• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/184

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

184 Cards in this Set

  • Front
  • Back
where is the lesion in this immage?
LOCATION:
MEDIAL TEMPORAL LOBE

- involves hippocampus and fills temporal horn
mass effect or local effects
what clinical symptoms could this person have?
headache
nausea/vomiting
drowsiness
papilledema
What are the mass effect of this lession?
What are the local effects of this lesion?
seizures
disrupted HC function:
? memory - only occurs with bilateral lesions unlikely with unilateral
fever
systemic signs
what other sx can be seen here in this lesion besides mass or local effects?
What are these sx related to?

-HEADACHE (ON WAKING)

-PROJECTILE VOMITING

- PAPILLEDEMA

- CARDIORESPIRATORY PHYSIOLOGIC CHANGES

- SINUS BRADYCARDIA

- IRREGULAR RESPIRATIONS

- HYPERTENSION

- DECLINE IN LEVEL OF CONSCIOUSNESS

- NEUROGENIC PULMONARY EDEMA

- FOCAL NEUROLOGIC SIGNS DUE TO TISSUE SHIFTS
SYMPTOMS OF ELEVATED
INTRACRANIAL PRESSURE
Is vision effected with this lesion?
Yes, you have contralateral hemienopsia
NEOPLASM

INFECTION

HEMATOMA

EDEMA
what are possible differencial dx for this lession?
GLIOMA

METASTASIS
What possible neoplasm could this lesion be?
CEREBRITIS

ABSCESS

GRANULOMA
what infection could result in this lesion?
is there any problem with the ventricles?
yes, hydrocephalis, review 4 types
is there a problem with the sulci?
yes, the are widened meaning the brain is atrophy
PROBABLY HYDROCEPHALUS EX VACUO
what is the dx of this pt?
what is the flow of csf?
1. LATERAL VENTRICLES

2. FORAMEN OF MONRO

3. THIRD VENTRICLE

4. CEREBRAL AQUEDUCT

5. FOURTH VENTRICLE

6. FORAMINA OF
LUSCHKA & MAGENDIE
type of hydrocephalus?

BLOCKAGE IN VENTRICULAR SYSTEM
OBSTRUCTIVE
(NON-COMMUNICATING)
type of hydrocephalus?

BLOCKAGE IN SUBARACHNOID SPACE, CSF-RESORPTION
NON-OBSTRUCTIVE
(COMMUNICATING)
type of hydrocephalus?

ATROPHY OF BRAIN
EX VACUO
type of hydrocephalus?

IDIOPATHIC
NORMAL PRESSURE
What type of study?
T1 MRI SCAN with contrast

-notice CSF is dark and ring enhanced mass
cortex with acute hypoxic-ischemic damage (shrunken “red neurons”)
What is this?
solid cellular neoplasm - lymphoma
what is this?
necrotic cells, intranuclear eosinophilic inclusions
(Cowdry type A): Herpes encephalitis

-viral inclusion in nucleus characteristic of herpes encephalitis effecting medial temporal lobe and esp hippocampus
what is this?
glioma: oligodendroglioma (“fried egg cells”) infiltrating cortex

-primary neoplasm in brain, does not make mass, can cause epilepsy
what is this?
A 66-year old man with a neurologic disease who died on hospital day 5. Describe
and evaluate this picture:
Middle cerebral artery infarct

Note mass effect + shift
FEATURES:

left cerebral lesion: dusky,
soft, well

demarcated: necrotic brain
what are the features?
What is the pathological diagnosis?
• encephalomalacia (brain necrosis with softening) corresponding to a particular
vascular territory

• left to right shift with compression of left
lateral ventricle
What clinical history would fit with this picture?
Recent (several days) but probably sudden onset of
right-sided paresis/plegia (hemiparesis/hemiplegia) and
aphasia (STROKE), now with worsening mental status
due to increasing intracranial pressure
what type of image is this and what is seen here?
T2 MRI, CSF is bright, notice lesion on right which is edema from the necrotic area
what is unusal on the right?
Second infarct in watershed territory on right (btwn anterior and middle cerebral artery). Why?
Suggests a second event: embolus, hypotensive event, etc.
Patient with glioblastoma
multiforme diagnosed 14 months earlier:

