Disorders of Equilibrium Flashcards
Balance and awareness of body position requires input from 2 of the 3 systems:
- visual (distance)
- labyrinthine/vestibular (acceleration, position change)
- proprioceptive (posture)
Romberg test–tests what?
does not test cerebellum!
- vestibular or proprioception
- patient with hands out, closes eyes (takes visual part away), if patient falls, 1 of the 2 systems is wrong
vertigo
illusion of movement of 1 self or objects around self
disequilibrium
- usually a nonvertiginous state
- altered static or dynamic balance due to dysnfunction of cerebellum, dorsal columns, motor systems
presyncope
lightheadedness or impending loss of consciousness
vertigo is due to? accompanied by? Associated with?
vestibular dysfunction (semicircular canals/otoliths)
- accompanied by sweating, nausea
- associated with hearing impairement, tinnitus
disequilibrium due to?
- sensory–proprioceptive deficit, visual impairment, compensated vestibular disorders, worse in dark!! romberg sign
- motor
- cerebellar–no romberg sign (cannot stand with feet together with eyes opened or closed)
presyncope associated with?
pallor, sweating, visual dimming or constricted fields, weakness
presyncope etiologies
- arrhythmia
- hypotension
- vasovagal excess
- pulmonary emboli
- drugs
presyncope aggrevated by?
- increased T
- prolonged standing
- large meals
- deconditioning
disorders of equilibrium–central (vs peripheral)–vertigo, duration of nystagmus, fatigue of nystagmus, direction of nystagmus, hearing loss, neuro symptoms
- vertigo-mild
- duration-persists
- fatigue-no
- direction-changeble, can be vertical
- hearing loss–rarely
- neuro symptoms–usually
disorders of equilibrium– peripheral (vs central)–vertigo, duration of nystagmus, fatigue of nystagmus, direction of nystagmus, hearing loss, neuro symptoms
- vertigo-intense
- duration–brief
- fatigue-yes
- direction-fixed, horizontal/diagonal (cant be vertical)
- hearing loss–possibly
- neuro symptoms–NEVER
peripheral causes of vertigo
- benign positional vertico
- vestibular neuronitis
- meniere’s disease
- drug induced ototoxicity
benign positional vertigo–etiology, what is it? due to?
- most common cause of recurrent vertigo!
- idiopathic, trauma, infection
- brief recurrent episodes of vertigo triggered by changes in head position
- due to debris floating in endolymph of semicircular canals (posterior most common)
BPV most common canal involved? Provacative maneuver?
posterior
-Dix Hallpike
BPV diagnosis?
- patient with positional vertigo
- confirmed by Dix-Hallpike position testing
BPV treatment
- positional excercises helpful
- vestibular suppressants (scopolamine)
- antiemetics
- anxiolytics
- vestibular rehabilitation
Dix Hallpike
- patients head rotated to affected side by 45 degrees
- patient lies down backwards quickly, head in 20 degrees of extension
- patients eyes observed for 45 seconds–5-10 second period of latency before nystagmus (towards ear affected)
Vestibular neuronitis–what is it?
- spontaneous attack of vertigo, no hearing loss or tinnitus, resolves spontaneously
- vertigo, nausea, vomiting–lasts up to 2 weeks
- not characteristically positional!!
Meniere’s disease–onset? what is it? due to?
- onset 20-50 years, females more common (3:1)
- recurrent episodes of spontaneous vertigo–typically hours
- low frequency hearing loss, tinnitus, aural fullness
- due to increase in volume of labyrinthine endolymph
Peripheral Equlibrium Disorders–drug induced
- alcohol
- salicylates (first sign of aspirin overdose is tinnitus)
- anti-epileptics
- quinine compounds
- antibiotics–aminoglycosides
- diuretics
- chemotherapeutic
central causes of equilibrium disorders–vascular
- elderly
- abrupt onset!
- ischemia of labyrinth, brainstem, or both
- vertigo with other neuro symptoms
-repeated episodes of isolated vertigo without other neuro symptoms suggests?
-non-neurological cause
central causes of equilibrium disorders–developmental
Chiari malformations
central causes of equilibrium disroders–neoplastic
CPA tumor
- acoustic neuroma, meningioma
- CNS 5, 7, 8 (first symptom is hearing loss and absent corneal reflex)
- acoustic neuroma associated with NF 1/2
- hearing loss, tinnitus, facial pain or sensory loss
central causes of equilibrium disorders–paraneoplastic
Paraneoplastic Cerebellar degeneration
- associated with cancer of breast, ovary, lung
- antibodies to tumor cell antigens that cross-react with cerebellar purkinje cells
Vestibular migraine
- 5 episodes of vestibular symptoms lasting 5 minutes to 72 hours
- migraine history
- migraine features with 50% of episodes
- unaccounted for by other diagnosis
central causes of equilibrium disorders–metabolic
- Vit B12, E deficiency
- hypothyroid–affects cerebellar (slowly evolves)
- Wilson’s disease (Copper)
central causes of equilibrium disorders–toxins
- heavy metals, CO, glue
- ethanol–chronic–affects cerebellar vermis (truncal, LE ataxias–stand with feet apart)
- medications
central causes of equilibrium disorders–degenerative
-Parkinson’s disease
Central cause of equilibrium disorders–spinocerebellar ataxias
- SCA1 (olivopontocerebellar) and SCA3 (Machado-Joseph)–most common
- cerebellar ataxia of limbs with brainstem signs and peripheral neuropathy
- affects gait early
central causes of equilibrium disorders–Friedrich’s Ataxia–obligatory features
- autosomal recessive (chrom 9)
- onset before age 20–bedridden before age 20 with 10-20 years
- gait ataxia
- progression of ataxia to all 4 limbs
- dysarthria, muscle weakness
Friedrich’s ataxia–secondary features
- extensor plantar responses
- pes cavus
- scoliosis
- cardiomyopathy
central causes of equilibrium disorders–Ataxia Telangiectasia
- autosomal recessive (chrom 11)
- gait, limb, trunk ataxia–begins in infancy (
