NMS Final Flashcards
(200 cards)
1
Q
What are the 2 types of episodic loss/lapse of consciousness?
A
Syncope and seizures.
2
Q
What is the difference between syncope and seizures?
A
Syncope is due to global cerebral and or brainstem ischemia. Seizures are due to abnormal cerebral neuronal discharges.
3
Q
What is the onset like for syncope and seizures?
A
Syncope is progressive onset of lightheadedness and in an upright posture usually. Seizures- sudden onset.
4
Q
How will syncope and seizures end?
A
Syncope promt recovery. Seizure- postictal confusional state may follow.
5
Q
Name some of the causes of seizures?
A
idiopathic (usually epilepsy), febrile convulsions (in kids with high body temps and are benign and haave no increase in risk of epilepsy, trauma, brain tumors, stroke, infections, metabolic.
6
Q
What are the 2 general types of seizures?
A
Generalized and partial.
7
Q
What are the generalized seizures like?
A
involve the entire brain, sudden onset and are usually bilateral and symmetrical. These have a high familial predisopistion and are usually benign.
8
Q
What are partial seizures like?
A
Invovle a focal part of the brain, usually secondary to a disease or pathology and have a wide variety of symptoms.
9
Q
What should be done with partial seizures?
A
They should be stereotyped.
10
Q
What are the different types of generalized seizures?
A
- Tonic-clonic (grand mal). 2. Absence (petit mal). 3. Other (tonic, clonic, myoclonic, atonic- drop attacks).
11
Q
What are tonic-clonic (gand mal) seizures like?
A
10-30 sec of tonic and then 30-60 sec of clonic (shaking) then 10-30 minutes of postictal confusional state.
12
Q
What are absence (petit mal) seizures like?
A
loss of consciousness but not postural tone, momentary lapses of consiousness. They may become tonic-clonic.
13
Q
What are the different types of partial seizures?
A
Simple and complex.
14
Q
What are simple partial seizures like?
A
Similar to TIA. Consciousness is maintained and symptoms correlate to area of the brain seizing and can have motor, sensory, autonomic, psychic, auditory, olfactory, etc.
15
Q
What are complex partial seizures like?
A
impairment of consciousness, but not loss. May have an aura that precedes it. Can have automatisms (involuntary motor activity like lip smacking or picking at a button).
16
Q
What type of imaging should be done for someone with seizures?
A
MRI to find a treatable cause of the brain. EEG to look for classic abnormalities in brain.
17
Q
What type of nutrition is recommended for someone with idiopathic generalized epilepsy?
A
no large meals, avoid alcohol and caffeine. Take vitamin E. Ketogenic diet.
18
Q
What is a hydrocephalus?
A
An abnormal accumulation of CSF.
19
Q
What are some causes of hydrocephalus?
A
may be idiopathic or secondary to meningitis, subarachnoid hemorrhage, or other pathologies.
20
Q
What are the signs and symptoms of someone with hydrocephalus?
A
Weird, wet, wobbly. Dementia, slowing of movement, urinary incontinence, gait apraxia.
21
Q
How will you diagnose hydrocuphalus?
A
MRI shows large ventricles without cortical atrophy. Lumbar puncture- may have normal or elevated opening pressure.
22
Q
What are the signs and symptoms of a brain tumor?
A
Cognitive changes and HA are most common.
23
Q
Name 2 hereditary causes of dementia?
A
Wilsons disease and huntingtons disease.
24
Q
What is Wilson’s disease?
A
a disorder of copper metabolism which lets copper accumulate in the brain, basal ganglia, liver, cornea and kidney. IT IS THE ONLY DEMENTIA SEEN IN KIDS AND HAS AN ONSET OF AGE 11-19.
25
What is Huntington's disease?
An autosomal dominant progressive dementia and chorea.
26
Name the 2 big types of HA we went over?
Pathological and Chronic/benign HA.
27
What % of HA are benign?
99.5% are benign. 1 out of 300 severe HA are pathologic.
28
What are the different types of pathologic HA?
brain tumor, CNS infection, subarachnoid hemorrhage, subdural hematoma, epidural hematoma, temporal arteritis, glaucoma, stroke-hemorrhagic.
29
Name some of the red flags for pathological HA?
recent trauma, worst HA of life, over 50, HA worse in morning and improves when upright, vomiting without nausea, visual distrubances.
