Central Vertigo & Multiple Sclerosis

Question 1

+HIT=?

Answer 1

vestibular neuritis/labrynthitis

Question 2

-HIT=

Answer 2

central vertigo

Question 3

What test is sensitive for determining central v. peripheral vertigo?

Answer 3

HiNTS

Question 4

causes of central vertigo (5)

Answer 4

stroke, vertebrocasilar insufficiency, multiple sclerosis, masses, migraine-equivalent

Question 5

3 types of stroke

Answer 5

hemorrhagic, ischemic, brainstem

Question 6

diplopia

Answer 6

double vision

Question 7

dysphonia

Answer 7

breathy voice from voice box spasms

Question 8

dysarthria

Answer 8

slow or slurred speech

Question 9

dysmetria

Answer 9

lack of coordination

Question 10

A pt presenting with any neurologic problems (including diplopia, dysphonia, dysarthria, dysmetria), has what kind of vertigo?

Answer 10

central

Question 11

Toes go up on Babinski test=?

Answer 11

central vertigo

Question 12

hyperreflexia/abnormal reflexes on Babinski=?

Answer 12

central vertigo

Question 13

What is HiNTs used to differentiate?

Answer 13

central and peripheral vertigo

Question 14

If HiNTS is vertical/changing direction=

Answer 14

central vertigo

Question 15

If HiNTS is horizontal (+/- torsional)= ?

Answer 15

peripheral vertigo

Question 16

Double vision

Answer 16

ocular misalignment

more concerning than monocular esp. with other neuro complaints, resolves when either eye is covered

Question 17

monocular vision

Answer 17

refractive or retinal issue and resolves when affected eye is covered

Question 18

when is double vision (ocular misalignment) resolved?

Answer 18

when either eye is covered

Question 19

when is monocular vision resolved?

Answer 19

when the affected eye is covered

Question 20

What is #1 based on presentation for MS?

Answer 20

double vision

Question 21

age and gender of MS

Answer 21

25-30yo W>M

Question 22

What is multiple sclerosis caused by?

Answer 22

inflammatory disease that causes demyelination of discrete areas (plaques); pathologic T cells in brain that can be dormant for years and then re-exposed causing inflammatory response

Question 23

Where is MS prevalent?

Answer 23

northern US, UK and Scandinavia
rare in Africans and Asians but African Americans have higher risk (bc in America’s climate)
Idaho>Texas

Question 24

Clinical fts of MS

Answer 24

dec. cognition- confusion, poor academics/work, memory
bilateral intranuclear opthalomoplegia**

wide variability in age, symptoms, location, severity, progression etc.

Question 25

Bilateral intranuclear ophthalmoplegia

Answer 25

eye can’t adduct (impaired conjugate gaze) | optic neuritis, pain and vision disturbance

Question 26

what symptoms is pathognomonic for MS?

Answer 26

bilateral intranuclear ophthalomoplegia

Question 27

What other system symptom is frequent in MS?

Answer 27

bowel/bladder dysfunction

Question 28

What labs are helpful for determining MS?

Answer 28

none

Question 29

Imaging for MS

Answer 29

MRI with contrast during episodes (diagnostic)

Question 30

Other tests for MS

Answer 30

lumbar puncture

Question 31

when do you do a lumbar puncture?

Answer 31

only after inc. ICP/mass is ruled out with MRI

Question 32

What do you look for in a lumbar puncture for MS?

Answer 32

inc. Ig proteins in CSF; pleocytosis (lymphyocytes)

Question 33

Mainstay of therapy for MS? What does it help with?

Answer 33

IV methylprednisolone DOC steroids- helps with relapsing-remitting MS and dec. risk of recurrence

Question 34

What is the steroid to treat for MS?

Answer 34

250-1000mg (high dose) IV methylprednisolone DOC for 3-7 days

Question 35

How do you administer meds for MS?

Answer 35

IV 250-1000mg; oral is not effective

Question 36

How long do you give steroids for MS?

Answer 36

3-7days

Question 37

Side effects of methylpredisolone

Answer 37

psychosis, infection, anxiety, GI bleed, fluid overload

Question 38

What is a complication of MS? (3)

Answer 38

exercise (inc. heat exasterbates symptoms), pain and spasms

Question 39

how do you treat the complications that come with MS? (3)

Answer 39

exercise- cooling vest pain- used carbamazepine, TCAs spasms- baclofen

Question 40

What do you give for spasms?

Answer 40

baclofen

Question 41

What do you give to MS patients for pain?

Answer 41

TCAs (tricyclics) and carbamazepine

Question 42

HIT=

Answer 42

head impulse test

Question 43

+ hallpike maneuver for HiNTS exam requires?

Answer 43

``` all 4- vertigo and nystagmus in supine position latency for 20s until it appears tortional and upbeating lasting <60s ```

Question 44

What do you order first for a pt you are unsure about having MS?

Answer 44

CT angiogram to see blood supply and risk of stroke (then do MRI)

Question 45

What is seen on MRI for MS?

Answer 45

plaques

Question 46

HiNTS=

Answer 46

head impulse nystagmus test of skew peripheral vertigo