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ENT, neuro, eyes > Balance > Flashcards

Balance Flashcards

1
Q

Determiners of balance

A

Vision
Vestibular system
Proprioception
Cerebellar modulation and integration - downward control

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1
Q

What can cause ataxia

A

Peripheral loss of proprioception or cerebellar problems

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2
Q

Causes of vertigo anatomical

A

Vestibular system, cerebrum or cerebrellum

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3
Q

History PC for inbalance

A
  • Onset - when, triggers, how long takes
  • Chronicity = come and go, persistent, attacks how long, space between
  • Ass symptoms - headache, hearing, vision, motor problems, cognitive problems
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4
Q

What is nystagmus

A

Uncontrolled eye movement on saccadic (sudden directional) movement

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5
Q

Causes of Nystagmus

A

BPPV
Vestibular neuronitis
Central cause

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6
Q

What type of nystagmus does BPPV cause

A

Vertical up-down and torsional on dix-hallpike

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7
Q

What nystagmus type does vestibular neuronitis cause

A

L-R nystagmus - gaze worse AWAY from affected side

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8
Q

Central cause nystagmus type

A

Gaze - evoked - no obvious unilateral componenet
Midbrain - also vertical

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9
Q

Dix hallpike test

A

****ix hallpike manouvere****

  • Turn head 45 degrees towards and observe eyes for 30s, lowered back so head 20 degrees over back of couch
  • Stay there for 1 minute
  • See nystagmus in 20-30s
  • Perform on both sides - side thats asymptomatic
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10
Q

Head impulse test

A
  • Corrective saccade on fast movement
  • Diagnose peripheral vestibular vertigo
  • Rapid jerk 10-20 degrees one direction, slow to centre repeat other way
  • Ask to look at nose
  • Normal = eyes stay fixed. normal or central cause
  • Abnormal = eyes saccade - rapid side to side movement
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11
Q

What is unterberger test

A

Walk in place with eyes closd
More than 30 degrees rotation = asymmetrical labyrinth funciton

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12
Q

HINTS test consists of

A

Head impulse
Nystagmus
Test of skew

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13
Q

Who d you perfrom the HINTS test on

A

Persistent vertigo hours or days
Nystagmus
Normal full neuro exam

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14
Q

What does flocculonodular lobe damage cause type of ataxia

A

Postural instability and nystagmus

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15
Q

Vermis damage lobe what type of ataxia

A

Truncal or gait ataxia

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16
Q

Hemisphere damage type of ataxia cause

A

Dysmetria, intention tremor, dysdiadochokinesia and slurred, staccato speech

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17
Q

DANISH symtpoms (cerebellar)

A

D - Disdiadochokinesia

A - Ataxic Gait (Broad-based)

N- Nystagmus

I - Intention Tremor

S - Slurred speech

H - Hypotonia

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18
Q

What is sponteanous vestibular prooblems

A

Discrete episodes with no clear trigger eg vestibular migraine, mennieres

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19
Q

What o triggered episodic vetibular syndrome look like

A

Discrete episodes minutes/hours of dizziness precipitated by specific trigger - BPPV, orthostatic hypotension

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19
Q

Poste exposure acute vestiibular syndrome

A

Persistent dizziness - lasting days to weeks history of precipitating event eg vestibular neuronitis, posterior circulation

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20
Q

Typical BPPV history

A

Middle age/older patient
Spinning when turn
Nausea
Nystagmus - vertical torsion on diz hallpike

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21
Q

Vestibular neuronitis typical history

A

Acute inflammation of vestibular system
Spontaneous, acute, no trigger
Constant vertio
Resolves in around a week
Intense ongoing nausea, vomitting

22
Q

Predispsoing factors for vestibular neuorinitis

A

Preceding viral infections
Prev bacterial CNS infections eg meningitis
Prev chronic otitis media
Choleastoma

23
Q

Investigations for vestibular neuritis

A
  • Horizontal, unidirectional nystafgmus
  • WORSE on gaze AWAY from affected side
    • head impulse test
24
Q

What is prochlorperazine used of vestibular

A

Nausea from vestibular/labyrinthine disorders

25
Q

Management of vestibular neuronitis

A

Conservative - physio, OT
Medical - antiemetics, antihistamines - prochlorperazine, cyclizine
Underlying cause treat

