Disorders of Equilibrium - Sachen Flashcards
Loss of 2 of WHAT three systems can cause loss of balance
Visual, Vestibular, Proprioceptive (peripheral nn and dorsal columns)
Importance of Romberg test
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
Loss of vestibular
Nausea, vomiting, dizzy, etc.
Vertigo
Causes?
Movement of self or objects around self
Vestibular or neurologic
Disequilibrium
Causes?
Altered static or dynamic balance
Cerebellum, dorsal columns, motor systems, basal ganglia
Presyncope
Lightheadedness or impending LOC due to orthostasis, arrhythmia, hyperventilation, fever, prolonged standing
Determining cause of disequilibrium
Romberg - positive = sensory (prop. or visual)
- negative = motor or cerebellar
Pale, sweating, weak, visual dimming
Causes?
Provoked by what?
Presyncope
Arrhythmia, orthostatic hypotension, vasovagal excess, pulmonary emboli, drugs
Hot, long standing, large meals
Peripheral equilibrium (ear) cause:
Vertigo Nystagmus Nausea and vomiting Hearing loss Neuro symptoms
V - intense N - brief, fatigueable, fixed direction, horizontal N/V - intense H - possibly N - never
Central equilibrium (CNS) cause:
Vertigo Nystagmus Nausea and vomiting Hearing loss Neuro symptoms
V - mild N - persistant, not fatiguable, can be VERTICAL (brainstem), changes direction N/V - mild H - rarely N - usually other neuro symptoms
4 peripheral causes of vertigo
Benign positional vertigo
Vestibular neuronitis
Meniere’s disease
Drug-induced ototoxicity
Brief recurrent episodes of vertigo triggered by changes in head position with respect to gravity
Cause?
Benign positional vertigo
Floater in endolymph
Most frequently canal affected in BPV
Nystagmus type?
Dix Hallpike finding?
Posterior
Torsional
Affected ear DOWN
Dix Hallpike maneuver
Head extended and rotates toward lesion side
Patient is quickly laid down while head is held in place
Medications for BPV
Vestibular suppressants (valium, scopolamine, meclizine)
Anti-emetics (phenergan, compazine(
Anxiolytics
Spontaneous attack of vertigo that does not have hearing symptoms
Resolves spontaneously
Vertigo, nausea, vomiting, NOT positional
Vestibular neuronitis
Recurrent spontaneous vertigo (typically hours long)
Subsequent disequilibrium for several days
Tinnitus
Aural fullness
Meniere’s Disease
Drugs that could cause vertigo
Alcohol, salicylates, anti-epileptics, antibiotics, diuretics, chemotherapy
Repeated episodes of vertigo without other neuro symptoms should suggest a ______
Non-neuro cause (i.e. vascular, etc.)
Neoplastic cause of vertigo
Generally involving what nerves?
CPA tumor (acoustic neuroma, meningioma)
V, VII, VIII
2 1st signs of a CPA tumor
Hearing loss, absent corneal reflex
Metastatic cancer to the CNS can commonly affect what?
How?
Cerebellum
Antibodies against Purkinje cells
Requirements to diagnose a vestibular migraine (3)
5 episodes of vestibular symptoms lasting over 5 min
Current/previous Hx of migraine
Migraine features w/ at least 50% of episodes
Viral causes of vertigo symptoms
Bacterial
Rickettsial
Fungal
EBV, herpes, HIV, PML, etc.
Meningococcal, pneumococcal, H. flu
RMSF, Lyme disease
Cryptococcal, Histoplasma
