Disorders of Equilibrium Flashcards
balance and awareness of body position in relation to surroundings requires input from 2 of following 3 systems
visual: judge distance
labyrinthine: to judge acceleration and positino change
proprioceptive: to judge posture
importance of rombergs test
to test proprioception
dizziness common in
elderly, diabetes pts, people taking antihypertensive meds
vertigo
illusion of movement of oneself or objects around self may be vestibular (semicircular canals/otoliths) or neurologic in origin
- sometimes accompanied by sweating, nausea and hearing impariment or tinnitus
- happens after ride rollercoaster
disequilibrium
- may be caused by vertigo
- but usaually a nonvertiginous state of altered balance due to dysfunction of:
- cerebellum, dorsal columns (sensory), motor systems (central or peripheral, basal ganglia)
presyncope
lightheadedness or impending loss of consciousness due to:
orthostasis, arrhythmia, hyperventilation
nonvertiginous altered static or dynamic balance (3)
sensory: proprioceptive deficit, worse in dark, associated with romberg sign
motor- mechanical arthritis, periph or central, cerebellar, no romberg sign
cerebellar: no romberg sign (can’t stand with feet together with eyes open or closed)
what is asociated with presyncope
-aggravated by what?
pallor, sweating, visual dimming
-increased temp, prolong standing, large meals
peripheral causes of vertigo
benign positional vertigo
vestibular neuronitis
meniere’s disesase
drug induced ototoxicity
benign positional vertigo
most common cause recurrent vertigo
- from traum or infection
- brief recurrent epsisode of vertigo triggered by change in head position
- spontaneous recover often
- debris floating in endolymph of SC canals (mainly posteior one)
posterior BPV provocative maneuver and nystagmus
dix hallpike and torsional
-nystagmus occurs after dix hallpike with affected ear down
treatment of benign positional vertigo
positional exercises
vestibular suppressants (scopolamine)
antiemetics
vestibular neuronitis
spontaneous attack of vertigo that does not involve hearing loss or tinnitus and resolves spontaneousl
vertigo, nausea and vomiting of acute onset lasts up to 2 wseeks
not characteristically positional
meniere’s disease
onset
male to female
path
onset 20-50 yrs old
3 to 1 females
increase voume of labyrinthine endolymph
meniere’s disease presentation
recurrent episodes of spontan vertigo last more than 20 mintues, usualy hours -subsequent dysequilibrium could last several days low frequency hearing loss tinnitus aural fullness
drug induced peripheral vertigo
salicylates
antibiotics like aminoglycosides, tetracycline, vancomycin
central cause vertigo: vascular (ischemic)
more common in elderly
abrupt onset
vertigo associated with other neuro symptoms
repeated episodes of isolated vertigo without other neuro symptoms should always suggest non-neuro cause
chiari malformation and vertigo
cause of central vertigo
central vertigo: neoplastic/paraneoplastic
acoustic neuroma (schwannoma), meningioma involves V, VII, VIII (hearing loss and absent corneal reflex)
NF1 and II for acoustic neuromas
paraneoplastic cerenellar degen (Cent vert)
antibodies from tumor antigens destory purkinje cells in cerebellum
-most commonly associated with cancer of breast, ovary, lung
central: vestibular migraine
5 episodes of mod/severe vestibular symptoms lasting 5 mintues to 72 hours
- current or previous history of migraine with/wthout aura
- one or more migraine features with at least 50% of episodes
central infectious
viral: ebv, hiv, hsv
rickettsial
bacterial: meningococcal, pneumococcal, h flu
fungal: cryptococcal, histoplasm
central: metabolic
deficiency of B1,B12, E vitamins
hypothyroid
wilson’s disease
central: toxins
toxins: glue (toluene), CO –>cerebellar degeneration
ethanol: affects cerebellar vermis = truncal and LE ataxia, irreversible
meds: AED, 5-FU
