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Gerontology Mod08

Vestibular System - Age and Pathologic Changes

What is vestibulopathy? Pathology of the peripheral vestibular system, central vestibular system, or neural pathway connecting htem
Common symptoms of vestibulopathy Vertigo Visual disturbances Oscillopsia Nausea and vomitting Imbalance Brain fog Fatigue
Signs of vestibulopathy Nystagmus Gaze instability Coordination deficits Gait ataxia Impulsion Oscillopsia Disequilibrium
Age related changes affecting vestibular system Vestibular hair cell degeneration Vestibulocular reflex deficits Peripheral neuropathy Otoconia displacement
Common causes of vertigo Imbalance of tonic vestibular signals arising from: Inner ear Middle ear Brainstem Cerebellum
Signs of a central lesion Impaired saccades Smooth pursuit Optokinetic nystagmus Usually seen with central lesions Diplopia Ataxia
Causes of central lesions Ischemia of the brain stem Cerebellar infarts Medullary infarcts MS etc.
Signs of Peripheral Vesitbulopathy Often involve hearing loss and tinnitus without neurologic signs Often develop acutely adn have intermittent and short lasting symptoms Tend to cause more severe vertigo with N&V
Benign Paroxysmal Positional Vertigo (BPPV) Syndrome characterized by short-lived episodes of vertigo associated with rapid chaqnges in head position Associated nystagmus with a latency of a few seconds and fatigues after 30 seconds Nystagmus in "signature" patterns
Canalithiasis Cause of BPPV Term used for loose otoconia flowing within the semicircular canals
Cupulolithiasis Cause of BPPV Term used when otoconia attach to the cupula within the ampulla making it gravity sensitive
Vestibular Hypofunction When the peripheral vestibular system is damaged unilaterally, neuronal activity reaching the ipsilateral vestibular nuclei is reduced compared to the contralateral vestibular nuclei
Signs of vestibular hypofunction Spontaneous nystagmus - typically resolves within a couple of weeks Loss of visual acuity: gaze instability, oscillopsia Postural instability
Endolymphatic Hydrops Abnormality in the quantity, composition, and/or pressure of the endolymph Primary - idiopathic = Meniere's disease Secondary - response to underlying condition (head trauma, ear surgery, inner ear disorders, allergies, systemic disorders)
What will visual acuity at a distance poorer than 20/50 affect? Significant effect on postural stability
What modification can be made to the vision test to check for vestibular hypofunction? With unilateral hypofunction there will be a doulbing of vision when turning the head to one side.
In a patient with vestibular hypofunction what is the result of the Head Impulse Test (Head Thrust Test)? The pt's eyes will go to the side that is weak then saccade back to the other side. This occurs when their vision is on a fixed point and their head is moved.
Medical treatments for vertigo Antihistamines - prevent motion sickness, nausea, vomitting, and vestibulopathy Phenothiazines - control severe N&V Anticholinergics - prevent N&V, and motion sickness Benzodiazepines - CNS depressant, used for anxiety - chronic problems
What medications should be discontinued if vertigo presents? Ototoxic medications (i.e. ASA)
Modified Epley Canalith repositioning maneuver for the posterior canal (BPPV)
Horizontal Roll Canalith repositioning maneuver for the horizontal canal (BPPV)
Vestibular Rehabilitation Therapy (VRT) Treatment for Hypofunction Relies on the plasticity of the CNS Does not regenerate or treat the damaged vestibular end-organ itself Allows CNS and brain to adapt to asymmetrical input from VOR and VSR
Created by: jpwittman



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