Vestibular Evoked Myogenic Potentials (VEMPs) and Vestibular Lesions Quiz
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Questions and Answers

What is the second most common cause of uni-lateral vestibular lesions?

  • Vestibular neuritis (correct)
  • Meniere's disease
  • Cerebellopontine angle tumors
  • Benign Paroxysmal Positional Vertigo

    • Which test is used to identify Benign Paroxysmal Positional Nystagmus?

  • Dix-Hallpike maneuver (correct)
  • Fistula test
  • Head impulse test
  • Chair test

    • What lifestyle factors can trigger Meniere's disease attacks?

  • Excessive sugar consumption, lack of physical activity, stress
  • Lack of sleep, excessive exercise, vitamins deficiency
  • Low blood pressure, dehydration, smoking
  • High salt intake, caffeine, alcohol consumption (correct)

    • Which treatment method causes permanent loss of vestibular function on the affected side in Meniere's disease?

    <p>Vestibular nerve section</p> Signup and view all the answers

    What can cause a unilateral vestibular lesion when it compresses into the pons?

    <p>Cerebellopontine angle tumor</p> Signup and view all the answers

    What is the mechanism behind Meniere's disease according to the text?

    <p>Increased endolymph volume and pressure</p> Signup and view all the answers

    'Otoconia dislodged and free in canals' is associated with which condition?

    <p>Benign Paroxysmal Positional Nystagmus</p> Signup and view all the answers

    What type of stimuli primarily stimulates the utricle and saccule in Vestibular Evoked Myogenic Potentials (VEMPs)?

    <p>Auditory tones</p> Signup and view all the answers

    Which type of lesions can cause a lag in a patient's eyes returning to fixation on the examiner?

    <p>Peripheral Vestibular Lesions</p> Signup and view all the answers

    What is a common symptom of unilateral vestibular lesions?

    <p>Vertigo</p> Signup and view all the answers

    What is a characteristic symptom of central vestibular lesions?

    <p>Nausea</p> Signup and view all the answers

    Which test can be used to assess postural instability related to vestibular disorders?

    <p>Dynamic posturography</p> Signup and view all the answers

    What type of response is evoked in tonically active muscles by auditory clicks or tone bursts in Vestibular Evoked Myogenic Potentials (VEMPs)?

    <p>Contraction</p> Signup and view all the answers

    In patients with unilateral vestibular lesions, what is a common symptom associated with vertigo?

    <p>Spontaneous nystagmus</p> Signup and view all the answers

    What is the likely cause of postural instability in individuals with vestibular disorders?

    <p>Sensory mismatch or conflict</p> Signup and view all the answers

    Which test assesses the function of the eyes dragging off the target when the head turns in patients with abnormal VOR?

    <p>Head Impulse Test</p> Signup and view all the answers

    What is a characteristic feature indicating central lesions in patients with vestibular disorders?

    <p>Nystagmus that changes directions on eccentric gaze</p> Signup and view all the answers

    What causes elevation of the function of otolithic organs in the inner ear, leading to maintenance of balance and spatial orientation?

    <p>Auditory clicks</p> Signup and view all the answers

    'Nausea in patients with vestibular lesions can be attributed to:'

    <p>Sensory mismatch or conflict</p> Signup and view all the answers

    'Rhomberg test, Fukuda test, and Dynamic posturography are used to assess:'

    <p>Postural instability</p> Signup and view all the answers

    What causes a lag in patients' eyes returning to fixation on the examiner due to peripheral vestibular lesions?

    <p>Spontaneous nystagmus</p> Signup and view all the answers

    What is a consequence of abnormal VOR in individuals with vestibular disorders?

    <p>Eyes being dragged off the target when the head turns</p> Signup and view all the answers

    Which test involves a recording of head and eye velocity to assess vestibular function?

    <p>Fistula Test</p> Signup and view all the answers

    What can trigger abnormal nystagmus in patients with a perilymph fistula?

    <p>Coughing</p> Signup and view all the answers

    In Meniere's disease, what lifestyle factor can potentially trigger attacks?

    <p>Stress</p> Signup and view all the answers

    Which condition involves the free flow of otoconia in the canals, usually in the posterior canal?

    <p>Benign Paroxysmal Positional Nystagmus</p> Signup and view all the answers

    What is a possible cause of bilateral vestibular loss according to the text?

    <p>Ototoxic medication like gentamicin</p> Signup and view all the answers

    What specific symptom is a result of a traumatic injury or severe pressure damage causing a round/oval window rupture?

    <p>Vertigo</p> Signup and view all the answers

    Which test is used to identify unilateral vestibular lesions by triggering muscle reflexes with high-intensity sound?

