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2. Neuro exam 2 > Sachen: Disorders of Equilibrium > Flashcards

Sachen: Disorders of Equilibrium Flashcards

1
Q

What are the main characteristics of sensory causes of Disequilibrium?

A
  • Proprioceptic deficit
  • Visual impairment
  • Compensated vestibular disorders
  • Worse in dark
  • Romberg sign
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2
Q

A positive Romberg test indicates what?

A
  • A somatosensory dysfunction (proprioception)

*With the eyes open, three sensory systems provide input to the cerebellum to maintain truncal stability. These are vision, proprioception, and vestibular sense. When pt closes eyes during Romberg test you remove that visual sense.

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3
Q

A sense of impending loss of unconsciousness often associated with pallor, sweating, visual dimming or constricted fields, is known as?

A

Presyncope

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4
Q

Etiologies of Presyncope?

What can make it worse?

A
  • Arrythmia, hypotension, vasovagal excess, pulmonary emboli, drugs
  • Aggravated by: increased temperature, prolonged standng, large meals, and deconditioning
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5
Q

With labyrinthine dysfunction (peripheral) leading to dysequilibrium what is the vertigo like, duration of nystagmus, direction of nystagmus, and neuro symptoms?

A
  • Intense vertigo
  • Brief nystagmus
  • Horizontal/diagonal nystagmus that is fixed
  • Never any neuro symptoms
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6
Q

With central dysfunction leading to dysequilibrium what is the vertigo like, duration of nystagmus, direction of nystagmus, and neuro symptoms?

A
  • Mild vertigo
  • Persistence of nystagmus, which can be in vertical direction
  • Usually some neuro symptoms
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7
Q

Which 4 structures are considered peripheral/labyrinthine for the maintenance of equilibrium?

A
  1. Utricle
  2. Saccule
  3. Semicircular canals
  4. Vestibular nerve
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8
Q

Most common cause of recurrent vertigo and characteristics?

A
  • Benign Positional Vertigo
  • Brief recurrent episodes of vertigo triggered by changes in head positon
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9
Q

What is the most comon location for debris causing Benign Positional Vertigo?

How is this diagnosed?

Direction of Nystagmus?

A
  • Posterior semicircular canal
  • Use Dix Hallpike manuever, nystagmus provoked w/ affected ear down
  • Nystagmus = torsional
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10
Q

Why is the direction of nystagmus provoked by the anterior type of Benign Postional Vertigo significant?

A
  • This is a more rare form
  • Dix Hallpike will causes a downbeat (vertical) nystagmus, which is usually only seen in central lesions.
  • Must carefully assess to rule out brainstem or cerebellar lesions!
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11
Q

Treatment for Benign Postional Vertigo?

A
  • Often resolves on its own within a few weeks
  • Positional exercises helpful: Sermont manuever
  • Meds such as: vestibular suppressants, antiemetics, and anxiolytics
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12
Q

How does Vestibular Neuronitis differ from BPV?

A
  • Spontaneous attack of vertigo, typically lasting up to 2 weeks (findings similar to BPV
  • But is NOT typically positonal
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13
Q

What are the characteristics of Meniere’s Disease and who is most often affected?

Hallmarks?

A
  • Recurrent episodes of spontaneous vertigo, lasting minutes to hours
  • Low frequency hearing loss = Hallmark
  • Tinnitus and aural fullness
  • Woman are 3x more affected
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14
Q

Treatment for Meniere’s Disease?

A
  • Sodium restriction
  • Diuretics: thiazdies, furosemide
  • Sugery: endolymphatic sac decompression
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15
Q

What are the characteristics of Mal de Debarquement (“Sickness of Disembarkment”)?

Duration?

Treatment?

A
  • Illusion of movement as an after effect of travel (sea, car, train)
  • Rocking, swaying feeling after getting off a boat
  • Duration = usually <24 hours; sometimes longer
  • Tx: meclizine, scopolamine, benzodiazepines (dizziness meds)
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16
Q

What are some of the drug induced causes of peripheral disequilibrium?

A
  • Alcohol!
  • Antibiotics - aminoglycosides, tetracycline, vancomycin
  • Diuretics
  • Chemotherapeutics: cisplatin, methotrexate, vincristine
17
Q

What are the requirements of diagnosis for a Vestibular Migraine (central)?