IDENTIFY:
notice labeled areas
type of brain herniation?

herniated part: ?

opening: subfalcine

special effect? compression of
anterior cerebral
artery
cingulate

herniated part: cingulate gyrus
type of brain herniation?

herniated part: ?

opening:
tentorial incisure

special effect: compression of
midbrain & CNIII:
coma, dilated pupil,
Duret hemorrhage
uncal (asymmetric)

herniated part: uncus (medial
temporal lobe)
type of brain herniation?

herniated part: ?

opening: tentorial incisure

special effect: compression of thalamus & midbrain: coma,
posturing, hydrocephalus
central (symmetric)

herniated part: diencephalon &
medial temporal lobes
type of brain herniation?

herniated part: ?

opening: foramen magnum

special effect: compression of
medulla: apnea, acute hydrocephalus, loss
of consciousness
tonsillar

herniated part: cerebellar tonsils & medulla
What kind of edema is this?
vasogenic edema secondary to tumor

mechanism: DAMAGE TO BLOOD-BRAIN BARRIER (INFLAMMATION, INFARCT, TUMOR, etc)

site: WHITE MATTER
type of cerebral edema?

DAMAGE TO BLOOD-BRAIN BARRIER (INFLAMMATION, INFARCT, TUMOR, etc)

site: WHITE MATTER
VASOGENIC
type of cerebral edema?

MEMBRANE ION PUMP DYSFUNCTION
(HYPOXIA, TOXINS, etc)

site: GRAY MATTER
CYTOTOXIC
type of cerebral edema?

↑ INTRAVENTRICULAR PRESSURE (OBSTRUCTIVE HYDROCEPHALIUS)

site: PERIVENTRICULAR WHITE MATTER
INTERSTITIAL
BASED ON THE PATHOLOGY, CONSTRUCT A LIKELY SEQUENCE OF EVENTS TO EXPLAIN THE PATIENT’S DEMISE
see above
A 48-
year-old cocaine abuser with hypertension died three
days after admission for persistent headache.

LOCALIZE THE LESION.
Main lesion is in left basal ganglia
A 48- year-old cocaine abuser with hypertension died three
days after admission for persistent headache

DESCRIBE THE LESION
Dark red (fresh) bloody mass (hematoma)
with extension into 3rd and lateral ventricles,
mass effect and L > R shift with compression of
hypothalamus and midbrain
A 48- year-old cocaine abuser with hypertension died three
days after admission for persistent headache

PROPOSE A DIFFERENTIAL
DIAGNOSIS
Differential: acute hemorrhage due to ruptured vessel (e.g., cocaine- related), Charcot-Bouchard aneurysm from HTN, vasculitis, vascular malformation, tumor (unlikely).
A 48- year-old cocaine abuser with hypertension died three
days after admission for persistent headache

PROPOSE THE LIKELY
PATHOPHYSIOLOGIC SEQUENCE OF
EVENTS
Acute cocaine-related hypertension led to rupture of muscular artery in basal ganglia; hematoma causes mass effect, dissects across internal capsule, ruptures into and fills ventricles, leading to massive increase in intracranial pressure and compression of midbrain &
hypothalamus
A 48- year-old cocaine abuser with hypertension died three
days after admission for persistent headache

DESCRIBE THE LIKELY SYMPTOMS/
SIGNS
Acute excruciating headache, followed by decreased consciousness and coma,
contralateral hemiplegia,
SUDDEN ONSET OF HEADACHE,
FOCAL DEFICITS, SIGNS OF INCREASING INTRACRANIAL
PRESSURE
INTRACEREBRAL HEMORRHAGE:
“HEMORRHAGIC STROKE”
type of intracerebral hemmorage?

site: basal ganglia, thalamus, pons,
deep cerebellum

usual cause: hypertensive
vascular disease

outcome: fatal
IPH: GANGLIONIC
type of intracerebral hemmorage?

site: cerebral lobes

usual cause: various
(malformation,
coagulopathy. etc.)

outcome: variable
IPH: LOBAR
type of intracerebral hemmorage?

usual cause: berry aneurysm,
AVM

outcome: often lethal, acute
vasospasm, chronic
hydrocephalus
SUBARACHNOID
Identify the image type and the lesion.
Non-enhanced T1 MRI scan - dark CSF

Degenerating subacute hemorrhage in left basal ganglia (hyperintense signal:methemoglobin).

