Week 10 Summary Neuro PDF

10.5 VR assessment subjective assessment of veritgo determine tx, refer or both bppv, msk balance impairments or cervicogenic dizziness subjective assessment v important include: -pt hx of vertigo -associated complaints -triggers -quality of vertigo q’s like: what does your dizziness or vertigo feel...

10.5 VR assessment subjective assessment of veritgo determine tx, refer or both bppv, msk balance impairments or cervicogenic dizziness subjective assessment v important include: -pt hx of vertigo -associated complaints -triggers -quality of vertigo q’s like: what does your dizziness or vertigo feel like? intensity? have you had a cold recently? numbness, difficulty swallowing or speaking? peripheral vs central vestibular dysfxn outcome measures 1. activities balance confidence (ABC scale) 2. visual vertigo analong scale subjective info helps narrow down what to test for objectively neurologic signs NEED to assess for red flags bc it could be CNS involvement aka emergency 5D’s and 3Ns HINTS + exam essential for peripheral vestibulopathy and vertebral basilar artery stroke 100 % SN, 96% SP for vbas w/in 48 hrs ^better than mri pt w vertigo has normal vestibular ocular reflex but direction changing saccades or skew eye deviation, emergent medical attention is required indicates central cause of vertigo -have a negative head impulse test or normal VOR, but present w direction changing, vertical or rotatory in nystagmus, skew eye deviation, w the potential for new unilateral hearing loss purpose is to better catch a stroke in the vestibular system that may not present w your typical neurological signs, and should be performed in someone w acute, unrelenting vertigo to rule out a stroke objective assessment of vertigo start w CN testing -assess VOR system- VOR test -screen c spine-BPPV -CN 3,4,6,8: smooth pursuit, saccades, convergence & vestibular ocular reflex goal: establish any asymmetry or changes in ocular motion, gait & balance w and w/o vestib system input refer our if changes in gait or balance know these!! objective assessment of vertigo screen for cerebellar issues -sensation -proprioception -coordination -Frenzel optical goggles -dynamic posturography using force plates or moving surrounds gold standard testing of the vestibular system can be caloric testing, rotatory chair testing, or assessing muscle activity in response to the stimulus stimuli. modified clinical test of sensory integration and balance, found to be useful w/in a clinical practice setting to better understand how the individual uses their vision, somatosensory system, and vestib system to help facilitate balance and orientation. central/non-vestibular origin vs peripheral origin know this chart!! summary, this presentation looks at basic vestibular subjective and objective assessment outside of investigating for benign paroxysmal positional vertigo, and the use of advanced technology. Subjectively, general questions seeking information on the quality, intensity, frequency, and instigators of vertigo are essential, along with more targeted questions regarding presence or absence of auditory symptoms. preceding illness or trauma and other symptoms are gathered to facilitate clinical reasoning during the differential diagnosis. the findings of the objective assessment can be then used to determine if a lesion is suspected in the periphery, near the vestibular apparatus, or along the nerve, impacts ocular motion dependent or independent of vestibular ocular reflex, or presents with other central nervous system impairments. OBJ BPPV Presentation Findings to diagnose 10.6 BPPV Assessment Benign Paroxysmal Positional Vertigo BPPV is most COMMON vertigo in ADULTS due to displaced otoconia which alters endolymphatic flow in the affected ear and changes PUSH. PULL signal in co planar canals. Otoconia- located in saccules and utricles for signaling acceleration in linear movement BPPV- otoconia escape otoliths and say GOOD BYE BITCH, and run into the semicircular canals or in the cupula 2 TYPES CANALITHIASIS Otoconia is diplaced in the canals. 85% in posterior canals 15% horizontal 1% in anterior canals Cupulolithasis attached to cupulas- 5% of BPPV cases BPPV Presentation Positional Latency Duration Fatigable Nystagmus GOGGLES- for videonystagmography Frensel goggles IR goggles CANALITHIASIS- severe vertigo when moving in the plane of the semicircular canal DOES NOT occur at rest. Lasts less than a minute Fatigable or decreases in intensity with repetition Delayed onset when first getting into a vertigo provoking position 3-5 second delay because it takes time for the otoconia to move in the canal Nystagmus direction would implicate one of the 6 canals CUPULOLITHASIS- otoconia doesnt move within the canal with gravity since its attached to the cupula Last longer than a minute If worsens with positional changes, alleviated with NO latency or delay rest, BPPV should be a potential diagnoses Fatigable and create nystagmus RARE More in elderly or young people with tbi TBI- cupulothiasis can happen at rest. ASSESSMENTS DIX HALLPIKE TEST Sit in long sit Rotate head 45degrees towards suspected side. Patient moved into supine 20-30 degrees neck ext Patient keeps eyes open, look for ocular motion MAY NEED TO REPEAT if did not ellicit strong reaction CHECK CERVICAL ROM ,PAIN , PATENCY for vertebral basilary artery system Position of ext and rotation over edge of bed may close off vertebral artery on one side. SIDE LYING TEST Posterior/Anterior canal issues Head turned 45 degrees away from suspected side Eyes open Observe presence of ocular motion and quality of subjective vertigo IF AFTER THE MANEUVERS Assess horizontal canals with ROLL test 30 degrees neck flexion in supine Patient turns head to one side observe Turn to other side observe NOTHING You can diagnose which horizontal canal is indicated Problem side is the same side patient turns to with most symptoms If nystagmus is GEOTROPIC (beat towards ground) last less than minute DIAGNOSIS IS HORIZONTAL Canalithiasis RISK factors