Ent- Vertigo

Front 1

Secondary inputs to the vetibular system and their influence:
1: visual
2: cerebellum

Back 1

1) important but is not primary because there is lots of movement in the world
2) has motor memory which helps you know how much to correct a motor perturbation

Front 2

Utricle and saccule purpose:

Back 2

sense of gravity and linear translation

Front 3

1) Hair cells depolarize when:
2) Hiar cells hyperpolarize when

Back 3

1) they tilt toward the kinocilium
2) they tilt away from the kinocilium

Front 4

When you look left the hair cells on your left ____1____ and the hair cells on the right ____2____

Back 4

1) depolarize
2) hyperpolarize

Front 5

Be able to describe the wiring of the eyes to the inner ears. This includes excitatory and inhibitory connections, as well as the abducens and oculomotor nuclei.

Back 5

When you turn your heal to the right, in order to keep stale gaze, the right sizes of your eyes (medial on the right and lateral on the left) must be stimulated. The left sides must be inhibited. Signals to the lateral side (both) must go through both the vestibular and abducens nucleui while signals to the medial side (nasal) must go through the vestibular and oculomotor nuclei.

Front 6

Signals to the lateral side of the eye (both) must go through both the:

Back 6

vestibular and abducens nucleui

Front 7

signals to the medial side (nasal) of the eye must go through the:

Back 7

vestibular and oculomotor nuclei.

Front 8

If the eyes become uncoupled in their movements what should you do?

Back 8

Neuro referral because the problems is central.

Front 9

Utricle is in what plane?

Back 9

axial

Front 10

saccule is in what plane?

Back 10

saggital

Front 11

Left labyrinth activation causes what reaction contralaterally and ipsilaterally extensors

Back 11

1) excitatory to contralateral extensory
2) inhibitory to ipsilateral extensors

Front 12

Where does your information come from in examining a dizzy patient?

Back 12

history 70%
physical 10-20%
Lab tests 10-20%

Front 13

Vertigo:
1) symptoms
2) findings
3) causes

Back 13

1) true sensations of disturbed motion
2)Nystagmus
3) 95% peripheral (labyrinthine or non-retrolabrynthine) or 5% CNS

Front 14

Dysequilibrium
1) symptoms
2) findings
3) causes

Back 14

1) Illusions of spatial disorientation or incoordination
2) no nystagmus
3) Systemis dosirder or vestibular CNS diseae

Front 15

Can we help:
1) vertigo
2) dysequilibrium

Back 15

1) yes
2) no

Front 16

Differentiation of Central vs. peripheral Dizziness:
Hallucinations of movement?

Back 16

Peripheral: definite
Central:less definite

Front 17

Differentiation of Central vs. peripheral Dizziness:
Onset

Back 17

Peripheral: paroxysmal
Central: usually constant

Front 18

Differentiation of Central vs. peripheral Dizziness:
Intensity

Back 18

Peripheral: usually severe
Central: seldom severe

Front 19

Differentiation of Central vs. peripheral Dizziness:
Duration

Back 19

Peripheral: seconds to hours
Central: up to days or weeks

NO-ONE has real vertigo for hours

Front 20

Differentiation of Central vs. peripheral Dizziness:
Influenced by headposition?

Back 20

Peripheral: frequently
Central: seldom

Front 21

Differentiation of Central vs. peripheral Dizziness:
Nystagmus

Back 21

Peripheral: Present
Central: Present of absent

Front 22

Differentiation of Central vs. peripheral Dizziness:
ANS symtoms

Back 22

Peripheral:Definite
Central: Absent usually

Front 23

Differentiation of Central vs. peripheral Dizziness:
Tinnitus

Back 23

Peripheral:Frequent
Central:Seldom

Front 24

Differentiation of Central vs. peripheral Dizziness:
deafness

Back 24

Peripheral:Frequent
Central:Seldom

Front 25

Differentiation of Central vs. peripheral Dizziness:
Disturbances of conciousness

Back 25

Peripheral:NEVER
Central:FREQUENT

Front 26

Differentiation of Central vs. peripheral Dizziness:
Other neuro signs

Back 26

Peripheral:absent
Central: often present

Front 27

Which is true vertigo, central or peripheral?

Back 27

Peripheral

Front 28

Physical Exam for Vertigo (6)

Back 28

Oculomotor Exam
Spontanous Nystagmus
Evoked Nystagmus (Gaze-positional)
VOR triad (headshake, head thrust, DVA)
Cerebellar/coordination tests
Posture and gait test

Front 29

Three tools for physical exam and why we use them

Back 29

1) Frenzel lenses- take away vison but let us observe eyes
2) 128Hz tunig fork for vibrotactile sense in the feet (maybe the imbalance is due to spinal cord)
3) 4" cushion tests vestibular sense by taking away proprioception

Front 30

When you see no nystagmus with eyes open, but nystagmus with frenzel lenses, then think....

Back 30

Vestibular neuritis (8th nerve viral infection)

Front 31

1) Define gaze nystagmus
2) If you see Gaze nystagmus what is the most likley diagnosis?
3) what is a possible other diagnosis?

