17: Dementia and Disequilibrium

Question 1

two tests to check for dementia in exam

Answer 1

mini-mental state exam, MOCA (montreal cognitive assessment)

Question 2

LP and EEG in alzheimer’s

Answer 2

LP: normal
EEG: normal or mild slowing

Question 3

MCI: Mild Cognitive Impairment

Answer 3

memory complaint noted by patient, with lower memory for age range, but does not meet criteria for dementia

Question 4

risk with MCI

Answer 4

5x more likely to develop Alzheimer’s

Question 5

tetrad of sx in lewy body disease

Answer 5

1. dementia
2. bradykinesia
3. rigidity
4. prominent psychotic sx
5. extreme sensitivity to anti-psychotic agents (bad rxns)

Question 6

presentation of pt with lewy body disease

Answer 6

sx vary a great deal from day to day, can have marked unexplained periods of confusion and then get better in a few days/weeks

Question 7

tx for NPH

Answer 7

ventriculoperitoneal shunting

Question 8

if tx for NPH helps, which sx is likely to resolve

Answer 8

gait disturbance

Question 9

MC manifestation of CADASIL

Answer 9

migraine, HA, or TIA/CVAs

Question 10

three types of input required for balance and awareness of body position (need 2/3 for awareness)

Answer 10

1. visual input
2. labyrinthine input
3. proprioceptive input

Question 11

what does romberg test do?

Answer 11

checks proprioception

Question 12

peripheral vs central anatomic causes of vertigo

Answer 12

1. peripheral: utricle, saccule, semicircular canals, vestibular nerve
2. central: vestibular nuclei, cerebellum, vestibulospinal path, proprioceptive path

Question 13

MC type of BPV

Answer 13

posterior

Question 14

how to dx BPV

Answer 14

DIx-Hallpike

Question 15

tx for BPV

Answer 15

1. often resolves on own
2. positional exercises
3. meds: meclizine, scopolamine, valium, anti-emetics, anxiolytics

Question 16

vestibular neuronitis

Answer 16

spontaneous attack of vertigo, not positional

Question 17

cause of vestibular neuronitis vs BPV vs Menieres

Answer 17

1. BPV: debris in endolymph
2. vestibular neuronitis: inflammation of CN 8
3. menieres: increased volume of labyrinthine endolymph due to poor absorption

Question 18

triad of sx for Menieres

Answer 18

1. vertigo
2. low frequency hearing loss
3. tinnitis
4. extra: aural fullness

Question 19

treatment for menieres

Answer 19

1. major: Na restriction (1.5-2g a day)

2. benzos, diuretics

Question 20

cerebellopontine angle tumor: CNs involved

Answer 20

CN 5, 7, 8 -> sx with these

Question 21

three tumors that cause cerebellopontine angle tumor

Answer 21

acoustic neuroma/schwannoma, meningioma, cholesteatoma

Question 22

paraneoplastic cerebellar degeneration

Answer 22

female malignancy -> Abs to Purkinje cells -> disequilibirum

Question 23

genetics of Freidrich’s ataxia

Answer 23

AR, chromosome 9 mutation

Question 24

features of freidrich’s ataxia**

Answer 24

1. onset before 20
2. gait ataxia -> progresses to ataxia of all four lims
3. dysarthria
4. impaired positional and vibratory sense in legs
5. muscle weakness
6. no DTRs in legs

Question 25

COD for most pts with Freidrich’s ataxia

Answer 25

cardiomyopathy

Question 26

genetics of ataxia telangiectasia

Answer 26

AR, chromosome 11 mutation

Question 27

three major parts of ataxia telangiectasia

Answer 27

1. ataxia
2. telangiectasias, esp oculocutaneous
3. immune deficiency (decreased IgA and IgE -> recurrent sinopulmonary infections)