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Clinical Neuroscience 2 > Clinical- 8 > Flashcards

Clinical- 8 Flashcards

1
Q

True or False: dizziness = vertigo.

A

False

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2
Q

What is dizziness?

A

sensations of light-headedness, faintness or giddiness. NOT associated with an illusion of movement.

ILLUSIONS, MICHAEL. TRICKS ARE WHAT WHORES DO FOR MONEY.

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3
Q

What is vertigo?

A

The illusion that you’re moving but you’re not actually moving.

“Lucille #2”

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4
Q

What happens in peripheral vertigo?

A

lesions that affect the labrynth of the inner ear, or VIII

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5
Q

What is central vertigo?

A

lesions of the brainstem vestibular nuclei or their connections, possible froma cerebral Cx lesion

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6
Q

QUICK FIRE: I’ll give a Sx and you tell me whether it’s peripheral or central vertigo. Ready?

Contant, less severe vertigo

A

Central

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7
Q

Nystagmus always present, unidirectional, never vertical

A

Peripheral

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8
Q

Tinnitus/heading loss often present

A

Peripheral

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9
Q

Usually has brainstem or cerebellar signs

A

Central

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10
Q

Verigo is intermittent, brief, and more severe

A

Peripheral

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11
Q

Nystagmus possible, can be uni- or bidirectional, can be vertical

A

Central

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12
Q

There are no intrinsic brainstm or cerebellar signs

A

Peripheral

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13
Q

Rarely is there tinnitus/hearing loss

A

Central

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14
Q

What is ataxia?

A

incoordination or clumsiness of movement that s not the result of muscular weakness

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15
Q

What is vestibular ataxia?

A

gravity-dependent (only when walking, standing), incoordination from the same central and peripheral lesions that cause vertigo

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16
Q

What is cerebellar ataxia?

A

irrgular rate, rhythm, amplitude and force of voluntary movements caused by lesions of the cerebelum or its afferent or efferent connections in the peduncle.s, red nucleus, pons, or spinal cord.

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17
Q

What is sensory ataxia?

A

impaired sensation of propriocepton and vibratory sense form disorders that affect those pathways.

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18
Q

True or False: There is NO vertigo, nystagmus and dysarthria in sensory ataxia.

A

True

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19
Q

Demonstrate the Dix-Hallpike technique (5 steps)

A
  1. sit pt on table with eyes forward
  2. quickly bring them supine with head over edge of table (30-45 deg)
  3. repeat with head turned 45 deg to the R
  4. repeat with head turned 45 deg to the L
  5. observe for nystagmus or vertigo
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20
Q

Positional nystagmus and vertigo are usually assoacited with lesions where?

A

peripheral vestibular lesions

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21
Q

What are the characteristics of peripheral nystagmus?

A

tends to remit spontaneously (fatigue), reduces with repetition.

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22
Q

Caloric testing can test disorders from where?

A

vestibuloocular pathway

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23
Q

What are the expected results from COLD water caloric testing?

A

Remember COWS (cold opposite, warm same)

Slow phase to irrigated ear, fast to opposite ear (side of nystagmus)

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24
Q

What are the expected results from WARM water caloric testing?

A

coWS

slow phase opposite of irrigated ear, fast to same side

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25
Q

What are the causes for the FAILURE of nystagmus to form fromcaloric testing?

A

unilateral labrynthine, vestibulocochlear n. or vestibular N dysfxn

26
Q

What is the most common cause of vertigo of peripheral origin, and is caused by canalolithiasis?

A

Benign positional vertigo

27
Q

What are the Sx of BPV?

A

breif episodes of severe vertigo, N/V, worse in lateral decubitus position with affected ear down,no hearing loss. can be peripheral or central Sx.

28
Q

BPV- Tx

A

respositioning (epley) maneuvers that use gravity to move the canaloliths out of the SC canals and into the vestibule where they can be reabsorbed.

29
Q

Define: disorder that has repeated episodes of vertigo lasting minutes-days and accompanied by tinnitus and progressive sensorineural hearing loss.

A

Meniere’s disease

30
Q

Meniere’s- etiology

A

from endolympahtic hydrops, sporatic, men > women, 20-50 y/o, familial related to mutation in cochlin gene.

31
Q

Meniere’s- Sx

A

tinnitus, heading loss, sense of fullness in the ears, vertigo, N/V. Recurring intervals from weeks-years.

32
Q

Menieres- clinical findings

A

spontaneous horizontal or rotatory nystagmus, impaired vestibular fxn with caloric testing, low-freq pure-tone hearing loss.

