Dizziness Flashcards
What is the pathology behind central vertigo?
Posterior fossa insults –> get MRI;
neighborhood signs, cerebellar signs, focal neurologic deficits
What is peripheral vertigo?
Tinnitus, hearing loss, no brain stem signs, no FND
What are the main posterior fossa lesions?
Stroke
MS
tumor
less common: complex migraines, seizures, abscess
What is the pathology behind BPPV?
Otolith;
recurrent and reproducible vertigo <1 min;
peripheral vertigo does not require MRI
What is the pathology being vestibular neuritis?
“post-viral”
patient presents 4 weeks post URI with vertigo lasting 1-10 min;
hearing loss and n/v may also be present
What is the treatment for vestibular neuritis?
Steroids, meclizine;
What is the treatment for Meniere’s disease?
Salt restriction;
thiazide diuretics
Anti-vertigo meds?
What is a common first symptom of MS?
Optic neuritis
How is MS diagnosed?
LP - oligoclonal bands;
MRI is nonspecific but first line;
If MRI is inconclusive, evoked potentials test
What is the treatment for an MS flare?
high dose IV steroids over 3-4 days
What is MG?
An autoimmune disease against the acetylcholine receptors;
How is MG diagnosed?
EMG;
Do CT to r/o thymoma
What treatment is recommended to extend life in ALS patients?
Riluzole
What treatment is recommended for Lambert-Eaton syndrome?
Chemo/surgery;
Azathioprine
How will a patient with Lambert-Eaton syndrome?
Proximal muscle weakness;
difficulty rising from a chair;
difficulty combing hair
What is the pathology of Lambert Eaton syndrome?
Antibodies against presynaptic calcium channels;
paraneoplastic
How will a patient present with MG?
Fatigability of small muscles;
blurry vision;
dysphagia worse at the end of the day
What is the treatment for MG?
Use neositgmine to increase ACh in the cleft;
in resistant disease:
use steroids in over 60s;
thymectomy if under 60 can be curative;
IVIg for emergencies (= to plasmapheresis)
What does an LP reveal in a patient with GB?
Lots of protein;
few cells
What is the treatement for GB?
NEVER steroids;
IVIg - plasmapheresis
What is given for MS with urinary incontinence?
Amitriptyline
