Clinical Approach to Disorders of Equilibrium (Hon)

Question 1

Balance and awareness of body position in relation to surroundings requires input from two of the following three systems:

Answer 1

1) Visual (to judge distance)
2) Labyrinthine (to judge acceleration and position change)
3) Proprioceptive (to judge posture)

Question 2

The Romberg test is assessing what system?

Answer 2

Proprioceptive

Question 3

What is characterized by illusion of movement of oneself or objects around self may be vestibular or neurologic in origin?

(rotational, spinning component, and is the perception of movement, either of the self or surrounding objects)

Answer 3

Vertigo

Question 4

What may be caused by vertigo but is usually a nonvertiginous state of altered static or dynamic balance?

(Unsteadiness, imbalance, or loss of equilibrium that is often accompanied by spatial disorientation)

Answer 4

Disequilibrium

Question 5

What is characterized by lightheadedness or send of impending loss of consciousness often due to orthostasis, arrhythmia, hyperventilation and aggravated by high temp?

Answer 5

Presyncope

Question 6

Vertigo is due to disturbance in?

Answer 6

Vestibular dysfunction (semicircular canals/otoliths)

Question 7

What is the most common cause of recurrent vertigo?

Answer 7

Benign Positional Vertigo

Question 8

Benign Positional Vertigo is triggered by?

Answer 8

Changes in head position with respect to gravity

Question 9

Which semicircular canal is most commonly affected by BPV?

Answer 9

Posterior

Question 10

BPV is confirmed by?

Answer 10

Dix-Hallpike position testing

Question 11

What is Vestibular Neuronitis

Answer 11

Spontaneous Vertigo attack that does not involve tinnitus or hearing loss and is not positional

Question 12

How does Vestibular Neuronitis differ from BPV?

Answer 12

Vestibular Neuronitis is not triggered by positional changes

Question 13

Meniere’s disease is due to?

• onset?
• sex?
• treatment?

Answer 13

Increase in the volume of labyrinthine endolymph because of poor absorption (endolymphatic hydrops)

• 20-50’s
• Female
• Restrict Sodium and diuretics

Question 14

What are the symptoms of Meniere’s disease?

Answer 14

1) Recurrent spontaneous vertigo
2) Low frequency hearing loss
3) Tinnitus
4) Aural fullness

Question 15

If vertigo symptoms are less than 24 hours, is it BPV or Vestibular Neuronitis?

If it lasts for about 3 months?

Answer 15

1) Vestibular Neuronitis

2) BPV

Question 16

What is an autosomal recessive disorder due to a mutation on chromosome 9?

What is the onset?

Answer 16

1) Friedrich’s Ataxia

2) Before age 20

Question 17

What symptoms are associated with Friedrich’s Ataxia?

Answer 17

1) Gait ataxia
2) Dysarthria
3) Impaired position/vibratory sense in legs
4) Muscle weakness
5) Absent tendon reflexes in legs

Question 18

What is often the cause of death in patients with Friedrich’s Ataxia?

Answer 18

Cardiomyopathy

Question 19

Ataxia-Telangiectasia

• What are the inheritance pattern
• What Chromosome is the issue?

Answer 19

• Autosomal Recessive

- Chromosome 11

Question 20

Ataxia-Telangiectasia is characterized by?

Answer 20

1) Progressive ataxia
2) Oculocutaneous telangiectasia
3) Immunologic deficiency

Question 21

Around what age does the oculocutaneous telangiectasia usually appear?

Answer 21

Teen years

Question 22

What Igs are decreased with Ataxia-Telangiectasia?

The immunological impairment becomes evident later in childhood and is manifested by?

Answer 22

1) IgA and IgE

2) Recurrent sinopulmonary infections

Question 23

Deficiency of B12 can cause what?

Answer 23

Fatigue
Gait/balance problems
Distal sensory loss
Babinski/Romberg Sign

Question 24

Vit B12 Deficiency causes degeneration of?

Answer 24

Posterior columns
lateral corticospinal tracts (UMN)
Peripheral neuropathy (LMN)

Question 25

What levels of are increased with Vit B12 Deficiency?

Answer 25

1) Homocysteine

2) Methylmalonic acid