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Updated: Mar 10 2021

Vestibular System

  • Overview
  • Introduction
    • Vestibular system
      • angular acceleration of the head is detected by the semicircular canals
        • this is secondary to endolymph movement via the ampulla
          • the hair cells will then send excitatory input into the primary sensory neuron which have their cell bodies in the
            • vestibular ganglia (of Scarpa) which send axons via the
              • vestibular nerve which runs in the internal acoustic meatus
      • linear acceleration of the head and head tilt is detected by maculae (which is contained within the utricle and saccule)
        • maculae contain otolith (calcified crystals)
          • otolith may be pulled with linear acceleration and activate hair cells which
            • excites primary sensory neurons → vestibular ganglia → vestibular nerve
              • vestibular nerve runs synapses to the vestibular nuclei which then relays to other structures within the central nervous system such as
                • medial longitudinal fasciculus
                  • which mediates the vestibulo-ocular reflex
                • spinal cord
                • cerebellum (e.g., flocculonodular lobes and vermis)
                • cerebral cortex via the thalamic ventral posterior nucleus
    • Clinical correlate
      • caloric testing
        • a test that stimulates the vestibulo-ocular reflex via
          • warm or cold water infusion into the ear
        • normal findings
          • warm water
            • nystagmus with the fast phase towards the side of infused water
          • cold water
            • nystagmus with the fast phases towards the opposite side of infused water
          • mnemonic
            • COWS (Cold Opposite, Warm Same)
      • nystagmus
        • describes rhythmic movements of the eye which can result from
          • an asymmetric vestibular inputs
      • vertigo
      • Summary of Peripheral Vs. Central Vertigo
      • Vertigo Type
      • Etiology
      • Differential
      • Symptoms
      • Peripheral vertigo
      • Lesion affecting the
        • vestibular apparatus (in the inner ear)
        • cranial nerve VIII
      • Benign paroxysmal positional vertigo (BPPV)
      • Vestibular neuritis
      • Meniere's disease
      • Acoustic neuroma
      • Aminoglycoside toxicity
      • Semicircular canal dehiscence syndrome
      • Perilymphatic fistula
      • Herpes zoster oticus (Ramsay Hunt syndrome)
      • Intermittent and positional vertigo
      • Can be associated with tinnitus as well as
        • hearing loss
        • postural unsteadiness
      • Nyastagmus is
        • delayed in onset
        • rotatory or horizontal
        • prominent if vertigo is present
        • adaptive
      • Vertigo stops with visual fixation
      • Central vertigo
      • Lesion affecting the
        • brainstem nuclei
        • cerebellum
      • Vestibular migraine
      • Brainstem stroke
      • Multiple sclerosis
      • Ischemic or hemorrhagic damage to the cerebellum
      • Non-positional vertigo
      • May accompany other cranial nerve injuries such as
        • facial droop
        • dysarthria
      • Nystagmus is
        • immediate or delayed in onset
        • rotatory, horizontal, or vertical
        • not adaptive
      • Vertigo does not stop with visual fixation
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