30
How will brain tumors present?
focal neurologic deficits, personality/behavior changes, HA that gets progressively worse without remission, partial (focal) seizures are common, sighns of increased intracranial pressure (papilledema).
31
What % of brain tumors will present with a HA?
60% will.
32
What are HA caused by brain tumors like?
50% have nausea/vomiting, vomiting may precede HA by days to weeks (bad sign), 2/3 have increaed ICP, 1/# have seizures. Not as severe as migrains.
33
Will a brain tumor more likely be from metastasis or primary?
Metastasis from lung, breast and melanoma.
34
What is the difference between a brain tumor and a cerebral abcess?
Similar clinical picture but a Pt with cerebral abscesses will have a history of illness or is currently ill.
35
What is a pseudotumor cerebri?
benign intracranial hypertension.
36
What are the signs and symptoms of pseudotumor cerebri?
HA that gets worse with straining, nausea/vomiting, papilledema, visual disturbances, NO MENTAL CHANGES OR FOCAL BRAIN SIGNS.
37
What is a HA caused by a subarachnoid hematoma like?
Sudden, explosive, severe onset. "worst HA of my life"
38
What is the most common cause of subarachnoid hemorrhage?
Congenital (aneurysm) not traumatic.
39
What is a sentinel bleed?
minor leaks before rupture of a subarachnoid hemorrhage.
40
An aneurysm may be preceded by a HA and it may affect what CN?
III.
41
Will there be focal neurological deficits seen with aneurysm rupturs?
Usually no.
42
What is a stroke?
hemorrhagic and ischemic loss of blood. Can be caused by an anyersm and atherosclerosis, HTN.
43
HA in combination with what will be classified as a stroke?
HA in combination with focal neurolgical deficits.
44
What are the ancillary tests to order for someone who might have a subarachnoid hemorrhage?
CT scan and if negative order lumbar puncture within 3 days or blood will be resorbed.
45
When would you take a MRI for subarachnoid hemorrhages?
To seen arteriovenous malformations.
46
How likely are people who have a sentinel bleed to have a rupture?
50% in one year.
47
What happens to people who have a rupture?
20% die before hospital, 25% die later from complications, 20% die from re-bleeding. Probability of death is correlated to the level of consciousness at the time of event.
48
What is Temporal arteritis (giant cell) like?
Rare before 50 years old. Risk of TIA or stroke of opthalmic artery and sudden blidness. 70% have tender temopral artery and 50% have jaw claudication. SED rate >50.
49
What is the HA like for someone with temporal arteritis?
dull boring with superimposed "ice-pcik jabs.
50
40-50% of people with temporal arteritis have what?
polymyalgia rheumatica.
51
What is glaucoma?
increased intra-occular pressure, vision loss.
52
What will glaucoma present like?
eye pain, HA, blurred vision, Halos, trigeminal division can have permanent vision loss.
53
What are cough HA like?
90% are benign and are HA caused by lifting, straining or cough.
54
How long will migraine attacks last?
4-72 hours.
55
What is the new theory on the mechanisms of migraines?
neuronal excitation phenomenon 2mm/min. Hypoperfusion to hyperemia over 6 min period. Role of seratonin.
56
What is a basilar migraine?
a migraine that is like a stroke and should have a full workup done on it.
57
What is a migraine equivalent?
a migraine without the HA, Pt has aura but no HA, more common in elderly, complete workup should be done to rule out TIA or stroke.
58
What type of diet can help with migraines?
magnesium, Riboflavin, Vitamin E, fish oil, antioxidant, feverfew.
59
What is the criteria for cluster HA?
severe pain lasting 15-180 minutes and has one of the following: conjunctival injection, lacrimatino, rhinorrhea, nasal congestion, meiosis, ptosis, eyelid edema, forehead and facial sweating. Also has frequency of attacks from 1 every day to up to 8 per day.
60
What are the 2 patterns for cluster HA?
episodic and chronic.
61
Who is more likely to get cluster HA?
males 6:1. onset 20-50 years old.
62
Cervicogenic HA come from what?
the first three cervical nerves.
63
What is the criteria for cervicogenic HA's?
pain localized to neck and occiput region and may project to the head, pain is precipitated or aggravated by special neck movments or sustained posture, one of the following: (resistance to passive neck movements, changes in neck muscle contour, texture, tone or response to stretching, abnormal tenderness to neck muscles).
