Ataxia

Question 1

Acoustic schwannomas

Answer 1

Gradual unilateral hearing loss w/ ringing in ear
Mass at cerebellopontine angle
Distinguish from CPA meningioma large enough to => hearing loss, nerve 5, 7 dysfn

Question 2

Postural hypotension

Answer 2

If on beta blocker tx, when stand up, vasodilate, but cannot increase pulse so get hypotension

Question 3

Hyperventilation

Answer 3

World closing in racing pulse, diaphoresis, SOB, and TINGLING (from the hypervent)

Question 4

Benign Paroxysmal Positional Vertigo

Answer 4

Turn over in bed and get dizzy/nausesous
Dix-Hallpike provocative
Epply maouever clears debris out and cures!
Path: otoliths stimulating hair cells => profound vertigo + unidirectional nystagmus

Question 5

Meniere’s disease

Answer 5

More than one episode of vertigo
Vertigo + tinnitus + low frequency hearing loss

tx: labyrinthine ablation + gentamicin

Question 6

Paraneoplastic Anti-Yo

Answer 6

Develop profound dizzy, dysarthria, ataxia over 1-0 days
Dysmetria bilaterally up and low extremities
Subacute- anti-Purkinje cell antibodies assoc w/ several malignancies (SCLC, gyno, NHL)

Question 7

Cerebellar hemorraghe

Answer 7

Severe occipital headache, spinning, falling to right, worsened by cough, vomiting increased, bilat horizontal nystagmus, can’t stand, htn
tx: OR for evacuation

Question 8

Vertebro-basilar TIA

Answer 8

Momentary vertigo, diplopia, numbness around mouth, inability to walk, all resolves

Question 9

Multiple System Atrophy (Shy-Drager)

Answer 9

Parkinsonism + autonomic insufficiency

cogwheel + resting tremor + BP orthostasis + constipation

Question 10

Communicating Hydroceph

Answer 10

No blockage @ Monro or anywhere else…symmetric ventric enlarge (obstruction of arach granulations post meningitis scarring, or post Subarach hemorraghe or trauma)
NPH? Do shunt after high volume tap

Question 11

Hydrocephalus ex vacuo

Answer 11

Brain atrophy (like Alzheimer’s)=> larger ventricles to fill the dilated space

Question 12

Parasagittal meningioma

Answer 12

selectively targets leg fibers, so meningioma => spasticity in legs, hyperreflexive and Babinskis!

Question 13

Aqueductal stenosis

Answer 13

Fourth ventricle normal, rest enlarged. Hydrocephalus might decompensate as an adult, bu tmight be totally fine!

Question 14

Guillan-Barre

Answer 14

Absent vibration/proprioception mean large myelinated fiber involvement
Peripheral nerve problem too?
Acquired inflamm demyelinating polyneuro
CSF = albumin high cells low

Question 15

Obstructive hydrocephalus

Answer 15

Positional headache, worse w/ bending forward and lying down

High ICP => nonlocalizing abducens deficit

Question 16

Medulloblastoma

Answer 16

Adult brain tumors = supratent
Pediatric <20 are infratent (in cerebellum) PNETs like medullo
(ie mild L facial weakness, dysmetria, papiledema)