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Neuro > Central Vertigo & Multiple Sclerosis > Flashcards

Central Vertigo & Multiple Sclerosis Flashcards

1
Q

+HIT=?

A

vestibular neuritis/labrynthitis

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2
Q

-HIT=

A

central vertigo

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3
Q

What test is sensitive for determining central v. peripheral vertigo?

A

HiNTS

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4
Q

causes of central vertigo (5)

A

stroke, vertebrocasilar insufficiency, multiple sclerosis, masses, migraine-equivalent

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5
Q

3 types of stroke

A

hemorrhagic, ischemic, brainstem

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6
Q

diplopia

A

double vision

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7
Q

dysphonia

A

breathy voice from voice box spasms

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8
Q

dysarthria

A

slow or slurred speech

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9
Q

dysmetria

A

lack of coordination

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10
Q

A pt presenting with any neurologic problems (including diplopia, dysphonia, dysarthria, dysmetria), has what kind of vertigo?

A

central

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11
Q

Toes go up on Babinski test=?

A

central vertigo

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12
Q

hyperreflexia/abnormal reflexes on Babinski=?

A

central vertigo

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13
Q

What is HiNTs used to differentiate?

A

central and peripheral vertigo

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14
Q

If HiNTS is vertical/changing direction=

A

central vertigo

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15
Q

If HiNTS is horizontal (+/- torsional)= ?

A

peripheral vertigo

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16
Q

Double vision

A

ocular misalignment

more concerning than monocular esp. with other neuro complaints, resolves when either eye is covered

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17
Q

monocular vision

A

refractive or retinal issue and resolves when affected eye is covered

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18
Q

when is double vision (ocular misalignment) resolved?

A

when either eye is covered

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19
Q

when is monocular vision resolved?

A

when the affected eye is covered

20
Q

What is #1 based on presentation for MS?

A

double vision

21
Q

age and gender of MS

A

25-30yo W>M

22
Q

What is multiple sclerosis caused by?

A

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

23
Q

Where is MS prevalent?

A

northern US, UK and Scandinavia
rare in Africans and Asians but African Americans have higher risk (bc in America’s climate)
Idaho>Texas

24
Q

Clinical fts of MS

A

dec. cognition- confusion, poor academics/work, memory
bilateral intranuclear opthalomoplegia**

wide variability in age, symptoms, location, severity, progression etc.

25
Q

Bilateral intranuclear ophthalmoplegia

A

eye can’t adduct (impaired conjugate gaze)

optic neuritis, pain and vision disturbance

26
Q

what symptoms is pathognomonic for MS?

A

bilateral intranuclear ophthalomoplegia

27
Q

What other system symptom is frequent in MS?

A

bowel/bladder dysfunction

28
Q

What labs are helpful for determining MS?

A

none

29
Q

Imaging for MS

A

MRI with contrast during episodes (diagnostic)

30
Q

Other tests for MS

A

lumbar puncture

31
Q

when do you do a lumbar puncture?

A

only after inc. ICP/mass is ruled out with MRI

32
Q

What do you look for in a lumbar puncture for MS?

A

inc. Ig proteins in CSF; pleocytosis (lymphyocytes)

33
Q

Mainstay of therapy for MS? What does it help with?

A

IV methylprednisolone DOC steroids- helps with relapsing-remitting MS and dec. risk of recurrence

34
Q

What is the steroid to treat for MS?

A

250-1000mg (high dose) IV methylprednisolone DOC for 3-7 days

35
Q

How do you administer meds for MS?

A

IV 250-1000mg; oral is not effective

36
Q

How long do you give steroids for MS?

A

3-7days

37
Q

Side effects of methylpredisolone

A

psychosis, infection, anxiety, GI bleed, fluid overload

38
Q

What is a complication of MS? (3)

A

exercise (inc. heat exasterbates symptoms), pain and spasms

39
Q

how do you treat the complications that come with MS? (3)

A

exercise- cooling vest
pain- used carbamazepine, TCAs
spasms- baclofen

40
Q

What do you give for spasms?

A

baclofen

41
Q

What do you give to MS patients for pain?

A

TCAs (tricyclics) and carbamazepine

42
Q

HIT=

A

head impulse test

43
Q

+ hallpike maneuver for HiNTS exam requires?

A 
all 4- 
vertigo and nystagmus in supine position
latency for 20s until it appears
tortional and upbeating
lasting <60s
44
Q

What do you order first for a pt you are unsure about having MS?

A

CT angiogram to see blood supply and risk of stroke (then do MRI)

45
Q

What is seen on MRI for MS?

A

plaques

46
Q

HiNTS=

A

head impulse
nystagmus
test of skew
peripheral vertigo

Neuro (7 decks)

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