64
What will radiologic examination reveal for cervicogenic HA's?
movement abnormalities in flexion/extension, abnormal posture.
65
Will cervicogenic HA be uni or bi lateral?
Unilateral.
66
What are tension-type HA's?
HA lasting 30 minutes to 7 days, at least 2 of the following: (pressure/tightening quality, mild or moderate intensity, bilateral location, no aggravation by walking stairs), both no nausea or photophobia.
67
What are the causes of tension-type HA?
stress and muscle tension, long lasting muscular contraction, lack or rest/sleep.
68
What are post-traumatic HA like?
usually starts within a day of trauma and is dull achy constant bi-occipital pain and may throb and get worse with cough, vertigo and dizziness is common, concentration is difficult.
69
What is the natural history of post-traumatic HA?
85% recover in 3 years, 80% in 2 years, 70% in one year.
70
Most HA are what type?
Mixed HA.
71
The research shows that manipulation is _____ for chronic tension HA's?
effective.
72
What is neuralgia?
pain in one or more nerves that ocurs without stimulation of pain receptor cells. A shooting/electrical nerve type pain.
73
what is the neuralgia that is maxillary and or mandibular pain 94% and 5% opthalmic pain?
trigmenial neuralgia aka tic douloureux.
74
Trigmeinal neuralgia is secondary to what?
focal demyelinating diease, MS in young people, cerebellopontine angel tumor.
75
What are the clinical features of trigeminal neuralgia?
unilateral face pain, lasting seconds and may recur in trains, triggers chew/talk/brush teeth, wind (light stimulation).
76
What is a neuro test like for someone with trigeminal neuralgai aka tic douloureux?
hyperalgesia and hyperestheisa. NO sensory loss is present.
77
What is herpes zoster of the face like?
usually unilateral itching/tingling/burning/aching 4-5 days before a rash and is a type of neuralgia. 25% will have it for > 1 year.
78
What is occipital neuralgia like?
C2 nerve root entrapment causing a lancinating "ice pick" pain in the scalp in the occipital area, paresthesia along the c2 dermatome, usually unilateral.
79
What is a glossopharyngeal neuralgia like?
usually unilateral and is uncommon, pain radiating up to ear and down throat to base of tongue, nocutranal attacks are common.
80
What is superior laryngeal neuralgia like?
a branch of the CN X, unilateral submandibular pain tirggered in the lateral neck above larynx by swallowing/strain of voice/head turn/ cough. May change voice.
81
What are the different patterns of sensory disturbances?
peripheral nerve lesions, spinal cord lesions.
82
What are motor deficit diseases?
anterior horn cell disease, neuromuscular junction disease, primary muscle disease (myopathy).
83
How can you tell the difference between the 3 types of motor deficit diseases?
anterior horn cell has UMN and LMN signs and the neuromuscluar junction and primary muscle disease just have LMN signs.
84
What are the 2 types of non-infectious anterior horn cell disorders?
ALS and motor neuron disease in children known as spinal muscular atrophy (SMA).
85
What is the difference between ALS and SMA?
SMA is in kids and has a genetic predisposition.
86
When is the onset for ALS?
30-60 yo
87
What is the case of ALS?
Unknown but has a 10% familial tendency. Could be autoimmune, virus, tobacco, excess physical activity.
88
What will ALS do?
a degenerative disease of the anterior horn cells in the spinal cord and causes ONLY MOTOR deficits.
89
What is motor weakness like with ALS?
described as easy fatigability, twitching, wasting, muscle cramps, stiffness. Has both upper and motor neuron signs.
90
How is a diagnosis for ALS made?
UMN and LMN signs in the bulbar and 2 spinal regions or in 3 spinal regions. No definitive test.
91
What is the prognosis for ALS?
death in 3-5 years due to pulmonary infections.
92
What is the difference between primary lateral sclerosis and ALS?
PLS is a variant of ALS and is just UMN signs and has a better prognosis of death in 10-20 years.
93
What type of diet can help with ALS?
high fat and low intesity exercise. Detoxification.
94
Name the infectious anterior horn disorders?
poliomyelitis, post-polio syndrome.
95
What is poliomyelitis like?
Only affects the LMN and is rare in the USA due to immuizations.
96
What is post-polio syndrome like?
onset 40-60 yo only LMN and is probably age related.