- Patient has recently bled
- New massive bleed seen on gross occurred in hospital
Possible etiologies?
Degenerating subacute hemorrhage in left
basal ganglia (hyperintense signal:methemoglobin).

Possible etiologies of hemorrhage:

-cocaine

-hypertension (Charcot-Bouchard aneurysm

- other (septic aneurysm, vascular malformation, etc.)
where is the old and fresh hemmorage?
see above
ID?
extra-axial solid mass indenting middle
cerebellar peduncle. Consider meningioma or schwannoma of cranial nerve VIII.
type of image?

what is the arrow pointing to?
T1 MRI with contrast

extra-axial contrast-enhancing mass, extending into internal auditory meatus (arrow)
tumor type?
Schwannoma: note the elongate cells arranged in bundles. Tumor lacks whorls or psammoma bodies characteristic of meningioma
Construct a plausible clinical history and choose
the most likely histological diagnosis corresponding to the gross and MRI
Adult man presenting with progressive unilateral hearing loss, possibly with
headache or mild cerebellar or vestibular symptoms.
If tumor is a schwannoma, consider the possibility of neurofibromatosis type 2,
especially if he has evidence of a second tumor on the opposite side or other
stigmata of NF 2.
IRREVERSIBLE LOSS OF
MULTIPLE COGNITIVE ABILITIES IN A PERSON WITH CLEAR SENSORIUM
DEMENTIA
WHAT CAUSES DEMENTIA?
criteria for dementia?
Would this person be likely to
have had dementia?
no bc this is an infarct which is acute and not progressive
What deficit(s) would be associated with this
lesion (only present on this side)?
SYMPTOMS:
acute (consciousness, deficits)

chronic (epilepsy, deficits)
Would this person be likely to
have had dementia?
no bc this is an infarct which is acute and not progressive
location of BLUNT HEAD INJURY:
CONTUSIONS AND LACERATIONS?
COMMON LOCATIONS: POLES, ORBITOFRONTAL, LATERAL TEMPORAL
irreversible, loss of cognitive functions with clear sensorium
dementia
reversible, loss of functions with clouding of sensorium
encephalopathy
what findings can be seen here?
FINDINGS:

-ENLARGED VENTRICLES

-NORMAL WT

-ABSENCE OF CAVITIES

-MASS
A brain autopsy is performed on a 78- year-old cachectic man with a diagnosis of multiinfarct dementia who died after 6 months in hospice following an acute urinary tract infection

What finding is seen here?
FINDING: NECROSIS WITH PSEUDOPALISADING

DIAGNOSIS: GLIOBLASTOMA, WHO GRADE 4
A brain autopsy is performed on a 78- year-old cachectic man with a diagnosis of multiinfarct dementia who died after 6 months in hospice following an acute urinary tract infection.

1. What other symptoms/signs should have been present?

a. left hemiparesis.

b. papilledema.

c. cachexia.

d. increased intracranial pressure.

e. movement disorder.
b, c, and d

1. What other symptoms/signs should have been present?

a. left hemiparesis.

b. papilledema.

c. cachexia.

d. increased intracranial pressure.

e. movement disorder.
A brain autopsy is performed on a 78- year-old cachectic man with a diagnosis of multiinfarct dementia who died after 6 months in hospice following an acute urinary tract infection

Which one of the following diagnoses best explains this patient’s
history of dementia?

a. Multiple old infarcts (multi-infarct dementia) led to hydrocephalus ex vacuo.

b. Alzheimer disease caused hydrocephalus ex vacuo.

c. Intraparenchymal hemorrhage obstructed ventricle.

d. Glioblastoma multiforme obstructed ventricle.

e. Chronic bacterial abscess obstructed ventricle.
d.