A
  • At least 5 episodes of moderate/severe vestibular sx’s lasting 5 minutes to 72 hours
  • Current or previous hx of migraine w/ or w/o aura
  • One of more migraine features w/ at least 50% of episodes: headache, photophobia, phonophobia, nausea, aura…
18
Q

Central: Vascular (ischemic) causes of equilibrium disoders are most commonly seen in?

A

The elderly

19
Q

Repeated episodes of isolated vertigo without other neurological symptoms should always suggest?

A

A non-neurologic cause

20
Q

What is the first sign and the first symptom of a Cerebellopontine Angle Tumor?

A
  • First symptom = hearing loss (CN VIII)
  • First sign = absent corneal reflex (loss of CN V and VII)
21
Q

Paraneoplastic cerebellar degeneration is most commonly associated with what cancers?

Antbodies cross react with?

A
  • Breast, ovary, and lung
  • Antibodies to tumor cell antigens cross-react with cerebellar Purkinje cells
22
Q

What are the most common forms of Spinocerebellar Ataxias?

Characteristic findings in these diseases?

A
  • SCA 1 (olivopontocerebellar)
  • SCA 3 (Machado-Joseph)

*Slowly progressive cerebellar ataxia of limbs combined w/ brainstem signs (dysarthria, oculomotor disturbance, spasticity) and peripheral neuropathy

23
Q

When is the typical onset of Friedrich’s Ataxia and what are the common findings?

A
  • Onset before age 20 (young persons disease)
  • Gait ataxia w/ absent tendon relfexes in legs and muscle weakness
  • Extensor plantar responses
  • Pes cavus
  • Kyphoscoliosis
24
Q

Common cause of death in someone with Friedrich’s Ataxia?

A

Cardiomyopathy

25
Q

Age of onset for Ataxia-Telangiectasia?

Common findings?

A
  • Disease of infancy (<4 yr. of age)
  • Progressive pancerebellar degeneration involving nystagmus, dysarthria, and gait, limb and trunk ataxia
  • Choreoathetosis, loss of vibration and position sense in legs, areflexia, and disorders of voluntary eye movements
26
Q

What age does Oculocutaneous telangiectasia usually appear?

Common findings?

A
  • Usually appears in teen years
  • Immunological impairment (decreased IgA and IgE) usually evident later on and manifested by recurrent sinopulmonary infections
  • Changes of skin and hair, hypogonadism, and insulin resistance
27
Q

Where is Spondylosis most commonly seen?

Can lead to?

Early signs?

A
  • Cervical region
  • Can lead to myelopathy (spondylotic)
  • Unexplained gait impairment or imbalance often an early symptom
28
Q

What will examination of someone with Spondylotic Myelopathy show?

A
  • Spastic tone in legs
  • Increase knee/ankle jerks
  • Babinski signs
  • Variable sensory deficits
29
Q

What can cause B12 deficiency?

A
  • Malabsorption syndromes
  • Surgery
  • Drugs (H2 receptor antagonists)
  • Nitrous oxide use (whip-its!!!)
  • Fish tapeworm
30
Q

What type of syndrome can be caused by Vitamine E deficiency?

A

Spinocerebellar similiar to Friedrich’s

31
Q

The syndrome associated with Copper deficiency can present very similar to what?

A

B12 deficiency

32
Q

How is diagnosis of Nitrous Oxide Toxicity made and what is the treatment?

A
  • Diagnosis: depletion of Vit B12 w/ similar symptoms
  • Tx: B12 replacement
33
Q

Describe Dix-Hallpike

A

Torsional nystagmus = posterior SCC

Downbeat w torsional nystagmus = anterior SCC

34
Q

What is the test used to dx BPPV caused by Horizontal SCC?

A

Supine roll test

Should see horizontal nystagmus

35
Q

Describe HINTS test

A

Help to distinguish brainstem lesion from peripheral lesion in someone with vertigo

Higher sensitivity than MRI when detecting acute stroke

__________________

Abnml signs: nml HITS, bidirectional or direction changing nystagmus, any skew deviation

2. Neuro exam 2 (16 decks)

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