97
name the different types of Neuromuscular junction diseases?
myasthenia gravis, boutulism, myasthenic syndrome Leaton.
98
what do neuromsuclar junction diseases do?
they block the neurotransmitter Ach.
99
What is myasthenia gravis like?
autoimmune attack against the NT ach and has a relapsing/remitting pattern anc can happen at any age. Can be caused by thyroid tumors.
100
Myasthenia Gravis affects what?
smaller muscles like ocular muscles and other CN innervated muscles.
101
How can you treat myasthenia gravis?
dramatic response to anti-cholinesterase drugs. Remove thyomas if they are causing the problem.
102
What will botulism do?
it is a toxin that prevents the relase of Ach at the neuromusclar junction causing paralysis and they need the anti-toxin and guanidine and respiratory support or they die.
103
What are the signs of botulism?
nausea, vomiting, paralysis of ocular muscles and other CN innervated muscles and respiration muscles (like myasthenia Gravis)
104
What are the different types of myopathies (primary muscle diseases)?
1. Muscluar dystrophy 2. endocrine myopathy. 3. inflammatory myopathy. 4. toxic myopathy.
105
What are the types of endocrine myopathies that cause primary muscle diseases?
hyper/hypo-thyroidism, parathyroid, adrenals, GH.
106
What are the types of inflammatory myopathies?
polymyositis and dermatomyositis.
107
What are the different types of toxic myopathies?
drugs, alcohol, toxins.
108
How will people get muscular dystrophy?
genetic and some are predominantly male like duchenne.
109
What is muscluar dystrophy like?
progressive weakness and wasting of proximal muscles.
110
How can you test for muscular dystrophy?
CPK will confirm and monitor it.
111
What is the prognosis for Duchenne's muscular dystrophy?
death in 15 years.
112
what is polymyositis?
An inflammaotry myopathy that you can get at any age and is an autoimmune reaction against muscles and is seen with RA, SS, SLE, AIDS, etc.
113
What is the muscle weakness seen with polymyositis like?
bilateral, symmetrical progressive proximal, wasting, mild pain. Seen with other autoimmune symptoms like malaise, weight loss, arthralgia, low grade fever, raynauds.
114
What is dermatomyositis?
the same as polymyositis with an erythematous rash over the eyelids and extensor surface. It is monitored and confirmed with CPK and aldolase, but muscle biopsy can also be done.
115
Besides the rash what other risks will dermatomyositis have that polymyositis will not?
higher risk for cancers.
116
What is the difference between polymyalgia rheumatica and polymyositis?
Polymyalgia rheumatica has muscle pain, negative biopsy, and is associated with temporal arteritis.
117
What are the different types of sensorimotor diseases?
sensory only, mixed with motor, CNS and PNS disease.
118
What are the types of peripheral nerve disease that cause sensory motor loss?
radiculopathy, plexopathy, peripheral neuropathy.
119
What are the 2 types of peripheral neuropathy?
mono- and poly- neuropathy.
120
What can cause a mononeuropathy?
entrapments, trauma, HNP, osteophytes, TOS.
121
What will a polyneuropathy be like?
usually distal and symmetrical like stocking and glove sensory defictis, DTR's diminished and are usually a metabolic systemic and diffuse.
122
What are the most common causes of polyneuropathy?
DM, alcoholic, hereditary, cancer, infections, B12 deficiency.
123
Name a very aggressive type of polyneuropathy?
Guillain-Barre syndrome.
124
What is guillain-Barre syndrome?
an unknown caused autoimmune disease that attacks schwann cells and not oligodendrocytes and is the PNS version of MS.
125
What are the 2 types of Guillain-Barre syndrome?
1. AIDP which is the demylinating form and the most common. 2. CIDP which attacks the axon.
126
What are the signs and symptoms of Guillain-Barre syndrome?
more motor weakness compared to sensory loss, usually begins in the legs, tachycardia, labile BP, distrubed sweating, bowel and bladder usually not effected.
127
How is Guillain-Barre syndrome diagnosed?
Lumbar puncture shows high protein in CSF with normal cell count.
128
What is the prognosis for AIDP type of Guillain-barre syndrome?
4 weeks it peaks and takes months to recover but it is self-limiting and 75% have a full recovery and only 5% die.
129
What is the difference in presentation for Guillain-barre syndrome CIDP vs AIDP?
