Disorders of Equilibrium - Sachen

Question 1

Loss of 2 of WHAT three systems can cause loss of balance

Answer 1

Visual, Vestibular, Proprioceptive (peripheral nn and dorsal columns)

Question 2

Importance of Romberg test

Answer 2

Loss of visual system…if one of other 2 are gone, get positive test

REALLY checking the proprioceptive system (dorsal columns) - would already know about vestibular issues

Question 3

Loss of vestibular

Answer 3

Nausea, vomiting, dizzy, etc.

Question 4

Vertigo

Causes?

Answer 4

Movement of self or objects around self

Vestibular or neurologic

Question 5

Disequilibrium

Causes?

Answer 5

Altered static or dynamic balance

Cerebellum, dorsal columns, motor systems, basal ganglia

Question 6

Presyncope

Answer 6

Lightheadedness or impending LOC due to orthostasis, arrhythmia, hyperventilation, fever, prolonged standing

Question 7

Determining cause of disequilibrium

Answer 7

Romberg - positive = sensory (prop. or visual)

- negative = motor or cerebellar

Question 8

Pale, sweating, weak, visual dimming

Causes?

Provoked by what?

Answer 8

Presyncope

Arrhythmia, orthostatic hypotension, vasovagal excess, pulmonary emboli, drugs

Hot, long standing, large meals

Question 9

Peripheral equilibrium (ear) cause:

Vertigo
Nystagmus
Nausea and vomiting
Hearing loss
Neuro symptoms

Answer 9

V - intense
N - brief, fatigueable, fixed direction, horizontal
N/V - intense
H - possibly
N - never

Question 10

Central equilibrium (CNS) cause:

Vertigo
Nystagmus
Nausea and vomiting
Hearing loss
Neuro symptoms

Answer 10

V - mild
N - persistant, not fatiguable, can be VERTICAL (brainstem), changes direction
N/V - mild
H - rarely
N - usually other neuro symptoms

Question 11

4 peripheral causes of vertigo

Answer 11

Benign positional vertigo
Vestibular neuronitis
Meniere’s disease
Drug-induced ototoxicity

Question 12

Brief recurrent episodes of vertigo triggered by changes in head position with respect to gravity

Cause?

Answer 12

Benign positional vertigo

Floater in endolymph

Question 13

Most frequently canal affected in BPV

Nystagmus type?

Dix Hallpike finding?

Answer 13

Posterior

Torsional

Affected ear DOWN

Question 14

Dix Hallpike maneuver

Answer 14

Head extended and rotates toward lesion side

Patient is quickly laid down while head is held in place

Question 15

Medications for BPV

Answer 15

Vestibular suppressants (valium, scopolamine, meclizine)
Anti-emetics (phenergan, compazine(
Anxiolytics

Question 16

Spontaneous attack of vertigo that does not have hearing symptoms
Resolves spontaneously
Vertigo, nausea, vomiting, NOT positional

Answer 16

Vestibular neuronitis

Question 17

Recurrent spontaneous vertigo (typically hours long)
Subsequent disequilibrium for several days
Tinnitus
Aural fullness

Answer 17

Meniere’s Disease

Question 18

Drugs that could cause vertigo

Answer 18

Alcohol, salicylates, anti-epileptics, antibiotics, diuretics, chemotherapy

Question 19

Repeated episodes of vertigo without other neuro symptoms should suggest a ______

Answer 19

Non-neuro cause (i.e. vascular, etc.)

Question 20

Neoplastic cause of vertigo

Generally involving what nerves?

Answer 20

CPA tumor (acoustic neuroma, meningioma)

V, VII, VIII

Question 21

2 1st signs of a CPA tumor

Answer 21

Hearing loss, absent corneal reflex

Question 22

Metastatic cancer to the CNS can commonly affect what?

How?

Answer 22

Cerebellum

Antibodies against Purkinje cells

Question 23

Requirements to diagnose a vestibular migraine (3)

Answer 23

5 episodes of vestibular symptoms lasting over 5 min
Current/previous Hx of migraine
Migraine features w/ at least 50% of episodes

Question 24

Viral causes of vertigo symptoms
Bacterial
Rickettsial
Fungal

Answer 24

EBV, herpes, HIV, PML, etc.
Meningococcal, pneumococcal, H. flu
RMSF, Lyme disease
Cryptococcal, Histoplasma

Question 25

Metabolic disorders that can cause vertigo symptoms

Answer 25

Vitamin deficiencies
Hypothyroidism
Wilson’s disease (copper metabolism)

Question 26

ALL spinocerebellar ataxias are ____

Answer 26

Trinucleotide repeat disorders

Question 27

Spinocerebellar ataxia symptoms

Answer 27

Defective gait
Progressive ataxia of limbs
Dysarthria, CN 3 lesion, spasticity
Peripheral neuropathy

Question 28

Friedrich's ataxia
Obligatory features (7)

Answer 28

Autosomal recessive, chromosome 9 mutation

Before 20, gait ataxia, progression to quadriplegia, dysarthria, impaired dorsal columns, weakness, absent LE DTR

Question 29

Ataxia-Telangiectasia

Answer 29

Autosomal recessive, chromosome 11 mutation
Progressive ataxia, oculocutaneous telangiectasia, recurrent sinopulmonary infections, many other possible movement symptoms