important note* why the ‘eyes are the liars’ handout.pdf · 2019-08-27 · 8/20/2019 2 superior...
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8/20/2019
1
Why the
‘eyes are the liars’
Relevance of the AVNS in
Patient Care and Management
in whiplash & mTBI Patients
Brenda E. Berge, Au.D. , F-ADA
Doctor of Audiology, Fellow ADA
Important Note*
Images in this presentation are used with
permission from the sources or as set out
in the rules of use
They are not to be reproduced without
permission or used for distribution
Referencing and acknowledgment of
these copyrights are provided
Vestibulocochlear Nerve: Schema
Anterior (superior) semicircular canal and duct
Posterior semicircularcanal and duct
Common crus and duct
Lateral semicircularcanal and duct
Stapes in oval(vestibular) window
Incus
Malleus
Tympanic cavity
External acoustic meatus
Tympanic membrane
Round (cochlear) window (closed by secondary tympanic membrane)
Auditory (Eustachian) tube
Vestibule
Cochlear aqueduct
Scala tympani
Cochlear duct
Scala vestibuli
Ductus reuniens
Helicotrema of cochlea
Saccule
Utricle
Endolymphatic sac
Endolymphatic duct in vestibular aqueduct
Dura materAmpullae
Membranous Labyrinths
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Superior division of vestibular nerve (from utricle and anterior and lateral ampullae)
Cochlear duct (basal turn)
Cochlear nerve
Vestibulocochlear nerve (VIII)
Vestibular nerve
Vestibular ganglion
Inferior division of vestibular nerve (from saccule and posterior ampulla
Saccule
Endolymphatic duct
Posterior membraneous ampulla
Posterior semicircular duct
Lateral semicircular duct
Common membranous duct
Lateral membranous ampulla
Anterior membranous ampulla
Anterior (superior) semicircular duct
Utricle
Inner Ear
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Axial T2 MRI
http://www.emedicine.com/ent/images/Large/597REVD622Ccloseupnorm_2.jpg
Cochlea
http://www.emedicine.com/ent/images/Large/664698FIG11.JPG
Superior Canal
Dehiscence
http://www.emedicine.com/ent/images/Large/21472147SCDS.jpg
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Auriculotemporal Nerve
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Muscles of Neck: Anterior View
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VSRVESTIBULO-
SPINAL REFLEX
SENDS DESCENDING
MOTOR CONTROL
SIGNALS TO THE
MUSCULOSKETAL
SYSTEM FOR
POSTURAL CONTROL
VCRVESTIBULOCOLLIC
REFLEX
ACTS ON THE MUSCLES
IN THE NECK TO
STABLIZE THE HEAD.
THE HEAD RESPONDS
TO MOVEMENT
SENSED BY THE
OTOLITHIC OR SCC
ORGANS.
From Halmagyi & Curthoys, In Herdman
Cervical Reflexes
COR - Cervico-Ocular: Eye movements driven
by the neck muscle proprioceptors. COR
supplements the VOR.
CSR - Cervicospinal: Changes in limb position
driven by neck muscle afferent activity. CSR
supplements the VSR.
CCR - Cervicocollic: Cervical reflex that
stabilizes the head on the body.
VOR
VESTIBULOCULAR
REFLEX
ALLOWS VISUAL
STABILIZATION
DURING ACTIVE
HEAD MOVEMENT
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Peripheral
pathways for
vertigo and
nystagmus
Medial longitudinal
fasciculus
Labyrinth
Vestibular nuclei
Vestibular
nerves
Internal
auditory canal
Scarpa’s
ganglion
III nerve
VI nerveIV nerve
Modified Fully-Supported Hallpike - BPPV
Vertebral Artery Test VOG Screening- Congenital Nystagmus
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