial infections?
labyrinthitis
What is a nonspecific type of dizziness that may be described as feeling woozy?
lightheadedness
How are vestibular disorders categorized by?
location into peripheral and central vestibular disorders
What is sensitivity to riding in a car or other moving vehicles?
motion intolerance
What is caused by a conflict between the vestibular, visual, and other proprioceptive systems?
motion sickness
What is the hallmark symptm of motion sickness?
nausea
How do you assess for ocular alignment?
observe seated pt for heald tilt, scewed deviation, ocular torsion, or a combo of the three (ocular tilt reaction)
What is visual instability with head movement in which objects in the environment appea to move or bounce, resulting in bluring/diplopia?
oscillipsia
Who most commonly gets labyrinthitis?
people in their 4th-7th decade
What is commonly called by a tear or defect in the oval and/or around windows that separate the air filled middle ear and the fluid-filled perilympatic space of the inner ear?
perilymphatic fistula (PLF)
Do central vestibular pathologies or peripheral vestibular pathologies have faster recovery?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies have hearing loss?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies have horizontal nystagmus?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies have more severe n/v?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies have nystagmus decreasing with fixation?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies have symptoms of vertigo surpressed with visual fixation?
peripheral
Do central vestibular pathologies or peripheral vestibular pathologies nystagmus increasing with gaze?
peripheral
What is used to identify whether a person has BPPV?
positional testing
What is perception that he/she is about to faint?
presyncope
Are hip strategies proximal to distal or distal to proximal?
proximal to distal
How do you assess for head-shaing indused nystagmus?
pt closes eyes and head is tilted forward 30 degrees and oscillates in horizontal plane for 20 seconds
How do you assess for head-thrust test?
pt fixates on a near target and grasp the pt's head, apply brief small amplitude and high-acceleration head turn to both sides. Observe and see if eyes are directed toward target
How do you assess for VOR cancellation?
pt voluntarily fixates on moving target while pt's head is moved in the same direction
What is the best AD to use for cerebellar damage?
rollator
What test allows evaluation of horizontal SCCs and head movement frequencies that are more physiologically natural in contrast to caloric test?
rotational chair testing
What foods should someone with Meniere's disease generally avoid?
salt, caffiene, and alcohol
What is SCC?
semicircular canals
What test assesses an individual's ability to integrate visual, proprioceptive, and vestibular inputs to maintain balance?
sensory organization test (SOT)
How do you assess for dyanmic visual acuity?
snellen chart (normal), snellen chart after head shaking
What do individuals with unilateral vestibular hypofunction experience?
spontaneous horizontal-rotary nystagmus, slight oscilopsia, acute onset of severe vertigo, postural instablity with a tendency to fall toward the affected side, and n/v
What variant of PLF occurs when a portion of the temporal bone that normally covers the superior SCC is thin or missing, exposing membranous SCC to stimuli that it normally does not receive?
superior semicircular canal dehiscence
What is a specific type of postural tremor characterized by slow-frequency oscillations of the head or trunk?
titubation tremor
What is the roll test used for?
to assess for horizontal cannal BPPV
What peripheral vestibular disorder is characterized by a reduction or loss of peripheral vestibular function and can be caused by viral or bacterial infection, and head trauma, vascular occlusion, and unilateral vestibulopathy following surgial procedures?
unilateral vestibular hypofunction
What 2 things are in otoliths?
utricles and saccules
What is blood supply to the brainstem, cerebellum, and inner ear derived from?
vertebrobasilar system
What are early complaints of vestivular schwannomas?
vertigo, disequillirbrium, tinnitus, and asymmetric hearing loss due to compression of the vestibular nerve
What is otolith function tested with?
vestibular evoked myogenic potential (VEMP)
What is the second most common peripheral type of vertigo?
vestibular neuritis
What tool is utilized clinically to assess the effectiveness of PT interventions on an individual;s symptoms and the impact of those symptoms of their QOL?
vestibular rehab benefit questionnaire
What medications are used to treat vertigo and n/v?
vestibular suppresant medications
What is the pharmacologic treatment of Meniere's disease?
vestibular suppresants
What tool can assist therapists to identify current limitations in activity participation?
vestivular activites of daily living scale
What is the most common intracranial tumor producing vestibular symptpms?
vestivular schwannomas
When does vertigo usually resolve?
within 3-7 days in lit environments
Who most commonly gets migraines?
women from 25-55
Who most commonly gets BPPV?
women in 4th and 5th decades of life
Who most commonly gets Meniere's disease?
women in their 4th-5th decades
Are BVH symptoms permenant?
yes
Does hearing remain intact with vestibular neuritis?
yes