Ataxia, Dizziness, and Gait Disorders

Question 1

Unilateral hearing loss and tinnitus developing over 4 months in a 40 year old man, found to have a cerebellopontine angle mass on MRI.

Answer 1

Acoustic Schwannoma

Question 2

Multiple episodes of tinnitus, vertigo, and low frequency hearing loss in a 24 year old woman.

Answer 2

Meniere’s Disease

Question 3

Treatment for essential tremor

Answer 3

Propranolol

Question 4

Definition of essential tremor

Question 5

Lightheadedness and fainting in 68 year old woman on a beta blocker

Answer 5

Postural hypotension

Question 6

Severe spinning dizziness and nausea in a 59 year old woman when she turns over in bed

Answer 6

BPPV

Question 7

Cure for BPPV

Answer 7

Epply maneuver (Dix-Hallpike = diagnosis)

Question 8

Dizziness, dysarthria, and ataxia developing over 10 days in a healthy 45 year old woman, including bilateral dysmetria of all extremities and inability to sit or stand without assistance

Answer 8

Paraneoplastic syndrome (anti-Yo)

Question 9

Anti-Yo Syndrome

Answer 9

Paraneoplastic syndrome characterized by anti-Purkinje cell antibodies, associated with small cell lung cancer, gynecologic cancers, or non-Hodgkin’s lymphoma. Causes subacute cerebellar dysfunction.

Question 10

Sudden severe occipital headache with sensation of spinning and falling to the right in a 79 year old man with elevated BP, symptoms worsened by coughing and accompanied by vomiting and bilateral horizontal nystagmus

Answer 10

Cerebellar hemorrhage

Question 11

Sudden momentary vertigo, diplopia, numbness around the mouth, and inability to walk in an 80 year old woman whose symptoms later resolve

Answer 11

Vertebrobasilar TIA

Question 12

Unsteadiness and lightheadedness on standing in a 55 year old man with mild resting tremor and cogwheeling in the upper limbs, as well as orthostasis and constipation

Answer 12

Multiple systems atrophy (Shy-Drager)

Question 13

Multiple systems atrophy (Shy-Drager)

Answer 13

Parkinsonism plus autonomic insufficiency. Less responsive to dopamine repletion.

Question 14

Slow shuffling steps, difficulty with turns, and urinary incontinence in a 59 year old alcoholic with prior history of pneumococcal meningitis

Answer 14

Communicating hydrocephalus (NPH) - meningitis can scar the arachnoid granulations

Question 15

Progressive forgetfulness in an 83 year old woman who has stopped driving because she gets lost in her neighborhood, fears someone will break into her house, fails to recognize her good friends and seems withdrawn, and now demonstrates grasp reflex, 0/3 objects on memory testing, and cortical atrophy with diffuse ventricular enlargement on MRI

Answer 15

Hydrocephalus ex vacuo (Alzheimer’s disease)

Question 16

57 year old man with progressive difficulty walking, tripping on his own feet, frontal headache, spasticity in the legs, hyperactive reflexes, bilateral Babinskis, no sensory deficits

Answer 16

Parasagittal meningioma

Question 17

Incidental finding of large ventricles with normal IVth ventricle in a 35 year old man who has an MRI scan as part of his pilot license application

Answer 17

Aqueductal stenosis

Question 18

60 year old man with tingling in arms and legs, sensation of swollen limbs, and unsteadiness in the dark, who then develops weakness and SOB over 4 days with loss of DTRs, absent proprioception and vibration sense, and mild bilateral facial weakness

Answer 18

Guillain-Barre Syndrome (proprioception and vibration suggest large myelinated fiber involvement)

Question 19

Headache worse when lying down or bending forward, accompanied by diplopia, nausea, and unsteadiness in a 39 year old woman with cervical cancer

Answer 19

Obstructive hydrocephalus

Question 20

Morning headaches, nausea, and unsteadiness in a 17 year old girl with mild left facial weakness, left limb dysmetria, and papilledema

Answer 20

Medulloblastoma

Question 21

Most common presentation of acoustic schwannoma

Answer 21

gradual unilateral hearing loss

Question 22

What tumor could cause hearing loss and dysfunction of CNs V & VII?

Answer 22

Cerebellopontine angle meningioma

Question 23

What sensory symptom can suggest hyperventilation?

Answer 23

Tingling

Question 24

Nystagmus in BPPV?

Answer 24

Uni-directional

Question 25

Treatment for Meniere’s

Answer 25

Labyrinthine ablation with gentamicin