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159 Cards in this Set
- Front
- Back
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Compact area that carries nearly all information between brain and remainder of body |
Brainstem |
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Where does CN I exit the skull |
Cribiform plate |
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Where does CN II exit the skull |
Optic Canal |
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Where do CN III, CN IV, CN VI, and CN V1 exit the skull |
superior orbital fissure into orbit |
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Where does CN V2 exit the skull |
Foramen Rotundum |
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Where does CN V3 exit the skull |
Foramen Ovale |
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Where does CN VII exit the skull |
Stylomastoid foramen |
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Where does CN VIII exit the skull |
Internal auditory canal to enter auditory canal |
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Where do CN IX, CN X, and CN XI exit the skull |
Jugular foramen |
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Where does CN XII exit the skull |
Hypoglossal foramen |
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Sensory nerves travel ______ |
Dorsally |
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Motor nerves travel ______ |
Ventrally |
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Mature nervous systems have ____ motor columns and _____ sensory columns |
3;3 |
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What CN is responsible for sensation of pharynx, meninges, and a small region near external auditory meatus |
Vagus |
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What CN is responsible for sensations of touch, pain, temperature, joint position, and vibration of the face, mouth, anterior 2/3 of tongue, nasal sinuses, and meninges |
Trigeminal |
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What CN is responsible for levator palpebrae superior and all extraocular muscles, except for superior oblique and lateral rectus |
Oculomotor |
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What CN is responsible for vision |
Optic |
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What CN is responsible for muscles of facial expression, stapedius muscle, and part of digastric muscle |
Facial |
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What CN is responsible for muscles of mastication and tensor tympani |
Trigeminal |
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What CN is responsible for sensation from middle ear, region near the external auditory meatus, pharynx, and posterior 1/3 of tongue. |
Glossopharyngeal |
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What CN is responsible for pharyngeal muscles and laryngeal muscles, along with parasympathetics to heart, lungs, and digestive tract down to splenic flexure |
Vagus |
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What CN is responsible for lateral rectus muscle; |
Abducens |
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What CN is responsible for superior oblique muscles |
Trochlear |
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What CN is responsible for sternomastoid and upper part of trapezius |
Spinal Accessory |
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What CN is responsible for hearing and vestibular sensation |
Vestibulocochlear |
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What CN is responsible for intrinsic muscles of the tongue |
Hypoglossal |
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What CN is responsible for the stylopharyngeus muscles and parasympathetics to parotid gland |
Glossopharyngeal |
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Where does the olfactory nerve synapse |
Olfactory bulb |
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The olfactory nerve travels via ______ to specific locations after synapsing in the olfactory bulb |
Olfactory tract |
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What is the term for olfactory sensory loss |
Anosmia |
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What happens with unilateral deficits of Anosmia |
the contralateral nostril compensates |
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What accompanies bilateral deficits with anosmia |
decreased taste |
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what are some common causes of anosmia |
1. head trauma 2. viral infections 3. parkinsons disease 4. alzheimers 5. intracranial lesions |
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Where does the Optic nerve travel |
from the retina to lateral geniculate of thalamus to the extrageniculate pathways |
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Before the chiasm the optic nerve is referred to as |
Optic nerve |
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After the chiasm the optic nerve is referred to as |
Optic tract |
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Optic nerve travels from orbit to intracranial cavity via ________ |
Optic tract |
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What CNs control extraocular eye muscles |
CN III, IV, and VI |
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How does CN VI move the eye |
abducts eye laterally in horizontal direction |
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How does CN IV move the eye |
rotates top of eye medially and moves it downward |
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Where is the nuclei located for CN III and IV |
Midbrain |
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Where is the nuclei located for CN VI |
The pons |
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How does CN III travel |
exits brainstem ventrally in interpeduncular fossa |
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How does CN IV travel |
dorsally from inferior tectum |
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How does CN VI travel |
Ventrally at pontomedullary junction |
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What CN also carries parasympathetic to pupillary constrictor and ciliary muscle of lens |
CN III |
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What are the 3 major divisions of the trigeminal nerve |
1. Opthalmic division (V1) 2. Maxillary division (V2) 3. Mandibular division (V3) |
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Small motor root-travels with V____ for muscles of mastication |
3 |
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CN that provides sensory to face |
Trigeminal |
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Where does Trigemnial nerve exit the brainstem |
ventrolateral pons |
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Where does the trigeminal nerve go after it exits the brainstem |
enters a small fossa- Meckel's cave |
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Which division of trigeminal nerve exits via foramen rotundum |
Maxillary division (V2) |
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Which division of trigeminal nerve exits via superior orbital fissure |
Opthalmic division (V1) |
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Which division of trigeminal nerve exits via foramen Ovale |
Mandibular division (V3) |
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Brief severe pain lasting seconds to minutes |
Trigeminal Neuralgia |
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How are episodes of trigeminal neuralgia provoked |
