Central Vertigo & Multiple Sclerosis Flashcards
+HIT=?
vestibular neuritis/labrynthitis
-HIT=
central vertigo
What test is sensitive for determining central v. peripheral vertigo?
HiNTS
causes of central vertigo (5)
stroke, vertebrocasilar insufficiency, multiple sclerosis, masses, migraine-equivalent
3 types of stroke
hemorrhagic, ischemic, brainstem
diplopia
double vision
dysphonia
breathy voice from voice box spasms
dysarthria
slow or slurred speech
dysmetria
lack of coordination
A pt presenting with any neurologic problems (including diplopia, dysphonia, dysarthria, dysmetria), has what kind of vertigo?
central
Toes go up on Babinski test=?
central vertigo
hyperreflexia/abnormal reflexes on Babinski=?
central vertigo
What is HiNTs used to differentiate?
central and peripheral vertigo
If HiNTS is vertical/changing direction=
central vertigo
If HiNTS is horizontal (+/- torsional)= ?
peripheral vertigo
Double vision
ocular misalignment
more concerning than monocular esp. with other neuro complaints, resolves when either eye is covered
monocular vision
refractive or retinal issue and resolves when affected eye is covered
when is double vision (ocular misalignment) resolved?
when either eye is covered
when is monocular vision resolved?
when the affected eye is covered
What is #1 based on presentation for MS?
double vision
age and gender of MS
25-30yo W>M
What is multiple sclerosis caused by?
inflammatory disease that causes demyelination of discrete areas (plaques); pathologic T cells in brain that can be dormant for years and then re-exposed causing inflammatory response
Where is MS prevalent?
northern US, UK and Scandinavia
rare in Africans and Asians but African Americans have higher risk (bc in America’s climate)
Idaho>Texas
Clinical fts of MS
dec. cognition- confusion, poor academics/work, memory
bilateral intranuclear opthalomoplegia**
wide variability in age, symptoms, location, severity, progression etc.
Bilateral intranuclear ophthalmoplegia
eye can’t adduct (impaired conjugate gaze)
optic neuritis, pain and vision disturbance
what symptoms is pathognomonic for MS?
bilateral intranuclear ophthalomoplegia
What other system symptom is frequent in MS?
bowel/bladder dysfunction
What labs are helpful for determining MS?
none
Imaging for MS
MRI with contrast during episodes (diagnostic)
Other tests for MS
lumbar puncture
when do you do a lumbar puncture?
only after inc. ICP/mass is ruled out with MRI
What do you look for in a lumbar puncture for MS?
inc. Ig proteins in CSF; pleocytosis (lymphyocytes)
Mainstay of therapy for MS? What does it help with?
IV methylprednisolone DOC steroids- helps with relapsing-remitting MS and dec. risk of recurrence
What is the steroid to treat for MS?
250-1000mg (high dose) IV methylprednisolone DOC for 3-7 days
How do you administer meds for MS?
IV 250-1000mg; oral is not effective
How long do you give steroids for MS?
3-7days
Side effects of methylpredisolone
psychosis, infection, anxiety, GI bleed, fluid overload
What is a complication of MS? (3)
exercise (inc. heat exasterbates symptoms), pain and spasms
how do you treat the complications that come with MS? (3)
exercise- cooling vest
pain- used carbamazepine, TCAs
spasms- baclofen
What do you give for spasms?
baclofen
What do you give to MS patients for pain?
TCAs (tricyclics) and carbamazepine
HIT=
head impulse test
+ hallpike maneuver for HiNTS exam requires?
all 4- vertigo and nystagmus in supine position latency for 20s until it appears tortional and upbeating lasting <60s
What do you order first for a pt you are unsure about having MS?
CT angiogram to see blood supply and risk of stroke (then do MRI)
What is seen on MRI for MS?
plaques
HiNTS=
head impulse
nystagmus
test of skew
peripheral vertigo
