Ataxia, Dizziness, and Gait Disorders Flashcards
Unilateral hearing loss and tinnitus developing over 4 months in a 40 year old man, found to have a cerebellopontine angle mass on MRI.
Acoustic Schwannoma
Multiple episodes of tinnitus, vertigo, and low frequency hearing loss in a 24 year old woman.
Meniere’s Disease
Treatment for essential tremor
Propranolol
Definition of essential tremor
Lightheadedness and fainting in 68 year old woman on a beta blocker
Postural hypotension
Severe spinning dizziness and nausea in a 59 year old woman when she turns over in bed
BPPV
Cure for BPPV
Epply maneuver (Dix-Hallpike = diagnosis)
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
Paraneoplastic syndrome (anti-Yo)
Anti-Yo Syndrome
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.
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
Cerebellar hemorrhage
Sudden momentary vertigo, diplopia, numbness around the mouth, and inability to walk in an 80 year old woman whose symptoms later resolve
Vertebrobasilar TIA
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
Multiple systems atrophy (Shy-Drager)
Multiple systems atrophy (Shy-Drager)
Parkinsonism plus autonomic insufficiency. Less responsive to dopamine repletion.
Slow shuffling steps, difficulty with turns, and urinary incontinence in a 59 year old alcoholic with prior history of pneumococcal meningitis
Communicating hydrocephalus (NPH) - meningitis can scar the arachnoid granulations
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gets lost in her neighborhood, fears someone will break into her house, fails to recognize her good friends and seems withdrawn, and now demonstrates grasp reflex, 0/3 objects on memory testing, and cortical atrophy with diffuse ventricular enlargement on MRI
Hydrocephalus ex vacuo (Alzheimer’s disease)
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
Parasagittal meningioma
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
Aqueductal stenosis
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
Guillain-Barre Syndrome (proprioception and vibration suggest large myelinated fiber involvement)
Headache worse when lying down or bending forward, accompanied by diplopia, nausea, and unsteadiness in a 39 year old woman with cervical cancer
Obstructive hydrocephalus
Morning headaches, nausea, and unsteadiness in a 17 year old girl with mild left facial weakness, left limb dysmetria, and papilledema
Medulloblastoma
Most common presentation of acoustic schwannoma
gradual unilateral hearing loss
What tumor could cause hearing loss and dysfunction of CNs V & VII?
Cerebellopontine angle meningioma
What sensory symptom can suggest hyperventilation?
Tingling
Nystagmus in BPPV?
Uni-directional
Treatment for Meniere’s
Labyrinthine ablation with gentamicin