Which one of the following diagnoses best explains this patient’s
history of dementia?

a. Multiple old infarcts (multi-infarct dementia) led to hydrocephalus ex vacuo.

b. Alzheimer disease caused hydrocephalus ex vacuo.

c. Intraparenchymal hemorrhage obstructed ventricle.

d. Glioblastoma multiforme obstructed ventricle.

e. Chronic bacterial abscess obstructed ventricle.
What diesease is seen in this image?

Is it dementia?
ACUTE: ENCEPHALOPATHY

CHRONIC: STATIC
ENCEPHALOPATHY/ NON-PROGRESSIVE DEFICITS

no demential
What can the following cause?

-usually from profound systemic hypotension (cardiac arrest, shock, etc.)

-systemic hypoxemia

- hypoglycemia

- CO poisoning
DIFFUSE HYPOXIC-ISCHEMIC DAMAGE
what areas of the brain are damaged with:

DIFFUSE HYPOXIC-ISCHEMIC DAMAGE
-hippocampus: Sommer's sector (CA1)

- cerebral cortex: laminar necrosis

- watershed zones

- cerebellum: Purkinje cells
What condition has the following clinical conditions?

-mild damage: transient post-ischemic confusional state

-intermediate damage: variable deficits, may be permanent (dementia)

- severe: brain death, persistent vegetative state

- “respirator brain”
ENCEPHALOPATHY
what is this structure? what area is associated with diffuse ischemic encephalopathy?
this is the hippocampus, area CA1 is refered to as Sommer sector which is one of the areas vulnerable to hypoxic ischemia
what is this?
LEUKODYSTROPHIES

DEFINITION: INHERITED DISEASES WHOSE PRINCIPAL MANIFESTATIONS RESULT FROM
DAMAGE TO MYELIN
INHERITED DISEASES WHOSE
PRINCIPAL MANIFESTATIONS RESULT FROM DAMAGE TO MYELIN
LEUKODYSTROPHIES
DEFECTS OF MYELIN DEGRADATIVE ENZYMES (lysosomal storage diseases)

name diseases in this category
-METACHROMATIC LEUKODYSTROPHY

-KRABBE’S GLOBOID CELL LEUKODYSTROPHY
disease?

DEFECTS OF MOLECULES FORMING MYELIN (dysmyelinating
diseases)
PELIZAEUS-MERZBACHER DISEASE (PLP)
what is going on here?
see above
What structures are involved with dementia
1. NUCLEUS BASALIS

2. HIPPOCAMPUS

3. MAMMILLARY BODY

4. PUTAMEN
what type of image is this? What condition does this patient have?
T2 MRI bc the gray matter is white and the white matter is gray.

MS
What CSF findings would be seen in this pt?
This pt has MS. The clinical findings in the csf are:

•pleocytosis

•increased protein/IgG

•oligoclonal bands (electrophoresis)
what condition has pattern of demylination in the form of plaques?
MS
what condition has pattern of diffuse perivascular demylination?
ADEM
what condition has pattern of diffuse demylination?
leukodystrophy
disease?
see above
common opportunistic CNS infections?
Toxoplasma encephalitis

PML

CMV

Cryptococcus meningitis
neurologic disease due to HIV infection itself
acute lymphocytic meningitis

chronic HIV encephalitis with progressive dementia
(AIDS dementia)

vacuolar myelopathy

peripheral neuropathy (various types)

inflammatory myopathy (polymyositis-like)
disease?
see above
disease?

site: neocortex, hippocampus, n. basalis

pathology: senile plaque, neurofibrillary tangles, amyloid angiopatholgy

clinical presentation: dementia
alzheimers
disease?

site: frontotemporal, hippocampus

pathology: lobar atrophy, pick bodies

clinical presentation: dementia
Pick
disease?

site: substania nigra

pathology: lewy bodies

clinical presentation: tremor, rigidity, dec movement
parkinson
disease?

site: cortex, basal ganglia

pathology: spongiform change

clinical presentation: dementia, myoclonus
CJD
disease?

site: caudate - putamen

pathology: gaba neurons

clinical presentation: chorea, dementia
huntington
disease?