chewing and shaving |
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What are causes of trigeminal neuralgia |
usually unknown, can occur in Pts with MS |
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Treatment for Trigeminal neuralgia |
medications |
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What are other functions of the Facial nerve (besides muscles of facial expession) |
tear production, salivation, taste-anterior 2/3 of tongue |
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Where is the facial nucleus located |
caudal pons |
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Where does the facial nerve exit the brainstem |
Ventrolaterally at pontomedullary junction- lateral to CN VI |
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What CN traverses subarachnoid space then enters intenal auditory meatus and joins CN III |
Facial Nerve (VII) |
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______________________ control LMN in contralateral face muscles of pons |
UMN face area of primary motor cortex |
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Superior regions of face controlled by projections descending from ___________________________ |
Ipsilateral and contralateral motor cortex |
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Divisions of the nerve are impaired and then gradually recover |
Bell's Palsy |
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What is the clinical presentation of Bell's palsy |
Unilateral LMN facial weakness |
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What is the cause of Bell's palsy |
unknown; possibly viral or inflammatory |
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T/F an MRI will yield abnormal results for Bell's Palsy |
FALSE |
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What is the medical management for Facial nerve lesions |
Oral steroids |
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What CN enters subarachnoid space to enter auditory meatus |
Vestibulocochlear |
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The vesitbulocochlear nerve exits the brainstem at__________ |
pontomedullary junction; just lateral to CN VII |
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CN VIII travels in the __________ through ______ to enter the ________ |
1. auditory canal 2. petrous portion of temporal bone 3. cochlea & vestibular organs |
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What structures are in the outer ear |
1. Pinna 2. External auditory meatus tube 3. Tympanic membrane |
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What structure brings sound to the tympanic membrane |
External auditory meatus tube |
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What structures make up the middle ear |
1. cavity in temporal bone 2. ossicles 3. oval & round windows 4. Eustachian tube 5. Malleus 6. Incus 7. Stapes |
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________ & ________ are the muscles that attach to the ossicles & regulate the sound energy that is then transmitted to the inner ear |
Tensor tympani & stapedius |
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Structures that make up the inner ear |
1. bony Labyrinth 2. Membranous Labyrinth - cochlear - vesitbule - semicircular canals |
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What are the 2 main ducts of the cochlear |
1.Scala Vestibuli 2. Scala Tympani |
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Sound vibrations enter here from the oval window |
Scala Vestibuli |
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Found at apex, spirals around and ends at Round Window |
Scala Tympani |
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What is the central duct of the cochlea |
Scala Media |
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Surrounded by the scala vestibuli above and the scala tympani below |
Scala Media |
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Higher frequencies activate hair cells near |
oval window |
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Lower frequencies activate hair cells near |
apex of cochlea |
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What 2 membranes Bind the Scala media |
1. Basilar membrane 2. Reissner's membrane |
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What does the Organ of Corti contain |
Hair cells (sensory receptors) |
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Hair cells that have sterocila embedded in tectorial membrane |
outer hair cells |
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Hair cells that free float in endolymph |
Inner hair cells |
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What structures make up 95% of auditory nerve |
Inner hair cells with spiral ganglion |
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What leads to depolarization of hair cells; leads to nerve impulses |
defelction of hair cells occurs with virbations of basilar membrane |
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What is in the scala vestibuli filled with |
perilymphatic fluid |
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What is in the scala tympani filled with |
perilymphatic fluid |
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What is in the cochlear duct |
endoymphatic fluid |
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What is the receptor organ for hearing |
The organ of corti |
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Where is the organ of corti located |
scala media |
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What happens in the outer ear of the auditory pathway |
air pressure waves causes tympanic membrane to vibrate |
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What happens in the middle ear of the auditory pathway |
oscillatory movements of the stapes against the oval window |
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What happens in the inner ear of the auditory pathway |
the endolymph inside the cochlea causes vibration of basilar membrane |
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What happens after the spiral ganglion axons form CN III |
The nerve synapses at the dorsal and ventral cochlear nuclei and heads upwards in lateral lemniscus tract and ascends to inferior colliculus |
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What happens in the auditory pathway after the information ascends to the inferior colluculus |
The information moves to the medial geniculate body of the thalamus via auditory radiations |
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Where does information go after it moves to the medial geniculate body of the thamalmus on the auditory pathway |
Information goes to Heschl's Gyri |
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What is usually seen with lesions in the CNS proximal to cochlear nuclei |
bilateral hearing loss |
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What are the 3 components of vestibular anatomy |
1. peripheral sensory apparatus 2. central processor 3. mechanism for motor output |
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What does the peripheral sensory apparatus consist of |
1. Membranous labyrinth 2. Bony Labyrinth 3. hair cells |
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What is the vascular supply of the peripheral sensory apparatus |
labyrinthine artery |
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What is the location of the Peripheral sensory apparatus |
inner ear |
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The bony labyrinth is filled with |
