Vestibular System - Age and Pathologic Changes
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| What is vestibulopathy? | Pathology of the peripheral vestibular system, central vestibular system, or neural pathway connecting htem
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| Common symptoms of vestibulopathy | Vertigo
Visual disturbances
Oscillopsia
Nausea and vomitting
Imbalance
Brain fog
Fatigue
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| Signs of vestibulopathy | Nystagmus
Gaze instability
Coordination deficits
Gait ataxia
Impulsion
Oscillopsia
Disequilibrium
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| Age related changes affecting vestibular system | Vestibular hair cell degeneration
Vestibulocular reflex deficits
Peripheral neuropathy
Otoconia displacement
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| Common causes of vertigo | Imbalance of tonic vestibular signals arising from:
Inner ear
Middle ear
Brainstem
Cerebellum
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| Signs of a central lesion | Impaired saccades
Smooth pursuit
Optokinetic nystagmus
Usually seen with central lesions
Diplopia
Ataxia
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| Causes of central lesions | Ischemia of the brain stem
Cerebellar infarts
Medullary infarcts
MS
etc.
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| 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
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| 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
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| Canalithiasis | Cause of BPPV
Term used for loose otoconia flowing within the semicircular canals
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| Cupulolithiasis | Cause of BPPV
Term used when otoconia attach to the cupula within the ampulla making it gravity sensitive
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| 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
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| Signs of vestibular hypofunction | Spontaneous nystagmus - typically resolves within a couple of weeks
Loss of visual acuity: gaze instability, oscillopsia
Postural instability
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| 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)
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| What will visual acuity at a distance poorer than 20/50 affect? | Significant effect on postural stability
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| 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.
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| 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.
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| 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
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| What medications should be discontinued if vertigo presents? | Ototoxic medications (i.e. ASA)
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| Modified Epley | Canalith repositioning maneuver for the posterior canal (BPPV)
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| Horizontal Roll | Canalith repositioning maneuver for the horizontal canal (BPPV)
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| 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
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