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NMSP Exam 1 > Approach to Equilibrium Disorders > Flashcards

Approach to Equilibrium Disorders Flashcards

1
Q

what PE test is key in diagnosing an equilibrium disorder?

A

romberg maneuver

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2
Q

who is predisposed to an equilibrium disorder?

A

elderly
chronic illness
certain meds

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3
Q

what is vertigo?

A

the illusion of movement of oneself or objects due to vestibular or neurologic dysfunction

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4
Q

what is disequilibrium?

A

may or may not be caused by vertigo

altered static or dynamic balance due to dysfunction of cerebellum, dorsal columns, motor systems, or basal ganglia

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5
Q

what is presyncope?

A

lightheadedness or impending LOC often due to orthostasis, arrhythmia, or hyperventilation

aggravated by heat, prolonged standing or large meals

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6
Q

what symptoms may be associated with vertigo?

A

sweating
nausea
hearing impairment
tinnitus

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7
Q

what type of disequilibrium will be associated with a positive romberg sign?

A

sensory

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8
Q

what symptoms may be associated with presyncope?

A

pallor
sweating
visual dimming/constricted fields
weakness

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9
Q

what are characteristics of peripheral vertigo?

A 
intensive symptoms
brief, fixed, horizontal nystagmus
intense N/V
possible hearing loss
no neuro sx
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10
Q

what are characteristics of central vertigo?

A

mild sx
persistent, changeable, vertical nystagmus
mild N/V
neuro sx present

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11
Q

what are causes of peripheral vertigo?

A 
BPV
Vestibular neuronitis
Meniere's disease
superior canal dehiscence
mal de debarquement
drug-induced ototoxicity
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12
Q

which type of BPV is most common?

A

posterior

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13
Q

what maneuver can induce posterior BPV?

A

Dix Hallpike with the affected ear facing down

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14
Q

what maneuver can induce anterior BPV?

A

Dix Hallpike with affected ear facing up

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15
Q

what maneuver can induce horizontal BPV?

A

supine roll test (Pagnini-McClure)

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16
Q

what is the treatment for BPV?

A

may resolve spontaneously
positional exercises (Semont Maneuver)
medications
PT

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17
Q

what is vestibular neuronitis?

A

spontaneous attack of vertigo that does not involve hearing loss or tinnitus and is not positional

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18
Q

what are the symptoms of vestibular neuronitis?

A

vertigo, N/V peaking within 24 hours and lasting for days to weeks

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19
Q

what is the etiology of vestibular neuronitis?

A

inflammatory CN VIII lesion

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20
Q

what is the treatment for vestibular neuronitis?

A

resolves spontaneously

steroids may be helpful

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21
Q

what is Meniere’s disease?

A

recurrent episodes of spontaneous vertigo lasting more than 20 mins but less than 24 hours

22
Q

what are the other symptoms of Meniere’s disease?

A

low-frequency hearing loss
tinnitus
aural fullness

23
Q

what is the etiology of Meniere’s disease?

A

increase in the volume of labyrinthine endolymph because of poor absorption

24
Q

what is the treatment for Meniere’s disease?

A

sodium restriction
diuretics
surgery for decompression

25
Q

what is superior canal dehiscence?

A

episodic vertigo caused by thinning of bone that separates the superior canal from middle fossa creating a third inner ear window

triggered by loud noises or pressure

26
Q

how is superior canal dehiscence diagnosed?

A

based on symptoms

MRI

27
Q

what is the treatment for superior canal dehiscence?

A

surgery to resurface superior canal

avoid triggers

28
Q

what is mal de debarquement?

A

“sickness of disembarkment”

the illusion of movement as an aftereffect of travel

29
Q

what are the symptoms of mal de debarquement?

A

rocking, swaying feeling occuring almost immediately after cessation of the precipitating event

lasts less than 24 hours

30
Q

what is the treatment for mal de debarquement?

A

meclizine
scopolamine
benzos

31
Q

what is required for the diagnosis of vestibular migraine?

A

at least 5 episodes of moderate/severe vestibular sx lasting minutes to hours

current or previous hx of migraine

one or more migraine features with at least 50% of episodes

unaccounted for by other dx

32
Q

what is the HINTS test and what is it used for?

A

“head impulse-nystagmus-test of skew”

helps distinguish brainstem lesion vs peripheral lesion in a patient with an acute vestibular syndrome

higher sensitivity than MRI to detect acute stroke

33
Q

what is considered an abnormal HINTS?

A

abnormal VOR reflex (head impulse)
vertical or horizontal nystagmus
uncover/cover test skew

34
Q

what metabolic disorders can cause disequilibrium?

A

vit B12 deficiency
hypothyroid
wilson disease

35
Q

what neoplasms can cause disequilibrium?

A

cerebellopontine angle tumor:
acoustic neuroma (Schwannoma)
meningioma
cholesteatomas

36
Q

what are the signs of neoplastic disequilibrium?

A 
hearing loss
absent corneal reflex
tinnitus
facial pain/sensory loss
facial droop
37
Q

what is paraneoplastic cerebellar degeneration?

A

remote effect of systemic cancer due to antibodies to tumor cell antigens that cross-react with cerebellar Purkinje cells

38
Q

what are the most common hereditary spinocerebellar ataxias?

A

SCA 1 = olivopontocerebellar

SCA 3 = Machado-Joseph

39
Q

what are the symptoms of spinocerebellar ataxias?

A

slowly progressive cerebellar ataxia of limbs + brainstem signs + peripheral neuropathy

40
Q

what is Friedrich’s ataxia?

A

AR disorder due to mutation on Ch. 9

sx onset before age 20
gait ataxia
dysarthria 
impaired leg sensation
muscle weakness
absent DTRs in legs
41
Q

what are the secondary features of Friedrich’s ataxia?

A 
extensor plantar responses
pes cavus
scoliosis
cardiomyopathy
optic atrophy
nystagmus
42
Q

what is LOFA?

A

Late onset freidrich’s ataxia

onset after 25 y/o

43
Q

how does LOFA differ from FA?

A 
in LOFA:
LE spasticity or retained reflexes
fewer cardiac abnormalities
fewer skeletal abnormalities
cerebellar atrophy on MRI
longer life span
44
Q

what is ataxia telangiectasia?

A

AR disorder due to mutation on Ch. 11

progressive pancerebellar degeneration beginning in infancy

45
Q

what are the hallmarks of ataxia telangiectasia?

A

progressive ataxia
oculocutaneous telangiectasia
immune deficiency

46
Q

what is spondylotic myelopathy?

A

nonspecific degenerative changes of the spine due to disk and/or joint disease and/or hypertrophy of spinal ligaments

47
Q

what are the symptoms of spondylotic myelopathy?

A 
unexplained gait impairment or imbalance
sensory symptoms in legs
bladder dysfunction
spasticity
hyper reflexive DTRs
Babinski signs
48
Q

what neuro signs are present with B12 deficiency/combined systemic degeneration?

A 
gait and balance problems
distal sensory loss
babinski signs
romberg sign
\+/- lhermitte sign
49
Q

what vitamin deficiency can mimic Freidrich ataxia?

A

Vitamin E def

50
Q

what toxin can cause B12 deficiency and therefore cause disquilibrium?

A

nitrous oxide

NMSP Exam 1 (17 decks)

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