Disorders of Equilibrium

Question 1

balance and awareness of body position in relation to surroundings requires input from 2 of following 3 systems

Answer 1

visual: judge distance
labyrinthine: to judge acceleration and positino change
proprioceptive: to judge posture

Question 2

importance of rombergs test

Answer 2

to test proprioception

Question 3

dizziness common in

Answer 3

elderly, diabetes pts, people taking antihypertensive meds

Question 4

vertigo

Answer 4

illusion of movement of oneself or objects around self may be vestibular (semicircular canals/otoliths) or neurologic in origin

• sometimes accompanied by sweating, nausea and hearing impariment or tinnitus
• happens after ride rollercoaster

Question 5

disequilibrium

Answer 5

• may be caused by vertigo
• but usaually a nonvertiginous state of altered balance due to dysfunction of:
• cerebellum, dorsal columns (sensory), motor systems (central or peripheral, basal ganglia)

Question 6

presyncope

Answer 6

lightheadedness or impending loss of consciousness due to:

orthostasis, arrhythmia, hyperventilation

Question 7

nonvertiginous altered static or dynamic balance (3)

Answer 7

sensory: proprioceptive deficit, worse in dark, associated with romberg sign

motor- mechanical arthritis, periph or central, cerebellar, no romberg sign

cerebellar: no romberg sign (can’t stand with feet together with eyes open or closed)

Question 8

what is asociated with presyncope

-aggravated by what?

Answer 8

pallor, sweating, visual dimming

-increased temp, prolong standing, large meals

Question 9

peripheral causes of vertigo

Answer 9

benign positional vertigo
vestibular neuronitis
meniere’s disesase
drug induced ototoxicity

Question 10

benign positional vertigo

Answer 10

most common cause recurrent vertigo

• from traum or infection
• brief recurrent epsisode of vertigo triggered by change in head position
• spontaneous recover often
• debris floating in endolymph of SC canals (mainly posteior one)

Question 11

posterior BPV provocative maneuver and nystagmus

Answer 11

dix hallpike and torsional

-nystagmus occurs after dix hallpike with affected ear down

Question 12

treatment of benign positional vertigo

Answer 12

positional exercises
vestibular suppressants (scopolamine)
antiemetics

Question 13

vestibular neuronitis

Answer 13

spontaneous attack of vertigo that does not involve hearing loss or tinnitus and resolves spontaneousl

vertigo, nausea and vomiting of acute onset lasts up to 2 wseeks

not characteristically positional

Question 14

meniere’s disease

onset
male to female
path

Answer 14

onset 20-50 yrs old
3 to 1 females
increase voume of labyrinthine endolymph

Question 15

meniere’s disease presentation

Answer 15

recurrent episodes of spontan vertigo
last more than 20 mintues, usualy hours
-subsequent dysequilibrium could last several days
low frequency hearing loss
tinnitus
aural fullness

Question 16

drug induced peripheral vertigo

Answer 16

salicylates

antibiotics like aminoglycosides, tetracycline, vancomycin

Question 17

central cause vertigo: vascular (ischemic)

Answer 17

more common in elderly
abrupt onset
vertigo associated with other neuro symptoms
repeated episodes of isolated vertigo without other neuro symptoms should always suggest non-neuro cause

Question 18

chiari malformation and vertigo

Answer 18

cause of central vertigo

Question 19

central vertigo: neoplastic/paraneoplastic

Answer 19

acoustic neuroma (schwannoma), meningioma
involves V, VII, VIII (hearing loss and absent corneal reflex)

NF1 and II for acoustic neuromas

Question 20

paraneoplastic cerenellar degen (Cent vert)

Answer 20

antibodies from tumor antigens destory purkinje cells in cerebellum
-most commonly associated with cancer of breast, ovary, lung

Question 21

central: vestibular migraine

Answer 21

5 episodes of mod/severe vestibular symptoms lasting 5 mintues to 72 hours

• current or previous history of migraine with/wthout aura
• one or more migraine features with at least 50% of episodes

Question 22

central infectious

Answer 22

viral: ebv, hiv, hsv

rickettsial

bacterial: meningococcal, pneumococcal, h flu
fungal: cryptococcal, histoplasm

Question 23

central: metabolic

Answer 23

deficiency of B1,B12, E vitamins
hypothyroid
wilson’s disease

Question 24

central: toxins

Answer 24

toxins: glue (toluene), CO –>cerebellar degeneration
ethanol: affects cerebellar vermis = truncal and LE ataxia, irreversible
meds: AED, 5-FU

Question 25

spinocerebellar ataxias

Answer 25

autosomal dominant mainly

SCA1 olivopontocerebellar and SCA 3 machado-joseph

-slow progressive cerebellar ataxia of limbs combined with brainstem signs (dysarthria, oculomotor disturbance, spasticity, and peripheral neuropathy

Question 26

friedrich’s ataxia

Answer 26

autosomal recessive disorder

onset before 20
gait ataxia, progression all 4 limbs
absent tendon reflexes

Question 27

secondary features friedrich’s ataxia

Answer 27

extensor plantar responses
pes cavus
scoliosis
cardiomyophathy

Question 28

ataxia telengiectasia

Answer 28

autosomal recessive
signs in infancy

progressive ataxia, oculocutaneous telangiectasia, and immunologic deficiency

• recurrent sinopulmonary infecions
• port wine stains near eyelid