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NS2 Test 3 > Disorders of Equilibrium > Flashcards

Disorders of Equilibrium Flashcards

1
Q

Balance and awareness of body position requires input from 2 of the 3 systems:

A
  • visual (distance)
  • labyrinthine/vestibular (acceleration, position change)
  • proprioceptive (posture)
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2
Q

Romberg test–tests what?

A

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
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3
Q

vertigo

A

illusion of movement of 1 self or objects around self

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4
Q

disequilibrium

A
  • usually a nonvertiginous state

- altered static or dynamic balance due to dysnfunction of cerebellum, dorsal columns, motor systems

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5
Q

presyncope

A

lightheadedness or impending loss of consciousness

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6
Q

vertigo is due to? accompanied by? Associated with?

A

vestibular dysfunction (semicircular canals/otoliths)

  • accompanied by sweating, nausea
  • associated with hearing impairement, tinnitus
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7
Q

disequilibrium due to?

A
  • 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)
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8
Q

presyncope associated with?

A

pallor, sweating, visual dimming or constricted fields, weakness

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9
Q

presyncope etiologies

A
  • arrhythmia
  • hypotension
  • vasovagal excess
  • pulmonary emboli
  • drugs
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10
Q

presyncope aggrevated by?

A
  • increased T
  • prolonged standing
  • large meals
  • deconditioning
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11
Q

disorders of equilibrium–central (vs peripheral)–vertigo, duration of nystagmus, fatigue of nystagmus, direction of nystagmus, hearing loss, neuro symptoms

A
  • vertigo-mild
  • duration-persists
  • fatigue-no
  • direction-changeble, can be vertical
  • hearing loss–rarely
  • neuro symptoms–usually
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12
Q

disorders of equilibrium– peripheral (vs central)–vertigo, duration of nystagmus, fatigue of nystagmus, direction of nystagmus, hearing loss, neuro symptoms

A
  • vertigo-intense
  • duration–brief
  • fatigue-yes
  • direction-fixed, horizontal/diagonal (cant be vertical)
  • hearing loss–possibly
  • neuro symptoms–NEVER
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13
Q

peripheral causes of vertigo

A
  • benign positional vertico
  • vestibular neuronitis
  • meniere’s disease
  • drug induced ototoxicity
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14
Q

benign positional vertigo–etiology, what is it? due to?

A
  • 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)
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15
Q

BPV most common canal involved? Provacative maneuver?

A

posterior

-Dix Hallpike

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16
Q

BPV diagnosis?

A
  • patient with positional vertigo

- confirmed by Dix-Hallpike position testing

17
Q

BPV treatment

A
  • positional excercises helpful
  • vestibular suppressants (scopolamine)
  • antiemetics
  • anxiolytics
  • vestibular rehabilitation
18
Q

Dix Hallpike

A
  • 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)
19
Q

Vestibular neuronitis–what is it?

A
  • spontaneous attack of vertigo, no hearing loss or tinnitus, resolves spontaneously
  • vertigo, nausea, vomiting–lasts up to 2 weeks
  • not characteristically positional!!
20
Q

Meniere’s disease–onset? what is it? due to?

A
  • 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
21
Q

Peripheral Equlibrium Disorders–drug induced

A
  • alcohol
  • salicylates (first sign of aspirin overdose is tinnitus)
  • anti-epileptics
  • quinine compounds
  • antibiotics–aminoglycosides
  • diuretics
  • chemotherapeutic
22
Q

central causes of equilibrium disorders–vascular

A
  • elderly
  • abrupt onset!
  • ischemia of labyrinth, brainstem, or both
  • vertigo with other neuro symptoms
23
Q

-repeated episodes of isolated vertigo without other neuro symptoms suggests?

A

-non-neurological cause

24
Q

central causes of equilibrium disorders–developmental

A

Chiari malformations

25
Q

central causes of equilibrium disroders–neoplastic

A

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
26
Q

central causes of equilibrium disorders–paraneoplastic

A

Paraneoplastic Cerebellar degeneration

  • associated with cancer of breast, ovary, lung
  • antibodies to tumor cell antigens that cross-react with cerebellar purkinje cells
27
Q

Vestibular migraine

A
  • 5 episodes of vestibular symptoms lasting 5 minutes to 72 hours
  • migraine history
  • migraine features with 50% of episodes
  • unaccounted for by other diagnosis
28
Q

central causes of equilibrium disorders–metabolic

A
  • Vit B12, E deficiency
  • hypothyroid–affects cerebellar (slowly evolves)
  • Wilson’s disease (Copper)
29
Q

central causes of equilibrium disorders–toxins

A
  • heavy metals, CO, glue
  • ethanol–chronic–affects cerebellar vermis (truncal, LE ataxias–stand with feet apart)
  • medications
30
Q

central causes of equilibrium disorders–degenerative

A

-Parkinson’s disease

31
Q

Central cause of equilibrium disorders–spinocerebellar ataxias

A
  • SCA1 (olivopontocerebellar) and SCA3 (Machado-Joseph)–most common
  • cerebellar ataxia of limbs with brainstem signs and peripheral neuropathy
  • affects gait early
32
Q

central causes of equilibrium disorders–Friedrich’s Ataxia–obligatory features

A
  • 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
33
Q

Friedrich’s ataxia–secondary features

A
  • extensor plantar responses
  • pes cavus
  • scoliosis
  • cardiomyopathy
34
Q

central causes of equilibrium disorders–Ataxia Telangiectasia

A
  • autosomal recessive (chrom 11)

- gait, limb, trunk ataxia–begins in infancy (

NS2 Test 3 (14 decks)

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