Central Vestibular Disorders: Pathology and Management
Presented by Laura Morris
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The central vestibular system is diffuse and is integrated into many different areas of the brain stem, cerebellum, spinal cord and cortex. There are many places along the pathways that are vulnerable to pathology, both acquired and traumatic. This course will describe the pathological conditions that may affect the central vestibular pathways. Differential diagnosis of central pathology is presented. Examination, evaluation, prognostic indicators and general intervention guidelines are discussed.
Meet your instructor
Laura Morris
Laura Morris, PT, NCS is a physical therapist and lecturer with over 30 years of experience in the management of adults with neurologic disorders. Her clinical work focuses on vestibular disorders and mild traumatic brain injury at Elmhurst Hospital, part of Edward-Elmhurst Healthcare system in the Chicago area. She…
Chapters & learning objectives
1. Focal Lesions
Focal lesions in the vestibular nuclei, brainstem, thalamus and cortex can cause significant postural control impairments, dizziness and functional mobility dysfunction. These lesions cause impairments that are based upon the anatomy that they affect, so knowing the underlying anatomy helps to identify the impairment. In this chapter, a few types of vestibular impairment are discussed, including information that is helpful for differential diagnosis.
2. Traumatic Brain Injury and the Central Vestibular System
Traumatic brain injury can affect the vestibular system, either by direct trauma to the skull, causing fractures, by direct trauma/hemorrhagic lesions, or by the more diffuse dysfunction that happens during concussion. The accompanying sequelae of signs and symptoms can make vestibular impairment difficult to discern. This chapter reviews TBI as it relates to the vestibular system and reviews some ways in which the vestibular system is affected by TBI.
3. Vestibular Migraine
Vestibular migraine is a common cause of dizziness. Due to the diffuse nature of migraine symptoms, it is challenging to identify vestibular migraine. This chapter will review the pathophysiology and central structures affected by migraine, the diagnostic criteria for vestibular migraine, and management considerations.
4. Persistent Postural-Perceptual Dizziness
Persistent postural-perceptual dizziness occurs due to changes in the brain that result in chronic symptoms of disequilibrium and dizziness. Psychologic conditions play a role in the development of PPPD. A clear understanding of the pathophysiology and diagnostic criteria for PPPD will help in managing this challenging diagnosis.
5. General Guidelines, Efficacy Research and Summary
The conclusion of this course focuses on the general oculomotor changes that occur with vestibular migraine and a review of the management guidelines for those with central vestibular disorders. A brief review of the rehabilitation efficacy research in central vestibular disorders will also be presented, followed by a summary of this course.