CIDP follows a slower course.
130
What are diabetic peripheral polyneuropathies like?
mixed pattern of sensory, motor and autonomic, pain (burning in feet), numbness, paresthesias, lower extremities most common, DTR and vibration is lost first.
131
What is B12 deficency like?
symmetric distal sensory, motor and DTR loss since it is needed to make myelin. The cord and or cortex may also be involved.
132
What are the different types of peripheral mononeuropathy?
radiculopathy, plexopathy, palsey (entrapment syndrome).
133
What are the causes of entrapment syndromes?
tunnel syndromes, meralgia paresthetica (sensory only), superficial peronela nerve injury, pronator teres syndrome, piriformis syndrome, ulnar nerve entrapmetn syndromes.
134
How can you tell you have an entrapment syndrome?
It will follow a peripheral nerve pattern and have a positive tinels.
135
What is the most common plexopathy?
brachial.
136
What can cause a plexopathy?
entrapment, trauma, infection, inflammation, tumor/SOL.
137
What kind of sings ware seen with myelopathy?
Usually UMN lesions, but can have LMN at the level of damage since the anterior horn has the motor nuclei.
138
A unilateral spinal cord lesion will have ipsilateral neurological deficits in all tracts besides what?
pain and temperature which will be contralateral.
139
Name some causes of myelopathies?
synrix, B12 deficiency, spondylosis, cervical and thoracic disc herniations, multiple sclerosis, trauma, infection, tumor/SOL, vascular (stroke).
140
A synrinx is a cavitation in the central canal that dustrubs the CSF flow and causes what type of damage?
intramedullary.
141
What things can cause a synrix?
Congenital (arnol Chiari Malformation), trauma, neoplasm, inflammatory, idiopathic.
142
Synringomyelia's affect what early on and why?
Pain and temperature since they cross the spinal cord in the center.
143
What is a common synringomyelia presentation?
bilateral loss of pain and temperature sensation along the shoulders and upper extremities . People may burn themselves in the tub or while cooking. As the synrix enlarges it can damage more parts of the spine.
144
What is arnold chiari?
congenital abnormality of platybasia occipitalization that can cause herniation of the cerebellar tonsil and brain stem through the foramen magnum.
145
What are the signs of arnold chiari malformation?
central vertigo, cerebellar sings, lower brainstem and CN signs. Often has neck pain.
146
What is MS?
a CNS demyelination disease of oligodendrocytes that causes inflammation and sclerotic plaques in the CNS (brain, brainstem, cerebellum, spinal cord).
147
What is the age people are most likely to get MS?
between 20-50.
148
What are the signs of someone with MS?
It can affect any part of the CNS so it can have a wide variety of presentations but will come in episodes separated in time and space. Often has visual problems.
149
What are the different types of MS?
3 types RRMS, SOMS, PPMS.
150
What is RRMS?
Relapsing-remitting MS. Not as disabling as other and 85% start this way.
151
What is SPMS?
secondary progressive MS- 50% of RRMS will develop this.
152
Wha tis PPMS?
primary progressive MS- tends to start ata later age and has an equal male:female ratio.
153
What is the typical Male:female ratio for MS?
1.6:1 Female:male.
154
What is the diagnostic criteria for MS?
2 attacks at least 1 month apart, clinical evidence of at least one lesion (MRI plaque or CSF analysis showing oligoclonal bands).
155
What is a typical history of someone with MS?
episodes of visual problems, bladder dysequilibrium, parestsias, weakness of UMN type.
156
What typically aggravates MS?
Heat.
157
What is the conservative treatment of MS like?
avoid fatigue, avoid excesive heat/fever, exercise, PT, CMT, anti-inflammatory diet, vitamin D.
158
What is the prognosis like for MS?
rule of thirds. 1/3- none-minimal disability. 1/3- middle ground disability. 1/3 severe disability (wheelchair).
159
What will give an indication to the disability that can be expected with MS?
The course of the disease in the first 5 years.
160
Where is the most common disc herniation at?
C6-7 and L4-S1.
161
What are the likely causes of spinal cord or NR compression?
disc herniations, trauma, DJD (stenosis).
162
90% of spinal cord tumors are where?
Extramedullary.
163
What is the most common symptom with a cord tumor?
Pain that worsens with coughing, sneezing, and straining.