site: motor neurons

pathology: UMN, LMN loss

clinical presentation: paralysis, spasticity
atrophic lateral sclerosis (ALS)
disease?
key pts: lewy bodies and the inclusions: alpha - synuclein
disease?
key pts: Intracellular inclusion and Neurofibrillary tangles
consequence of skull fracture?
hematoma, otorrhea, rhinorrhea, cranial nerve damage, pneumocephalus, infection
what do these have in common?

types of FOCAL BRAIN PARENCHYMAL INJURY
what do these have in common?

types of DIFFUSE BRAIN PARENCHYMAL INJURY
disruption/tearing of axons following sudden deceleration or torsion
DIFFUSE AXONAL INJURY (DAI)
location of DIFFUSE AXONAL INJURY (DAI)?
long tracts in brain stem (especially midbrain), corpus callosum, deep cerebral white
matter
cause of DIFFUSE AXONAL INJURY (DAI)?
shearing/rotational forces or acceleration/
deceleration lead to tearing of axons
symptoms of DIFFUSE AXONAL INJURY (DAI)?
unconscious from moment of injury

condition / disease?
see above
HEMATOMA IS ASSOCIATED WITH
SKULL FRACTURE
EPIDURAL HEMATOMA
HEMATOMA IS OFTEN ASSOCIATED
WITH MILD TRAUMA IN THE SETTING OF BRAIN
ATROPHY
SUBDURAL HEMATOMA
examine the
picture and construct a plausible clinical story based on your findings and diagnosis
see above
disease?
see above
cns tumor?
see above
disease?
see above
cns cancer?
see above
cns cancer?
see above
type of PARENCHYMAL BRAIN INJURY?

clinical feature: transient loss of conciousness (LOC)

characteristic: milde DAD?
CONCUSSION
type of PARENCHYMAL BRAIN INJURY?

clinical feature:loss of conciousness (LOC) +/- deficits

characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL
POLES, LATERAL TEMPORAL
CONTUSION
type of PARENCHYMAL BRAIN INJURY?

clinical feature: loss of conciousness (LOC) +/- deficits

characteristic: TORN PIA-ARACHNOID
LACERATION
type of PARENCHYMAL BRAIN INJURY?

clinical feature: prolonged loss of conciousness (LOC)

characteristic: TEARING OF AXONS (SPHEROIDS) IN CORPUS
CALLOSUM, LONG TRACTS
DIFFUSE AXONAL DAMAGE
type of TRAUMATIC VASCULAR INJURY?

source: dual arteries

clinical feature: loss of conciousness (LOC), then "silent (lucid)" interval

cause: skull fracture
epidural hematoma
type of TRAUMATIC VASCULAR INJURY?

source: bridging veins

clinical feature: acute subacute chronic

cause: trauma can be mild; brain atrophy, coagulopathy
subdural hematoma
type of TRAUMATIC VASCULAR INJURY?

source: parenchymal laceration

clinical feature: variable

cause: variable; usually severe trauma
subarachnoid / intraparenchymal hematoma
type of TRAUMATIC VASCULAR INJURY?

source: shearing of axons and vessels

clinical feature: similar to DAD

cause: similar to DAD
diffuse vascular injury
What is the most likely
diagnosis?

a. Cord astrocytoma

b. Sarcoid

c. Meningioma

d. Bone metastases

e. Spinal hematoma
d. Bone metastases

bc you can see lack of fat in vertebral bodies because they have been replace with tumor
What type of hemorrhage is
this?

a. Intraparenchymal

b. Intraventricular

c. Subdural

d. Subarachnoid

e. Epidural
d. subarachnoid hemmorage (CT)

cistern filled with blood (bright) should be filled with dark csf
Which imaging sequence is
the most sensitive for an
acute stroke?

a. T2 MRI

b. CT

c. T1 with contrast

d. FLAIR

e. DWI
e. DWI
What space is this tumor
in?

a. Intradural

b. Intramedullary

c. Intraaxial

d. Epidural

e. Intradural/Extra
medullary
d. epidural

bc out side dura, compressing sac (CT)
image type?
unenhanced ct
image type?
enhance ct
image type?
mri T1 axial
image type?
mri T2 axial
What Grade of Tumor is this in this patient??
Low grade Astrocytoma
What Grade of Tumor is this in this patient??
High Grade Glioblastoma
What disease would this be see in?
these are ALPHA-SYNUCLEIN: LEWY BODY & LEWY NEURITES

found in AD
What disease does this relate to?
SENILE (“NEURITIC”)
PLAQUES & NEUROFIBRILLARY TANGLES (NFT) found in AD
type of neuropathy?

