Clin: Disorders of Equilibrium Flashcards
How does Vestibular Neuronitis differ from BPV?
- Spontaneous attack of vertigo, typically lasting up to 2 weeks (findings similar to BPV
- But is NOT typically positonal
Why is the direction of nystagmus provoked by the anterior type of Benign Postional Vertigo significant?
- This is a more rare form
- Dix Hallpike will causes a downbeat (vertical) nystagmus, which is usually only seen in central lesions.
- Must carefully assess to rule out brainstem or cerebellar lesions!
What is the most comon location for debris causing Benign Positional Vertigo?
How is this diagnosed?
Direction of Nystagmus?
- Posterior semicircular canal
- Use Dix Hallpike manuever, nystagmus provoked w/ affected ear down
- Nystagmus = torsional
What type of syndrome can be caused by Vitamine E deficiency?
Spinocerebellar similiar to Friedrich’s
Repeated episodes of isolated vertigo without other neurological symptoms should always suggest?
A non-neurologic cause
Paraneoplastic cerebellar degeneration is most commonly associated with what cancers?
Antbodies cross react with?
- Breast, ovary, and lung
- Antibodies to tumor cell antigens cross-react with cerebellar Purkinje cells
How is diagnosis of Nitrous Oxide Toxicity made and what is the treatment?
- Diagnosis: depletion of Vit B12 w/ similar symptoms
- Tx: B12 replacement
What can cause B12 deficiency?
- Malabsorption syndromes
- Surgery
- Drugs (H2 receptor antagonists)
- Nitrous oxide use (whip-its!!!)
- Fish tapeworm
A positive Romberg test indicates what?
- A somatosensory dysfunction (proprioception)
*With the eyes open, three sensory systems provide input to the cerebellum to maintain truncal stability. These are vision, proprioception, and vestibular sense. When pt closes eyes during Romberg test you remove that visual sense.
Most common cause of recurrent vertigo and characteristics?
- Benign Positional Vertigo
- Brief recurrent episodes of vertigo triggered by changes in head positon
Age of onset for Ataxia-Telangiectasia?
Common findings?
- Disease of infancy (<4 yr. of age)
- Progressive pancerebellar degeneration involving nystagmus, dysarthria, and gait, limb and trunk ataxia
- Choreoathetosis, loss of vibration and position sense in legs, areflexia, and disorders of voluntary eye movements
What is the first sign and the first symptom of a Cerebellopontine Angle Tumor?
- First symptom = hearing loss (CN VIII)
- First sign = absent corneal reflex (loss of CN V and VII)
With central dysfunction leading to dysequilibrium what is the vertigo like, duration of nystagmus, direction of nystagmus, and neuro symptoms?
- Mild vertigo
- Persistence of nystagmus, which can be in vertical direction
- Usually some neuro symptoms
A sense of impending loss of unconsciousness often associated with pallor, sweating, visual dimming or constricted fields, is known as?
Presyncope
What are the characteristics of Meniere’s Disease and who is most often affected?
Hallmarks?
- Recurrent episodes of spontaneous vertigo, lasting minutes to hours
- Low frequency hearing loss = Hallmark
- Tinnitus and aural fullness
- Woman are 3x more affected
With labyrinthine dysfunction (peripheral) leading to dysequilibrium what is the vertigo like, duration of nystagmus, direction of nystagmus, and neuro symptoms?
- Intense vertigo
- Brief nystagmus
- Horizontal/diagonal nystagmus that is fixed
- Never any neuro symptoms
