Neuro: Disorders Of Equilibrium

Front 1

To what locations does the vestibular nerve project?

Back 1

Vestibular nucleus, flocculonodular lobe of cerebellum

Front 2

Which nucleus of the cerebellum is involved in vestibular nerve function?

Back 2

Fastigial nucleus

Front 3

Through which cerebellar peduncle do vestibular fibers travel to hit flocculonodular lobe of cerebellum?

Back 3

Inferior cerebellar peduncle

Front 4

What classically causes superior cerebellar vermis damage and what syndrome does it cause?

Back 4

Alcoholic cerebellar degeneration


Exclusive or primarily ataxia of gait

Front 5

Patterns of cerebellar ataxia give signs

Midline

Superior vermis

Cerebellar hemisphere

Pancerebellar

Back 5

Midline - nystagmus, head and trunk titubation, gait ataxia

Superior vermis - Gait ataxia

Hemisphere - Nystagmus, ipsilateral gaze paresis, dysarthria, ipsilateral hypotonia, ipsilateral limb ataxia, gait ataxia, falling to side o lesion

Pancerebellar - Nystagmus, bilateral gaze peresis, dysarthria, bilateral hypotonia, bilateral limb ataxia, gait ataxia

Front 6

Patterms of cerebellar ataxia give most common causes

Midline

Superior vermis

Cerebellar hemisphere

Pancerebellar

Back 6

Midline - Tumor, MS

Superior vermis - Wernicke encephalopathy, alcoholic cerebellar degeneration, tumor, MS

Cerebellar hemisphere - Infarction, hemorrhage, tumor, MS

Pancerebellar - Drug tox, hypothyroid, hereditary degeneration, paraneoplastic degeneration, Wilson disease, infectious, parainfectous encephalomyelitis, CJD, MS

Front 7

Describe gait from cerebellar ataxia.

Back 7

Wide based
Oscillation of head or trunk
Deviation towards side of lesion
Tandem gait impairment

Front 8

Describe gait in sensory ataxia

Back 8

Wide based
Tandem gait is impaired
Steppage gait - high lifting of feet, slapping down
Stability is dramatically improved with a cane

Front 9

What is the classic cause of pendular nystagmus?

Back 9

Visual impairment starting in infancy

Front 10

How does cerebellar disease affect reflexes?

Back 10

Decrease in reflexes

Front 11

Pathogenesis of BPV?

How is it treated?

Back 11

Canalolithiasis - semicircular canal debris stimulates canal

Repositioning maneuvers

Vestibulosuppressant drugs - antihistamines (meclizine, promethazine, demenhydrinate), anticholinergics (scolpolamine), Benzos (Diazepam), Sympathomimetics (Amphetamine, ephedrine)

Front 12

Onset of Meniere's disease

Gender predilection?

Cause?

Back 12

20-50 years

Men

Increased endolymphatic fluid (endolymphatic hydrops)

Front 13

Treatment of Meniere's disease?

Back 13

Diuretics - HCTZ, triamterene

Vestibulosuppressant drugs

Endolymphatic shunting, labyringthectomy, vestibular nerve section

Front 14

How does acute peripheral vestibulopathy present?

Back 14

Vertigo, nausea, vomiting, lasting up to 2 weeks, some symptoms may be permanent

Patient lies with affected ear up and reluctance to move head
Nystagmus with fast phase away from affected ear always

Front 15

How is acute peripheral vestibulopathy treated?

Back 15

With vestibulosuppressant drugs or with prednisone for 2 weeks

Front 16

Otosclerosis pathogenesis and etiology?

Onset?

Back 16

Immobility of stapes
Familial occurrence is common

Onset by 30 years

Front 17

Presentation of otosclerosis?

Treatment?

Back 17

Conductive hearing loss
Episodic vertigo without positional vertigo

Combination Sodium fluoride, calcium gluconate, Vitamin D
Consider surgery if refractory

Front 18

What is cinchonism and which drugs can produce the syndrome?

Back 18

Tinnitus, impaired hearing, vertigo, visual deficits (color vision), N/V, abdominal pain, sweating, flushed skin

Fever, encephalopathy, coma, death in severe cases

Quinine, quinidine

Front 19

Which drugs can produce vestibulopathy?

Back 19

Alcohol, aminoglycosides, salicylates, quinine, quinidine, cis-platinum

Front 20

Clinical findings in Benedickt's syndrome?

Occlusion of which artery causes this syndrome?

Back 20

Ipsilateral medial rectus palsy with fixed dilated pupil, contralateral limb ataxia

Occlusion of paramedian penetrating branches of basilar artery

Front 21

What area of the brain is affected by alcoholic cerebellar degeneration and how does it present?

Back 21

Superior cerebellar vermis - gait ataxia

Front 22

Which tumors are most likely to produce a cerebellar paraneoplastic syndrome?

Which ones produce Anti-Yo?

Anti-Hu?

Anti-Ri?

Back 22

Lung cancer, ovarian cancer, Hodgkin disease, breast cancer

Ovarian and breast

Small cell lung cancer

Breast cancer

Front 23

Which chromosome is the Friedrich's ataxia gene located on and what is it called?

Inheritance pattern?

Back 23

9 - frataxin gene

AR

Front 24

What areas degenerate in Friedrich's ataxia?

Back 24

Spinocerebellar tracts
Posterior columns
Dorsal roots

Front 25

What lab abnormalities occur in ataxia telangiectasia?

Inheritance pattern?

Back 25

Alpha fetoprotein elevation
CEA elevation

AR

Front 26

Why can ataxia telangiectasia often confused with Friedrich's ataxia?

How can AT be seperated from Friedrich's ataxia?

Back 26

Vascular manifestations occur well after neurologic manifestations

AT - earlier onset (before 4 years), choreoathetosis, absence of skeletal abnormalities