-CSF shows elevated protein, usually by three days after onset of symptoms

-Mononuclear cells, <10/mm3

-Pleocytosis is common with AIDP associated with HIV seroconversion

-Traditionally, pleocytosis indicates polio

-Electrodiagnosis shows demyelination, especially F-waves and distal latencies
Acute, inflammatory demyelinating polyneuropathy (AIDP)

this is a category of Guillain-Barré Syndrome
type of neuropathy?

strongly correlated with
Campylobacter jejuni infection
Acute motor axonal neuropathy (AMAN)
what are key points for neuropathy evaluations?
type of neuropathy?

-involves ataxia, areflexia, ophthalmoplegia (& unreactive
pupils)
Fisher syndrome
type of neuropathy?

-inolves antibodies against
the ganglioside GQ1b, which is
concentrated in oculomotor fibers and is also present on sensory ganglia. These antibodies can interfere with quantal release
at neuromuscular junctions.
Fisher syndrome
type of disease?

Presentation of Myopathy
type of myopathy?

• acid maltase, debrancher& brancher deficiencies

• long- & very-long-chain acyl-CoA dehydrogenase (fatty acid oxidation) deficiencies

• mitochondrial disease
Metabolic Myopathies:
Progressive Weakness
what type of myopathy do these all fit in to?

Toxic Myopathy
type of paraysis?

Sodium channel mutations
Hyperkalemic Periodic Paralysis (HyperPP)
type of paraysis?

Calcium channel mutations
Hypokalemic Periodic Paralysis (HypoPP)
type of paraysis?

Sodium, calcium or chloride channel mutations
Myotonia
disease?

Myositis
what disease type is this associated with?
dermatomyositis - progressive weakness of muscles often with myalgia and muscle tenderness and is associated with distinctive erythematous dermatitis
type of dystrophy

• 1:3300 males

• X-linked

• Xp21

• Dystrophin Absent

• CHF in late stages

• 30% static encephalopathy
Duchenne Dystrophy
type of dystrophy

• 1:3300 males

• X-linked

• Xp21

• Dystrophin reduced or abnormal

• CHF in late stages

• 30% static encephalopathy
Becker's Dystrophy
type of dystrophy?

• 1:200,000

• Autosomal Dominant

• Second decade onset

• 4q35

• Scapular fixation for arm abduction

• Dysphagia
Facioscapulohumeral Dystrophy
type of dystrophy?

• Autosomal Dominant

• Onset after age 50

• 14q11.2-q13

• Dysphagia and progressive ptosis

• French-Canadian descent
Oculopharyngeal Dystrophy
type of dystrophy?

• 1:8500

• Autosomal Dominant

• Trinucleotide Repeat (CTG)

• Myotonia

• "Hatchet face"

• Cardiac arrhythmias (rarely CHF)

• Mild dysphagia

• Cataracts and endocrine dysfunction
Myotonic Dystrophy
what lab test is imp in dx of muscular dystrophy?
Elevated CPK
what disease has the following clinical features?

Myasthenia Gravis
what disease uses the following test for dx?

Tensilon test
Myasthenia Gravis
what disease is treated with the following drugs?

-Pyridostigmine to enhance cholinergic transmission

-Prednisone ± azathioprine

-Thymectomy

-Plasmapheresis
Myasthenia Gravis
disease?

Caused by circulating antibodies which interfere
with ACh release by binding presy
Lambert-Eaton Myasthenic
Syndrome (LEMS)
what disease has the following clinical features?

