Week 10 Summary Neuro (PDF)

10.4 central, non-ontological causes of dizziness central nervous system vestibular pathology attributed to about 25% of cases of dizziness often due to damage to the cerebellum or brainstem caused by -strokes, -tumors, -insufficient blood supply, - demyelinating diseases such as - multiple sclerosi...

10.4 central, non-ontological causes of dizziness central nervous system vestibular pathology attributed to about 25% of cases of dizziness often due to damage to the cerebellum or brainstem caused by -strokes, -tumors, -insufficient blood supply, - demyelinating diseases such as - multiple sclerosis, - shearing forces sustained during trauma. CNS vestib patho TBI dizziness is often a common complaint along with tinnitus, headache, fatigue, and blurred vision. significant percentage will recover from a concussion w/in 2 weeks, about a quarter of patients will have persistent symptoms that will require assessment and tx ex concussion pathology: interrelated the many structures of the brain - w damage to any of these structures, or to the white fiber tracts connecting these structures= dizziness or vertigo peripheral vs central vestibular pathology know this chart!! non-otologic vertigo 1. vestibular migraine 2. cdizziness 3. persistent postural-perceptual dizziness vestibular migraine: neuro anatomy : condition in which symptoms of vertigo are associated with the timing of migraines scientists believe vestibular system and migraines can be associated due to the shared neural pathways bw the vestib nerve and trigeminal nerve or ganglia for pain or nociception. If there are spasms that affect the blood circulation in the posterior arterial supply, arterial supply to the vestibular system, cerebellum, or brainstem can be temporarily compromised, creating migraine and vertigo symptoms. most common cause of vertigo in the pediatric population, and for adults, must be a condition considered only after ruling out other peripheral or central vestibular pathology that is paired w migraines. vestibular migraine episodic vertigo or postural imbalance for 72 hrs report headache or aura additional symptoms -visual vertigo -intolerance to sounds, odors or bright lights confirm dx w + response to meds meds migraine prophylaxis or abortion to link mamngemnt of migraines and vertigo symptoms common meds: beta blockers, tricyclic antidepressants, anticonvulsants, or calcium channel blocker triptans: effective during migraine to abort progression pts usually do well w meds, no need to refer out research: favor of efficacy w vestib therapy positive response to visual rehab, vestib integration, habituation exercises, gait and balance for training and endurance training cervicogenic dizziness considered after ruling out peripheral and central pt has to be complaining for limited neck mvmnt or pain pathophysiology unknown some believe its linked to compromise proprioceptive neuropathways in cervical portion of sc which is linked to vestibuliocular coordination and postural stability neural connections bw the cervical region of the sc and the vestibular system are extensive, particularly bw the mechanical receptors in C1 to C3 to the vestibular nuclei, superior colliculus, cerebellum, and the listed reflex pathways degeneration or altered biomechanics can compromise these neural pathways and lead to complaints of dizziness or imbalance cervicogenic dizziness: dx stiffness difficulty moving neck muscle tenderness of cervical region dizziness w positional changes (even w body on neck rotation) do not complain of true rotatory vertigo subjective hx: preceding neck injury or cervical condition, dizziness and neck pain general assessment: combo of msk and vestib asssessments cervicogenic dizziness: tx targeted vestib rehab program PT for postural retraining manual therapy for c spine impairments =jnt and soft tissue mobs strengthening and vestib rehab= + impact on dizziness and neck pain persistent postural perceptual dizziness : condition that presents with persistent feelings of unsteadiness or dizziness without vertigo that worsens w upright posture, head or body mvmnt, or exposure to complex or moving environments. pts will often avoid busy or visually stimulating environments leading to isolation and decreased participation in quality of life. PPPD associated w a hx of concurrent, otologic vestibular conditions along depression, anxiety, or obsessive-compulsive disorders. persistent postural perceptual dizziness in detail factors for tx -cognitive behavioral strategies -impact of psychosocial factors, along w vestib rehab PT: work w other healthcare works for secondary impairments research: symptom improvement with serotonin or norepinephrine medication, habituation type of vestibular and balance rehabilitation, and cognitive behavioral therapy summary central vertigo can be differentiated from peripheral vertigo based on provoking factors and associated impairments non-otologic causes of dizziness less common, but do benefit from vestibular rehabilitation in combination with other interventions