Neuro- disorders of Equilibrium

Question 1

what is equilibrium?

Answer 1

ability to maintain orientation in the body and its parts in relation to external space

Question 2

what is disequilibrium? what is it confused with? what are the 2 ways it presents clinically?

Answer 2

inability to maintain orientation of the body, often confused w/ syncope/presyncope.
2 ways it presents: vertigo and ataxia

Question 3

what is syncope?

Answer 3

light-headed, giddy, faint w.out illusion of movement

• decreased supply of blood, O2 or glucose to brain
• more vascular than neuro problem
• presyncope –> syncope when LOC
• “dizzy” is presyncope if not vertigo

Question 4

how many adults will have syncope?

Answer 4

1/3

Question 5

2 components of syncope

Answer 5

• cardiac (more often ): mostly vasovagal: standing up, blood pools in legs, supposed to get reflex inc in HR and vasoconstriction so blood goes to the head. (carotid response to drop in BP)
• neurologic: excess vagal stim, bradycardia, vasodilation - no blood to head.

Question 6

what is orthostatic hypotension?

Answer 6

BP drops too much and cant get inc in HR fast enough

-in eldery, DM, on diuretics, alpha blockers, anticholinergics

Question 7

what is vasomotor/vasovagal syncope?

Answer 7

most common type of syncope

-sudden inc vagal tone (stress or painful situation)

Question 8

postmicurition (defecation) syncope

Answer 8

• inc vagal tone from urination causes syncope

- defecation/constipation = inc intrabdominal pressure = carotid body stim = pass out

Question 9

what does low vasal tone mean?

Answer 9

Vagal tone is a measure of cardiovascular function that facilitates adaptive responses to environmental challenge. Low vagal tone is associated with poor emotional and attentional regulation in children and has been conceptualized as a marker of sensitivity to stress

Question 10

syncope vs seizure

Answer 10

syncope: no post-ictal state, only mild symptoms of disorientation, no confusion/fatigue

Question 11

not well explained syncope…. what tests will you run?

Answer 11

1. ECG (esp if it’s their first one)
2. autonomic testing- tilt table test (looks for orthostatic hypotension)
3. electrophysiologic studies- invasive, to see electricity of heart

Question 12

Va state driving recommendations after syncope?

Answer 12

no driving 6 months, up to pt to report

Question 13

what is ataxia? what do you need for a stable stance?

Answer 13

lack of coordinated movement

• intact cerebellum, vestibular system, intact sensation (vision and proprioception)
• cerebellum is most important component

Question 14

vestibular ataxia.. what causes it and how do you test for it?

Answer 14

same lesions that cause peripheral vertigo- now have abnormal stance/gait

• romberg test
• mild vestibular ataxia w/ earache (pressure on middle ear –> pressure on inner ear)

Question 15

what is cerebellar ataxia?

Answer 15

lesions of cerebellum or its connections

• greatest abnormal movements w/ irregular rate, rhythm, amplitude or force of voluntary movements
• cant stand eyes open or closed
• wide gait

Question 16

what is sensory ataxia?

Answer 16

lose proprioception = ataxia

• deficit most often w/ bilateral peripheral nerves or posterior columns of spinal cord
• romberg- close eyes and fall
• decreased joint position and vibratory sense (steppage gait)

Question 17

3 abnormalities w/ cerebellar disease

Answer 17

1. hypotonia: poor posture, limbs easily moved with small force
2. incoordination: accel and deceleration of movement decreased, jerky appearance, see best in walking
3. eye movement- nystagmus, gaze paralysis or dec. pursuit movements

Question 18

nystagmus with ataxia…

Answer 18

vestibular= nystagmus
cerebellar= usually w/ nystagmus
sensory = none

Question 19

vertigo is classified as …

Answer 19

peripheral or central- determines how you treat it

• peripheral: inner ear or CN 8
• central: brainstem or cerebellum (lesions)

Question 20

nystagmus w/ vertigo…peripheral vs central

Answer 20

peripheral- horizontal

central- may be vertical, unidirectional, multidirectional and may be different in each eye

Question 21

BPPV

Answer 21

otoliths in semiCs

• always assoc. w/ horizontal nystagmus
• txt: antiemetics, repositioning, habituation

Question 22

triad of menieres

Answer 22

vertigo, hearing loss, tinnitus

also…drop attacks when unable to stand (Ataxia)

Question 23

peripheral vs central vertigo

Answer 23

central: hypereflexive- inhibition is off , hearing loss rarely present, less severe vertigo

Question 24

what three things to ask the “dizzy” pt

Answer 24

how did it happen? when did it occur? describe the sensation…