-Weakness and muscle fatigability similar to MG,
but bulbar and respiratory muscles are less
frequently involved and gait is usually affected

- Autonomic dysfunction (dry mouth, sexual impotence, sometimes sphincter dysfunction) is common

- Reflexes are often depressed but can be restored
after a brief period of acitivty

- 60% of cases are associated with small cell lung cancer
Lambert-Eaton Myasthenic
Syndrome (LEMS)
illusion of movement: rotation, translation or tilt
Vertigo
imbalance while standing or
walking; ataxia, proprioceptive or kinesthetic
dysfunction, motor dysfunction
Dysequilibrium
lightheadedness, graying out of vision
Presyncope
reset the eyes during prolonged rotation and direct gaze towards the oncoming visual scene
nystagmus quick phases
stucture in ear responsible for rotational acceleration?
semi-circular canals
fxn of vestibulo-ocular reflexes
gain and phase
holds an image of a stationary object on the fovea when the head is stationary
visual fixation
lose of vestibulo-ocular reflexes
oscillopsia
test for vestibular fxn?

• Have patient turn head 45o to one side and extend
neck- this puts the posterior canal on that side in
the plane of rotation

• Move patient quickly from sitting to lying, letting
head hang below horzontal plane- observe for
nystagmus for one minute

• Move patient quickly back to sitting- observe
again for nystagmus for one minute

• Repeat with head turned the other way to test the
posterior canal on the other side
Hallpike-Dix Maneuver
test for vestibular fxn?

Flush warm or cold water into one external ear canal
Bárány’s Caloric Test
for the Bárány’s Caloric Test, what happens if cold water is added to one ear?
Cold water = nystagmus beating to the opposite side
(slow phase toward the ear being tested)
for the Bárány’s Caloric Test, what happens if warm water is added to one ear?
Warm water = nystagmus beating to the same side
(slow phase away from the ear being tested)
for the Bárány’s Caloric Test, what happens if cold water is added to both ear?
Cold water in both ears = nystagmus beating upward
(slow phase downward)
for the Bárány’s Caloric Test, what happens if warm water is added to both ear?
Warm water in both ears = nystagmus beating downward (slow phase upward)
mnemonic for Bárány’s Caloric Test
COWS CUWD

one ear: cold water opposite nystagmus, warm water same side nystagmus

both ears: cold water upward nystagmus, warm water downward nystagmus
how is Benign paroxysmal positional vertigo (BPPV) diagnosed and treated?
Dx: Positive Hallpike-Dix maneuver

Rx: Epley's maneuver

Modified Epley's Maneuver (prefered)
• One minute to change positions, four minutes
in each postion
• Debris (otoconia) falls into saccule
• Soft collar, no bending, sleep sitting up for two
days
dizziness for less than one minute
Benign paroxysmal positional vertigo (BPPV)
dizziness for one hour or less
Transient ishemic attack (TIA)

Migraine

Panic Attacks
dizziness for hours to days
Meniere's syndrome
what type of dizziness is dx and tx as follows?

Dx: fluctuating hearing loss, low frequency sensorineural hearing loss, tinnitus

• Rx: Low salt diet, no caffeine, Diamox, surgery
Meniere's syndrome
what type of dizziness is dx and tx as follows?

Dx: Positive Hallpike-Dix maneuver

• Rx: Epley's or Semont's maneuver
Benign paroxysmal positional vertigo (BPPV)
most commmon adult form of motor neuron disease
amyotrophic lateral sclerosis (ALS)
disease with gene mutation in SOD1, the gene encoding a superoxide dismutase on chr 21
amyotrophic lateral sclerosis (ALS)
disease?

without tracheostomy and ventilatory support, the life expectancy is less than 2 years after bulbar involvement. If there is predominately spinal involvement, the five year survival is approximately 20%
amyotrophic lateral sclerosis (ALS)
what part of nervous system is damaged in the following NEUROGENIC MUSCLE DISEASE?

ALS, SMA, poliomyelitis
anterior horn cell
what part of nervous system is damaged in the following NEUROGENIC MUSCLE DISEASE?

trauma, disc, tumor
nerve root
what part of nervous system is damaged in the following NEUROGENIC MUSCLE DISEASE?

neuropathies
peripheral nerve
what disease is this and what clinical manifestations can be seen in this pt?
This is ALS, specifically anterior horn neuron loss associated with loss of lower motor neurons

clinical features: muscle weakness, paralysis, fasiculations, neurogenic atrophy of skeletal muscles