Back 31

1) direction of nystagmus changes with direction of gaze
2) EtOH intoxication
3) Cerebellar problem

Front 32

Saccades should have 4 characteristics

Back 32

Cojugate
Accurate
Fast
Minimal Deay

Front 33

If a person has:
1) slow saccades--Dx?
2) other saccadic problem

Back 33

1)MS
2) brain problem

Front 34

Internuclear Opthalmoplegia

Back 34

One eye drags because of uncoupling of saccadic reflex (indicates a CNS injury)

Front 35

The three VOR triad of tests

Back 35

1) heat thrust
2) Headshake
4) DVA (Dynamic visual acutiy)

Front 36

Frenzel lenses
1) put on and nystagmus gets worse:
2) put on and nystagmus gets better:

Back 36

1) inner ear problems
2) Brain Problem

Front 37

Head Thrust Test
1) how to do it
2) what reflex it tests
3) Findings

Back 37

1)passively jerk head ~20 degrees and look to see if the eyes are maintain gaze stabiliztion or if they move with the head and then have to correct with a saccade
2) Vestibulo-ocular refelx
3) corrective saccada is a positive finding. The eye with the ocorrctive saccade is the one with the deficit

Front 38

Headshake Test:
1) how to perform
2) positive finding

Back 38

1) Using Frenzel lenses, passively shake the head about 2o times, 30 degrees in wither direction
2) Positive finding is ANY nystagmus. Beats toward the Healthy side.

Front 39

Dynamic visual acuity test
1) how to perform
2) positive finding

Back 39

1) passively shake the pt.'s head at 2Hz while he reads a snellen chart
2) positive finding is a 3 or more decrease in lines correctly read.

Front 40

The most important sene for maintaining upright posture?

Back 40

propioception

Front 41

Hallpike Test
1) how to do
2)Findings (reported ans observed)
3) diagnostic for?

Back 41

1) tilt head 45 degrees to side of injury so as to get posterior SCC in midsaggital plane.
2) this should cause vertigo and both eyes to beat up and twist outward
3) diagnostic for benign positional vertigo

Front 42

Common complaint for BPV

Back 42

“I get dizzy just for seconds, but only when I tilt my head in a certain way”

Front 43

In a positive hallpike test do the eyes twist towards or away from the offending side?

Back 43

Toward

Front 44

Etiology of BPV?

Back 44

Crystal comes off and finds way into posterior canal and when moves around, stimulates cupula so when lie down on that side, get short intense spin

Front 45

a good question to ask a pt. who may have BPV.

Back 45

Do you get dizzy rolling over in bed?

Front 46

limb testing to determine if proprioception is in tact:
6examples

Back 46

finger-nose-finger
Heel-shin
rapid alternating motion
joint propriocpetion
vibration detection
flexibility/strength

Front 47

Romberg test is for what?

Back 47

proprioception in the dorsal column

Front 48

1) Electrooculogoraphy does what?

2) replaced by what?

Back 48

1) tracks eye movement
2) video

Front 49

If a pt has a UNILATERAL hearing deficit, what do you do?

Back 49

SNED THEM FOR IMAGING, they may have an tumor!

Front 50

1) What is another tool one ca use for low suspicion assymetric hearing loss?
2) what does it evaluates?

Back 50

1)Auditory brainstem response

2) fucntions of cranial nerves (1,3,5,7)

Front 51

Computerized dynamic posturography test what?

Back 51

How well do you use your reflexes to maintain balance.

Front 52

1)What kind of imaging is the gold standard for looking for imaging the 8th neve? (High suspicion assymetric hearing loss)
2) Contrast?

Back 52

MRI

2) Gadolinium

Front 53

When would we image a vertigo patient?

Back 53

When they have an additional complaint (headahe, hearing loss)

Front 54

What would you think of if a person has vertigo initated by sound?

Back 54

Hole in the Superior SC

Front 55

5 most common diagoses for vertigo

Back 55

1) BPV
2) vestibular neuritis
3) meniere's syndrome
4) migrane-related vertigo
5) Small vessel CVD

Front 56

Most patients with vertigo do or do not need surgery?

Back 56

Do not

Front 57

Medical options for therapy of vertigo

Back 57

dietary chages
diuretics
steroids
aminoglycosides
allergy

Front 58

4 Indications for vertigo surgery?

Back 58

Fluctuating endorgan disease
Inadequate medical control
Adequate capacity for compensation
Thorough informed consent

Front 59

3 types of surgery for vertigo?

Back 59

Total ablative-labyrinthectomy
Selective ablative-nerve section
Selective non-ablative- ELS surgery, SSC plugging

Front 60

3 Goals of vertigo rehab?

Back 60

quantify functional deficits
promote optimal balance strategies
Define alteration of lifestyle

Front 61

Mechanisms of vertigo rehab
(just be familiar)

Back 61

Recovery of VOR function
Central compensation/plasticity
Substitution
Reinforcement of remaining pathways
Resolution of visual-somatosensory conflict
Global conditioning
Psychological reinforcement
Alteration of lifestyle

Front 62

things that make someone a Candidate for Formal Vestibular
Rehabilitation Therapy

Back 62

1) moderate-severe bilateral loss
2) failed med and surg
3) head trauma
4) abnormal sensory conflict

Front 63

How do you tell btween someone with a stroke and someone with vertigo?

Back 63

vertigo can stand, stroke cannot

Front 64

if you have a utricle or saccule lesion which side do you fall to?

Back 64

the side of the injury

Front 65

VOR circuit

Back 65