33
Q

Meniere’s- Acute Tx

A

symptomatic with antihistamines, benzos, other vestibule-suppressant drugs

34
Q

Meniere’s- management

A

low-salt diet, diuretics, transtympanic insillation of gentamicin or dexamethasone.

35
Q

Define: disorder of spontaneous vertigo of no apparent cause that resolves spontaneously, causes NO hearing loss, and shows no signs of CNS dysfxn.

A

Vestibular neuronitis

36
Q

Vestibular neuronitis- Sx

A

vertigo, N/V up to 2 wks, recurring Sx

37
Q

Vestibular neuronitis- clinical findings

A

pt wants to lie of side with dysfxnl ear UP, nystagmus with fast phase AWAY from affected side (always present)

38
Q

Vestibular neuronitis- Tx

A

10-14 days of prednisone (antiinflamm) and a vestibulosupressant

39
Q

What are the 3 antihistamines used for vertigo?

A

meclizine, promethazine, mimenhydrinate

40
Q

What is the 1 anticholinergic used for vertigo?

A

scopolamine (remember this from pharm??)

41
Q

What is the 1 benzo used for vertigo?

A

diazepam

42
Q

What are the 2 sympathomimetrics used for vertigo?

A

amphetamine, ephedrine

CNS stuff

43
Q

Define: the most common type of tumor is an acoustic neuroma, but meningiomas and epidermoidal cysts can cause this type of tumor too. Close to V-XII from the braimstem.

A

Cerebellopontine angle tumor

44
Q

Which AD disorder causes bilateral acoustic neuromas?

A

NF2

45
Q

CPAT- Sx

A

insiduous hearing loss, headache, vertigo, gait ataxia, facial pain, tinnitus, sensation fo fullness in the ear, facial weakness, unsteadiness.

See a trend here? V, VII, VIII affected.

46
Q

What are the 5 drugs that cause toxic vestibulopathies?

A
  1. alcohol (>40mg/dL in blood)
  2. aminglycosides
  3. salicylates
  4. quinine and quinidine
  5. cisplastin (antineoplastic drug)
47
Q

What is the pathogenesis of cerebellar stroke?

A

infarct in one of the 3 arteries that supplies the cerebellum (superior cerebellar, AICA, and PICA)

48
Q

What are the clinical features of cerebellar strokes?

A

IPSILATERAL limb ataxia, lateroplusion and hypotonia

can also have contralateral hemiparesis

49
Q

Cerebellar strokes- Dx

A

CT or MRI

50
Q

Cerebellar strokes- Tx

A

brainstem compression indicates surgical decompression and resection of infarcted tissue.

51
Q

Cerebellar hemorrhage- pathogenesis

A

hypertension; anticoagulation, arteriovenous malformation, blood dyscrasia, tumor, trauma

52
Q

Cerebellar hemorrhage- Sx

A

sudden headache, gait ataxia, IL gaze palsy, IL peripheral facial palsy, IL corneal reflex depression

53
Q

Cerebellar hemorrhage- Dx

A

DO NOT do an LP cuz of possible herniation. CT or MRI

54
Q

Cerebellar hemorrhage- Tx

A

surgical evacuation

55
Q

Ataxia Telangectasia- pathogenesis

A

autosomal recessive disorder; onset in infancy; results from loss-of-function mutation in the ataxia-telangiectasia mutated gene (ATM) which codes for a Ser/Thr protein kinase causing a defect in repair of dsDNA breaks

56
Q

Ataxia telangiectasia- clinical Sx

A

progressive cerebellar atxia, oculocutaneous telangiectasia, sinopulmonary infections, lymphoid tumors

57
Q

Friedrich ataxia- onset

A

autosomal recessive disorder; onset in childhood (avg age = 13); avg age at death is 40 yrs; displaces anticipation;

58
Q

Friedrich ataxia- mutation

A

expanded GAA trinucleotide repeat in noncoding region of FXN gene → loss of function mutation in frataxin

59
Q

Friedrich ataxia- defect

A

degeneration of dorsal root ganglia, large myelinated peripheral sensory nerve axons, corticospinal tracts, and dentate nuclei;

60
Q

Friedrich ataxia- Sx

A

progressive gait ataxia, followed by limb ataxia, dysarthria, and sensory gait ataxia; knee and ankle areflexia, impaired dorsal column modalities; leg weakness; Babinski sign; pes cavus; kyphoscoliosis; chronic restrictive lung disease; cardiomyopathy; optic atrophy and diabetes mellitus

Clinical Neuroscience 2 (16 decks)

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