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Neurology > Disorders of Equilibrium > Flashcards

Disorders of Equilibrium Flashcards

1
Q

True or false: dizziness may result from a disorder in any organ system

A

True

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2
Q

What are the four major organ systems that generally lead to the development of dizziness?

A
  • Brain
  • vestibular apparatus
  • CV
  • Endocrine system
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3
Q

True or false: dizziness may be physiologic

A

True

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4
Q

What is the definition of disequilibrium?

A

Altered sense of balance

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5
Q

What are the three major inputs for equilibrium?

A
  • Visual
  • Proprioceptive
  • Vestibular
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6
Q

What part of the spinal column is responsible for proprioception?

A

Dorsal columns

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7
Q

What are the three major organ systems that can produce vertigo?

A
  • Labyrinthine apparatus
  • Vestibular nerve
  • Brainstem
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8
Q

True or false: vertigo is always pathologic

A

false

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9
Q

How can you identify vertigo that is psychogenic in nature?

A

Absence of nystagmus

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10
Q

Psychogenic vertigo is usually seen in patients who have what conditions?

A

Panic disorder or agoraphobia

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11
Q

What is agoraphobia?

A

Afraid of open spaces/leaving their home

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12
Q

Can you have true vertigo without vestibular system involvement

A

no

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13
Q

Where can the lesions located with vestibular system disorders? (3)

A
  • Inner ear
  • Acoustic nerve
  • Brain
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14
Q

What are the receptors for vertical motion?

A

Saccule and utricle

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15
Q

What bone houses the vestibular apparatus?

A

temporal bone

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16
Q

What is the position sensing apparatus within the semicircular canals?

A

Cupula

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17
Q

What is the blood supply to the labyrinth?

A

internal auditory nerve

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18
Q

The endolymphatic fluid is high in what mineral? Low?

A

High in K

Low in Na

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19
Q

What is the pathway that transmits information from CN VIII?

A

Medial longitudinal fasciculus

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20
Q

What causes height vertigo?

A

Widening of the tiny saccular movements of the eyes d/t taller objects

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21
Q

What, generally, is physiologic vertigo?

A

Exaggerated response to normal phenomenon

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22
Q

What are the three HEENT exam bits that should always be obtained with a complaint of dizziness?

A
  • Otoscope exam
  • EOMs/Nystagmus
  • hearing exam
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23
Q

Which is usually pathologic and which is physiologic: jerk vs pendular nystagmus?

A
  • Physiologic=pendular

- Pathologic=jerk

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24
Q

How is the dix-hallpike maneuver performed?

A

Hold patient’s head at 45 degree angle (extended), and have them look to the right/left while turning their head.

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25
Q

How can jerk nystagmus be brought about physiologically?

A

have eye move toward punctum so that no cornea is seen

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26
Q

How is nystagmus defined: by the fast or the slow phase?:

A

Fast phase

27
Q

Is there nystagmus with pts in a coma?

A

No–controlled by the cerebral hemispheres

28
Q

What are the characteristics of peripheral jerk nystagmus in terms of:

  • Latency
  • Vertigo
  • Positional adaptation
  • fatigue on repeat testing
A
  • 2-20 second Latency
  • Associated Vertigo
  • Has Positional adaptation
  • Will fatigue on repeat testing
29
Q

What are the characteristics of central jerk nystagmus in terms of:

  • Latency
  • Vertigo
  • Positional adaptation
  • fatigue on repeat testing
A
  • No Latency
  • Variable Vertigo
  • No Positional adaptation
  • Little fatigue on repeat testing
30
Q

Where do CN VIII nerves decussate?

A

In the pons

31
Q

What, generally, is the BAER test?

A

Measuring the action potential of CN VIII as is traverses up the brain

32
Q

What is the order of nerves/nuclei in the auditory pathway?

A
  1. Acoustic nerve
  2. Cochlear nerve
  3. Superior olivary nucleus
  4. Lateral lemniscus
  5. Inferior colliculus
  6. Medial geniculate
  7. Auditory radiations (thalamocortical)
33
Q

What are ENGs?

A

Electronystagmography–measuring the eye movement by detecting the changes in electrical activity whilst injecting cold water

34
Q

What way does nystagmus occur with cold water injection in the ear?

A

Toward the side

35
Q

Vertigo only with head movement = ?

A

Peripheral process

36
Q

Jerk nystagmus at rest/exacerbated by movement = ?

A

Central process

37
Q

Otologic s/sx associated with vertigo most likely indicates what?

A

Peripheral vertigo

38
Q

What type of nystagmus is usually found with peripheral disorders?

A

Jerk

39
Q

What is vestibular neuritis?

A

Inflammation of the vestibular nerve, usually of viral etiology

40
Q

What is labyrinthitis?

A

Inflammation of the labyrinth, usually

41
Q

What is Ramsey-Hunt syndrome?

A

Zoster infection of the labyrinth

42
Q

What are the traumatic causes of peripheral vestibular disorders?

A

Perilymph fistulas

Cupulo-lithiasis

43
Q

What is the classic sign of Ramsey-Hunt syndrome?

A

Vesicles in the ear canal

44
Q

What is Meniere’s syndrome?

A

Endolymph hydrops (too much fluid in the ear), which flows into other areas, causing damage

45
Q

What is the classic triad of symptoms for Meniere’s disease?

A

Vertigo
Tinnitus
Hearing loss

46
Q

What is cholesteatoma?

A

Hyalinized epithelium of the middle ear

47
Q

What is the bloody supply to CN VIII?

A

Internal auditory artery

48
Q

What is the usual presentation of a labyrinthine infarction?

A

Sudden hearing loss

49
Q

What are the associated symptoms of motion sickness?

A

Autonomic overtones (sweating, salivation, yawning)

50
Q

What, generally, causes motion sickness?

A

Overstimulation of peripheral vestibular system

51
Q

True or false: motion sickness may be induced by eye movements

A

True

52
Q

Is BPV usually unilateral or bilateral?

A

Unilateral

53
Q

What usually precipitates episodes of vertigo with BPV?

A

Movement of the head

54
Q

What causes acoustic neuromas?

A

Schwannomas

55
Q

Bilateral schwannomas = ?

A

NF2

56
Q

Vertigo that comes on at rest or worse with position changes = ?

A

Central vertigo

57
Q

What are the other, general, signs associated with central causes of vertigo?

A

CNS findings (e.g. diplopia, dysarthria, ataxia etc)

58
Q

What is the arterial supply to the pons?

A

Basilar artery

59
Q

What is the general medication class that is used to treat central vertigo?

A

Vestibular suppressants

60
Q

What are the four major classes of drugs used to treat vertigo?

A
  • Antihistamines
  • Benzos
  • Phenothiazines
  • Scopolamine
61
Q

What is the goal with the Epley maneuvers?

A

Reposition the otoconia

62
Q

How can you tell which ear is affected with BPV?

A

Nystagmus will go to the side of the lesion

63
Q

How, generally, are the Epley maneuvers performed?

A

Lay head down towards the side of dysfunction

Neurology (23 decks)

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