26
Q

What condition is betahistine used in

A

Mennieres

27
Q

How does ondenastron eork

A

Serotonin receptors

28
Q

What is dexamethasone used in causing inbalance

A

Space occupying lesions

29
Q

Vestibular neuonitis vs labyrinthitis anatomy

A

Labyrinthitis involves cochlear therefore causes hearing loss

30
Q

Labyrinthitis management

A

Corticosteroids for acute hearing loss
Prednisolone 60mg OD 10-14 days
Taper for 5 days

31
Q

Mennieres symptoms

A

Attacks Recurrent rotatory vertio
Sensorineural hearing loss - gradual low frequency, unilateral
Tinnitus
Sensation of fullness in affected ear

32
Q

Dagnosis of mennieres

A

Audiometry - sensorineural hearing loss
Pure tone audio, electrocholeography - measure APs generated through sound

33
Q

Side effect of betahistines esp in older

A

Constiaption

34
Q

Management of mennieres incl social

A
  • Reassure attacks will settle
  • Reduce salt intake in diet - endolymphatic fluid theory
  • DVLA
  • Support groups
  • Hearing devices
  • Antiemetics
  • Severe → IV, may require fluids
35
Q

Surgical management of mennieres

A

Endolymphatic sac surgery
Vestibular nerve dissection
Chemical labyrinthecoty - gentamycin (ototoxic)

36
Q

Diagnositc criteria for migraine vestibular

A

=/>5 episodes vestibular symptoms mod/sev, 5 mins - 72 hours
Current or prev history migraine with or without aura
One or more migraine features with at least half of all vestibular episodes

37
Q

What migraine features need with at least half of all vestibular episodes for diagnosis of vestibular migraine

A
  • Headahce with at least two of: unilateral, pulsating, moderate or severe pain, aggravation by physical activity
  • Photophobia + phonophobia
  • Visual aura
38
Q

How treat vestibular migarine

A

Like normal migraine;
- Avoid triggers
- Propanolol for prophylaxis
- Triptans for acute attacks

39
Q

Conditions affecting sensory afferent neurons

A

Diabetes
GBS
Vasculitis
Charcot-marie tooth
Chemo - platinum, vinca alkaloids, taxanes
Dorsal root ganglion conditions
Dorsal column

40
Q

Dorsal root ganglion conditions

A

sjrogens
paraneoplastic syndrome - anti-Hu antibodies

41
Q

Dorsal column conditions causing sensory afferent neurones

A

B12 deficiency - subacute with degeneration of cord
Tabes dorsalis - late neurosyphilis

42
Q

Signs of sensory ataxia

A

High stepping gait
Rombergs positive

43
Q

Investigation for sensory ataxia

A

Bloods - vasculitis, paraneoplastic, AI
MRI - spinal cord problems
NC studies

44
Q

MRI of SACD

A

Hyperintensity on T2 MRI in dorsal section of cord

45
Q

What does nitrus oxide abuse cause neurologically

A

Functional B12 deficiency
Normal blood levels but unable to be used by cells
Methionine synthase which uses B12

46
Q

Test for functionl B12 deficiency

A

Test methylamonic acid and homocysteine levels
Elevated

47
Q

Causes of cerebellar ataxia

A

Stroke - AICA, PICA
Alcohol
Trauma
MS
Gluten
Neurodegenerative diseases - atypical parkinsonism
Genetic condition

48
Q

Genetic conditions

A

Spinocerebellar ataxias
Friedrichs ataxia
Ataxia telangiectasia

49
Q

Spinocerebellar ataxias

A

N-acetyl-leucine
Middle age presentation
#Cerebellar atrophy

50
Q

What is Friedrichs ataxia

A

Inherited condition Multiple body systems prolems from childhood/early aduthood

51
Q

Inheritnce of friedrichs ataxia

A

Autosomal recessive inheritance - fratacin gene on Chr9

52
Q

Symptoms of Friedrichs ataxia

A

dysarthria, hyporeflexia, hypertrophic CM and conduction defects - ECG/ECHO
Scoliosis,diabetes
Wlaking aids in 20s
Control cardiac issues

53
Q

Inheritance Ataxia telagneictasia

A

Autosomal recessive ATM gene on Chr 11
Childhood starts

54
Q

Symptoms of ataxia telangiectasia

A

Oculomotor - problems reading
Telangictasia in sclera
Immune problems

55
Q

What does ataxia telangiectasia increase the risk of

A

25% lifetime risk of leukaemia or lymphoma
Slow rising alphafetoproteins
Cerebellar atrophy

ENT, neuro, eyes (34 decks)

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