perilymphatic fluid |
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The membranous labyrinth is filled with |
endolymphatic fluid |
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What are the dynamic receptors of the inner ear |
Semicircular canals |
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Bulge at the base of the semicircular canals and contains the crista ampullaris |
ampulla |
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primary sensory structure |
crista ampullaris |
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What are the 2 otoliths |
1. utricle 2. saccule |
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What type of receptors are the utricle and saccule |
Static receptors |
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What is the primary sensory structure of the 2 Otolithic organs |
Hair cells embedded in the macula |
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What happens when sterocilia are bent towards kinocilia |
depolarization |
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What happens with sterocilia are bent away from kinocilia |
hyperpolarization |
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What is the main function of hair cells |
to convert displacement of head movement into neural firing |
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What is the vascular supply of the central processor of the vesitbular nerve |
1. AICA 2 PICA 3. Basilar Arteries |
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Information from the vestibular nuclei is processed in the |
cerebellum |
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The information from the vestibular nuclei to the cerebellum travels via |
vestibulospinal tract |
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Inner ear function relates directly, influencing and synapsing on CN nuclei of which Cranial nerves |
CN III, IV, VI |
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The vestibular nuclei has input to |
1. CN X 2. Thalamus 3. Parietal Lobe |
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What might present if the vermis is affected by the vestibular nuclei |
Pts will have issues with posture and holding themselves up |
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what might present if the flocculus is affected by the vestibular nuclei |
Issues with the ratio of eye movements to head movements |
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What is the purpose of the VOR |
To keep vision stable while the head is being moved |
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What is the purpose of the VSR |
To keep head & body stabilized |
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What are the functions of the vestibular system |
1. head stability 2. muscle tone & postural control 3. awareness of body position & movement in space 4. contributes to balance 5. contributes to integration of 2 sides of body 6. ocular function 7. influences proprioception 8. auditory processing |
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abnormalities of external auditory canal or middle ear |
Conductive hearing loss |
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Causes of conductive hearing loss |
1. otitis 2. tympanic membrane perforation |
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disorders of the cochlea or CN VIII |
Sensorineural hearing loss |
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Causes of sensorineural hearing loss |
1. exposure to loud noises 2. Meniere's disease 3. Tumor |
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What is the Gold Standard hearing loss assessment |
Audiometry |
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Compares Air conduction to Bone conduction |
Rinnes Test |
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T/F Normally an individual hears louder air conduction over bone conduction |
TRUE |
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What is Weber's test and what does it detect |
compares both sides and detects sensorineural hearing loss |
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Dizziness vs. Vertigo |
Dizziness is very broad term that can be caused by many different reasons Vertigo is suggestive of vestibular pathology |
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Lesions anywhere on the vestibular pathway could lead to |
Vertigo |
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Number one cause of peripheral vestibular pathology |
BPPV- Benign paroxysmal positional vertigo |
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What is BPPV |
presence of Otoconia in SCC |
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Where should the Otoconia be sitting |
on top of the otolithic membrane |
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Assessments for BPPV |
1. Dix-Hallpike 2. Roll Test |
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Treatment for BPPV |
1. Canalith repositioning maneuver 2. Semont Lieratory maneuver |
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inflammation of vestibular ganglia or nerve |
vestibular neuritis |
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excess fluid & pressure in endolymphatic system |
Meninere's disease |
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Symptoms of Vestibular neuritis |
intense vertigo for days & loss of postural control for weeks to months |
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Symptoms of Meninere's disease |
recurrent episodes of vertigo accompanied by fluctuating hearing loss and tinnitus |
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Vestibular Schwannoma- slowest growing tumor in the body |
Acoustic neuroma |
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Symptoms of Acoustic Neuroma |
hearing loss, tinnitus, vertigo & LOB |
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Where does the glossopharygeal nerve exit the brainstem |
along the upper ventrolateral medulla between inferior olive and inferior cerbellar peduncle |
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Where does the vagus nerve exit the brainstem |
ventrolateral medulla just below CN IX between inferior olive and inferior cerebellar peduncle |
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Where do the nerve rootlets of CN XI leave the nucleus |
the lateral aspect of the spinal cord between the dorsal and ventral roots just dorsal to the dentate ligament |
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Where does the hypoglossal nerve exit the brainstem |
the ventral medulla between the pyramid and inferior olivary nucleus |
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If there is an UMN lesion of the hypoglossal nerve what would you see |
contralateral weakness of the tongue |
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what would you see if there was a lesion of the hypoglassal nerve at the nucleus or below |
ipsilateral weakness of the tongue |
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abnormal articulation of speech |
Dysarthria |
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Impaired swallowing |
Dysphagia |
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Common causes of dysarthria |
infarct, MS, BS lesions, lesions of cerebellar and BG pathways |
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Common causes of dysphagia |
neoplasms, esophageal strictures, neural components |
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What does a PT/OT need to be careful of with a Pt with dysphagia |
aspiration pneumonia |
