CENTRAL VERTIGO

PROBLEMS IN MS N BRAIN
NO HEARING LOSS AND TINNITUS
NYSTAGMUS NEVER STOPS (DOES NOT SUPPRESS WITH FIXATION)
GRADUAL
FOCAL NEUROLOGICAL FINDINGS/DYSARTHRIA/ DYPLOPIA
e.c. PHENYTOIN TOXICITY -> HORIZONTAL NYSTAGMUS
SEVERE TOXICITY-> VERTIGAL NYSTAGMUS
MULTIPLE SCLEROSIS
Cure: MECLIZINE. Diazepam when severe.
ATAXIA
PERIPHERAL VERTIGO
HEARING LOSS AND TINNITUS
NYSTAGMUS STOPS
SUDDEN
benign positional vertigo:
no hearing loss or tinnitus. VERTIGO AJA. EXCLUSIVELY ONLY
WHEN STANDING UP. Otoliths block lymph in SCC.
Acoustic neuroma: not only when standing up. Hearing
problem. Ataxia.
Labyrinthitis and menieres: not only when standing up.
Hearing loss. Tinnitus. Labyrinthitis: single episode that lasts
days e.c. viral infection
Menieres: short episode and recurrent. Overproduction of
endolymphatic fluid in the ear. Need salt restriction and
diuretics.
Perilymph fistula: . Hearing problem.
History of trauma. Surgery.

MULTIPLE SCLEROSIS (MULTIPLE NEUROLOGICAL DYSFUNCTIONS IN

A PROGRESSING STATE)
USUALLY PRECEEDED BY OPTIC NEURITIS. ALSO AFFECTS MOTOR
AND SENSORY FUNCTIONS. BOWEL. BLADDER.
EPIDEMIOLOGY: COLD AREAS
TYPES:
RELAPSE-REMITTING: GET BETTER->GET WORSE
OVER AND OVER AGAIN UNTIL PERSON ENDS UP IN WHEELCHAIR
PRIMARY PROGRESSIVE: PROGRESSIVELY WORSE FROM FIRST
ONSET. GA ADA ACARA GET BETTER.
SECONDARY PROGRESSIVE: PROGRESSIVE WITH CONSTANT
WORSENING.
MENTAL STAYS INTACT
YOU CANNOT DIAGNOSE MULTIPLE SCLEROSIS BY A SINGLE
NEUROLOGICAL DEFICIT. YOU NEED TO SEE MULTIPLE
NEUROLOGICAL SYMPTOMS.
FIRST LINE DIAGNOSIS: MRI-> DEMYELINATING PLAQUES
CSF ONLY WHEN REALLY NEEDED. SEE SMALL AMOUNTS OF
PROTEIN (low). OF CELLS. SHOULD BE MILD ONLY. IF ISNT,
THEN IT IS NOT MULTIPLE SCLEROSIS.
CSF: OLIGOCLONAL BANDS OF IGG-> only done when mri is
inconclusive
TREATMENTS:
STEROIDS FOR ACUTE-SEVERE
INTERFERON BETA
GLATIRAMER ACETATE (REPLACES MYELIN BASIC PROTEIN)
- DISEASE MODIFYING
SYMPTOMATIC THERAPY:
Baclofen- spasticity
Trigeminal neuralgia- carbamazepine/phenytoin
Bladder hyperactivity? Block ach! Oxybutynin
Bladder hypoactivity (urinary retention)? Give ach! Bethanechol

GUILLAIN BARRE syndrome (acute inflammatory polyneuritis)

CHARACTERISTICS: ASCENDING PARALYSIS (descending weakness:
myasthenia gravis)
ETIOLOGY: CAMPYLOBACTER JEJUNI/Epstein barr/CMV
IT GOES THROUGH A DEMYELINATION PROCESS OF THE PERIPHERAL
TRACTS -> LMN -> LOSS OF DEEP TENDON REFLEXES
IT IS AUTOIMMUNE. ANTIBODIES ATTACK OWN MYELIN. ANTIBODIES
UNDERGO MOLECULAR MIMICRY TO LOOK LIKE ANTIGEN. OWN
ANTIBODIES ATTACK OWN ANTIGENS
Loss of diaphragmatic reflex -> respiratory complications
DIAGNOSIS:
CSF: HIGH PROTEIN (ALBUMIN CYTOLOGIC DISSOCIATION), LOW
CELL
DIAPHRAGMATIC STIMULATION
NERVE CONDUCTION STUDIES (EMG)---TREATMENT:
PLASMAPHARESIS-> REPLACE ALL THE ANTIBODIES THAT ATTACK
MYELIN
IV IMMUNOGLOBULIN
NO CORTICOSTEROIDS
MECHANICAL VENTILATION (INTUBATION)
DONT WAIT FOR HYPOXIA

DELIRIUM
CALCIUM/SODIUM PROBLEM/GLUCOSE/UREMIA (TOXIN PROBLEM)
AWARENESS PROBLEM (FEVER: DELIRIUM)
DEMENTIA
CONSCIOUS, AWARE, BUT MEMORY LOSS THAT DISTURBS SOCIAL
AND OCCUPATIONAL FUNCTIONING, B12 DEFICIENCY, HIV,
CREUTZFELD JACOB DISEASE (RAPID FROM DIAGNOSIS TO DEATH,
MYCONIC JERKS. DIAGNOSIS: BIOPSY)
ALZHEIMERS: MEMORY LOSS WITH LOSS OF COGNITION
MILD COGNITIVE IMPAIRMENT: MEMORY LOSS ONLY
LEWY BODY DEMENTIA: PRESENTS WITH PARKINSONIAN
SYMPTOMS+HALLUCINATIONS. FLUCTUATING COGNITIVE
IMPAIRMENT
DIAGNOSIS:
CT SCAN: ELIMINATE STROKE, NORMAL PRESSURE HYDROCEPHALUS
(WOBBLY, WACKY, WET) , TUMORS
MMSE
NEUROLOGICAL FINDINGS
-ELIMINATE THYROID
CR
B12
TREATMENT FOR ALZHEIMERS:
ACETYLCHOLINESTERASE INHIBITORS: DONEPEZIL, RIVASTIGMINE (3
MONTHS)
NMDA ANTAGONISTS: MEMANTINE -> SEVERE DEMENTIA
Acetylcholine: MAKES THE BODY SECRETE! INCLUDING THE BRAIN>THOUGHT
ACETYLCHOLINESTERASE INHIBITOR: INCREASE SALIVATION,
LACRIMATION, STOOL
NO CSF CHECK