164
Name 3 types of dizziness?
Vertigo, light-headedness, dysequillibrium.
165
What is a typical history of someone with dizziness/vertigo?
precipitating factors (head positions, sneezing cough, loud noises with Menieres) associated symptoms (nausea/vomiting, hearing, diplopia).
166
What are the 2 types of vertigo?
central and peripheral.
167
What is the difference between central and peripheral?
Central- CNS disease and signs are greater than symptoms (vertical nystagmus present. Peripheral- PNS disease and symptoms are greater than signs (may have horizontal nystagmus).
168
How bad is peripheral vertigo?
Usually severe.
169
Name the 3 features of peripheral vertigo?
latency (take a few seconds to start with certain head positions), habituation, fatiguability.
170
Can you have vertical nystagmus with peripheral vertigo?
NO.
171
Will there be signs of brain, brainstem, or cerebellar diseases with peripheral vertigo?
No.
172
What is the first position the head is put into for hall-pike maneuver?
45 degrees with or without extension.
173
As you lay patient supine during hall-pike maneuver what should you do?
Not allow the neck to move.
174
What is BPV?
Benign positional vertigo (otoliths in the inner ear).
175
What causes BPV?
trauma, infection, age.
176
What will a BPV attack be like?
Hits like a ton of bricks and lasts for 30-45 seconds.
177
What is the epley manuever and it is aka?
treatment for otoliths in the inner ear and aka canalith repositioning procedure.
178
What is cervicogenic vertigo?
disorder of upper cervical proprioceptors and can cause vertigo.
179
Cervicogenic vertigo is assoicated with what?
cervical trauma, degeneration or other medical problems.
180
What type of symptoms will you have with cervicogenic vertigo when the head moves while the neck is fixed?
None. Only occurs with neck motion.
181
What is a treatment for cervicogenic vertigo?
CMPT, TPT.
182
What is a test you can do for cervicogenic vertigo?
Swivel chair test.
183
What is acute labyrinthitis?
an inner ear infection that occurs post-viral and is a peripheral vertigo.
184
What is acute labyrinthitis like?
rapid onset and ramps up and will be constant not an episodic vertigo, but reaches a peak and then subsides gradually.
185
What is Meniere's disease?
a peripheral vertigo.
186
What is Meniere's disease like?
triad of symptoms (vertigo, sensorineural hearing loss, tinnitus, pressure in ear), attacks are recurrent and last minutes to hours.
187
What trigger meniere's disease?
loud noise or air/wind.
188
Name other causes of peripheral vertigo not mentioned already?
toxic vestibulopathy (drugs), traumatic vestibuolpathy (PSC), middle ear pathology, acoustic Neuroma (benign).
189
Besides Epley manuever what is a treatment for peripheral vertigo?
vestibular habituation training (assume position that triggers vertigo and hold for 30 seconds, then return to a neutral position. Repeate 5 times per set and do this 5-10 times a day.
190
What is Otosclerosis?
hereditary overgrowth and immobility of the stapes causing conductive hearing loss with vertigo.
191
What is endolymph (perilymph) fistulas?
vertigo due to tiny cracks in the round window and are seen with head trauma. They are made worse with coughing, sneezing and straining.
192
name 4 causes of central vertigo?
braintumor or stroke, foramen magnum pathology, MS, cerebellar tumor or stroke/hemorrhage.
193
What are the signs of a vertebrobasilar artery insufficiency?
5 D's And 3 N's. Dizziness, drop attacks, diplopia, dysarthria, dysphagia, Ataxia, Nausea, nystagmus, numbness.
194
What is Wallenberg's syndrome?
Infarction of the PICA.
195
The PICA arises from what artery?
vertebral artery.
196
What are the signs seen with Wallenberg's syndrome?
vertigo, nystagmus, nausea, vomiting, (no extreme paresis), Hoarseness, HICCUPS, and diffuculty swallowing.
197
What would the ipsilateral and contralateral signs be with Wallenberg's syndrome?
ipsilateral- ataxia, slurred speech, loss of pain and temperature on face, Horner's syndrome. Contralateral- loss of pain and temperature on body.
198
What should be done with a patient who has hearing loss and vertigo?
MRI.
199
What is a cerebellar gait like?
staggering, clumsy, drunken.
200
What is a Parkinsonian gait like?
festinating shuffling gait, short steps.
