Central vestibulopathy.pptVIP

Other craniovertebral junction anomalies Basilar impression: occipital bone around foramen magnum deforms to cause a posterior and superior displacement of odontoid process (Paget disease, RA, osteomalacia, osteogenesis imperfecta, ricket) Assimilation of atlas: bony union between atlas and skull base, posterior displacement of odontoid (Klippel-Feil syndrome) Atlanoaxial dislocation :abnormal of transverse ligment (down syndrome, Hurler syndrome, Morquio syndrome, achondroplastic dwarfism) Spinal cord compression Treatment: surgical stabilization as well as decompression of odontoid process Multiple sclerosis Multifocal demyelinating disease (30~40 y/o, female preponderance) Immunologic disturbance Most: supratentorial white matter in the periventricular region Remyelinization during healing process Multiple sclerosis Blurred vision (by optic neuritis, common initial symptoms) Diplopia, weakness, sensory disturbance, clumsiness, ataxia Internuclear ophthalnoplegia is a strong supporting sign MRI: plaques within white matter during symptomatic periods, can appear normal during remission CSF show elevation of IgG Hearing loss (unclear if it’s a common result of process) Multiple sclerosis Vestibular symptoms: episodic vertigo, lightheadedness, imbalance. Dizziness is not common initial complaint. Up to 50% eventually develop some type. PE: nonspecific , abnormal balance, cerebellar function, spontaneous or positional nystagmus Abnormal on ENG: no specific pattern Treatment: high dose steroids, methotrexate, azathioprine, cyclophosphamide Multiple sclerosis Under study: statins, mycophenolate mofetil, monoclonal antibodies, antibiotics and antivirals, estriol For vestibular symptoms is mostly supportive, vestibular suppresion for acute vertigo and vestibular therapy for balance dysfunction Long term benefit is unclear Tumor Most common cause vestibular symptoms is vestibular schwannoma Less common, meningiomas of C-P angle Vestibular complaints: episodic vertigo, pos