    <p>Vestibular Evoked Myogenic Potentials (VEMPs)</p> Signup and view all the answers

    What does a labyrinthectomy primarily aim to treat?

    <p>Meniere's disease</p> Signup and view all the answers

    What does a unilateral vestibular lesion affect in terms of the patient's response during the fistula test?

    <p>Absence of reflex in ipsilateral muscles</p> Signup and view all the answers

    Study Notes

    Vestibular Evoked Myogenic Potentials (VEMPs)

    • Evoked by short-duration auditory tones or clicks via headphones
    • Stimulates primarily the utricle and saccule
    • Influences both vestibulo-spinal and vestibulo-ocular pathways
    • Auditory clicks/tone bursts evoke a muscular response in tonically active muscles
    • Elevates the function of otolithic organs in the inner ear, which maintains balance and spatial orientation

    Vestibular Lesions

    Peripheral Vestibular Lesions

    • Damage to labyrinths or vestibulo-cochlear nerve (VIII)
    • Causes a lag in patients' eyes returning to fixation on the examiner
    • Nystagmus on eccentric gaze that changes directions is indicative of a central lesion

    Central Vestibular Lesions

    • Damage to vestibular nuclei or pathways projecting to brainstem, thalamus, or cerebellum

    Unilateral Vestibular Lesions

    • Vertigo: due to spontaneous nystagmus even at rest
    • Can be caused by lesions anywhere in the vestibular pathway
    • Most cases are caused by peripheral disorders involving the inner ear
    • Nausea: due to sensory mismatch or conflict
    • Vestibular autonomic connections (flight or fight, gut response)
    • Postural instability
    • Rhomberg test, Fukuda test, Dynamic posturography
    • Fall or turn to side of lesion

    Abnormal VOR

    • Eyes are dragged off the target when the head turns (in one direction)
    • Followed by eye movements back to the target

    Other Conditions

    Meniere's Disease

    • Patient has recurrent episodes of vertigo, accompanied by fluctuating and stepwise, progressive hearing loss and tinnitus
    • Episodic (minutes – hours): First: fullness in ear, hearing loss, tinnitus; Next: vertigo, nausea, imbalance, drop attacks (vestibular attacks)
    • Mechanism: Increased endolymph volume and pressure
    • Small ruptures of membranous labyrinth
    • Causes: unknown – viral / autoimmune/ genetic
    • Lifestyle factors can increase attack such as salt, caffeine, alcohol, and stress are triggers
    • Treatment: Lifestyle change, surgery (vestibular nerve section, labyrinthectomy, endolymphatic saculotomy, transtympanic gentamicin)

    Periplymph Fistula

    • Increase in pressure suddenly, see a tar in ear
    • The pressure increases firing rate to hair cells
    • Traumatic Injury or severe pressure damage (SCUBA diving, ascent/descent on a plane)
    • Round/oval window ruptures allowing pressure changes to affect inner ear
    • Treated with rest or surgery
    • Abnormal nystagmus triggered with additional pressure (Fistula Test)
    • Tracks eye movements while pressure is applied to ear canal

    Benign Paroxysmal Positional Vertigo (BPPV)

    • Due to trauma or age
    • Otoconia dislodged and free in canals (usually posterior canal)
    • Identified with Dix-Hallpike Maneuver
    • Treated with Physical Therapy (Epley Maneuver - series of head movement)
    • Symptoms triggered by sudden position change of the head
    • Occitana membranes come off and free flows in endolymph fluid

    Bilateral Vestibular Loss (BVL)

    • Common symptoms: Postural Instability (without vision), Blurry vision (when moving and fixating)
    • Because no RVEM response, eyes bounce around in the head and can't fixate on an object
    • Causes: Ototoxic medication – gentamicin (up to 50% of BVL), Meningitis in children less than one year of age, Meniere's disease (bilateral)

    Central Vestibular Lesions

    • Opto-kinetic reflex involves medial vestibular nucleus
    • Adjusts eye position to reduce retinal slip
    • Can use combinations of tests to indicate whether lesion is peripheral or central
    • Use combo of OKR and VOR which relies on both central and peripheral
    • If damage central vestibular nucleus, both pathways are damaged
    • Abnormal VOR but normal OKR means there is an injury only in peripheral system

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    Description

    Test your knowledge on Vestibular Evoked Myogenic Potentials (VEMPs) and Vestibular Lesions. Learn about how VEMPs are evoked by short-duration auditory tones or clicks, their influence on vestibulo-spinal and vestibulo-ocular pathways, and the impact of vestibular lesions on balance and spatial orientation.

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