Week 10 Summary Neuro 2 PDF

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 an...

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