The patient with balance disorders ...
personal notes by dr. Claudio Italiano, hospital interns.
THE PATIENT Shambling!
What does this mean?
To those of you happened to get up in the morning and note that you can not keep
your balance? Revolves around the house or skids you?
The imbalance is the inability to maintain the orientation of the intentional
body in space. Usually the person can not keep upright while it is still or
walking, but sometimes even by sitting still reeling. These people also complain
about the so-called "vertigo", that is characterized by hallucinations of vision
circular movements.
Pathogenesis.
The imbalance is the result of sensory stimuli spinocerebellar disorders, ie the
nerve signals that travel from the marrow to the cerebellum, the organ that
processes them, also called vestibular. The inner ear, the saccule and dall'utricolo
that are sensitive to static head position and acceleration of the same. The
semicircular canals are sensitive, however, the movement of rotation. We're
talking, of course, ear and its system of reception of motion stimuli that are
transmitted via the vestibular nerve, vestibular nuclei, ie the receiving
station signal and then the nucleus fastigiale place deep in the midline of the
cerebellum and mossy fibers of the street glutaminergica will overlap with the
granule cells of the ipsilateral cerebellar cortex flocculonodulare. So you see,
is not simply the mechanics of posture and it can be altered by any disease and
any distortion level, ie the receiving body (inner ear) to take devices that
amplify, process and transmit the signal, including the vestibular nerve . Also,
when a person is in poastura, signals coming from the periphery to the brain and
head position on the limbs and trunk is detected by receptors sensitive to joint
position, movement joints and elongation or shortening of the muscle spindles
that are other sensory organs in the muscles of the axial skeleton and proximal
limbs. These signals travel to the posterior columns of the spinal cord pathways
lemniscali media elements and lead to the cerebellum via spinocerebellar
pathways. The median cerebellar cortex and nuclei are of great importance in the
integration of these signals and controlling, in turn, the answers. That is, if
I have to be standing up and the foot and art are breaking down and I'm about to
lose his balance, here is a signal that the brain download excitatory and
enhances muscle tone corresponding snaps and I call into balance!
Purkinje cells of the cerebellar cortex by acting with efferent activity, that
leaves the brain to carry signals to the body. So, ultimately, modulation of
cerebellar cortical level movement is mediated by a complex circuit-type
feed-back, that I have a signal and responds with a return that is responsible
for regulating the balance el ' homeostasis of the organism, in response to a
specific stimulus.
Trouble walking.
Walking is one of the more complicated and common physical activities of
everyday life. There are coninvolte structures described above. The cyclical
movements in gait, that the steps controlled by el spinal cord centers are
modified by influences of the cortex, basal ganglia, brain stem and cerebellum,
as stated above.
Diagnosis.
When you visit a patient is implementing a series of maneuvers, ie you do
perform simple tasks, such as provatallone-knee-shin test or index-nose, ie the
patient, with closed eyes, the nose must touch with the tip of the index, if
this is difficult, it is because motor incoordination, dysmetria. The dysmetria
does mean that there are errors in the measured strength and movements of the
limbs. For example, the intention tremor that occurs when the patient is
restrained by the arms outstretched, which jolted the issue, ie for
non-cerebellar control. The patient's ability to tap quickly and repetitive,
slow movements, gross deficits are signs of coordination from the first motor
neuron lesion, ie, the first deputy to the genesis of nerve cell stimulation of
movement. Beating the back and the palm is called disdiadococinesìa.
Imbalance.
Cerebellar ataxia, cerebellar disorders means for stimulating afferent or
efferent, that is going or leaving the cerebellum. Patients who suffer from
learning to walk with legs apart and you can have symmetrical nystagmus. Other
signs are dysmetria, intention tremor, disdiadococinesia. The vestibular
imbalance problems, namely dell'orechio internal, manifested by the tendency to
fall to one side and the patient complains of dizziness rather than changes in
the balance. Romberg positive fluctuations mean that the patient with eyes
closed, feet together, swing, because there is an imbalance associated with
sensory ataxia, impaired proprioception of the limbs, ie signals that inform the
cerebellum of muscle tone signals afferent.
After these beautiful disquisitions, that if I have a balance disorder?
Certainly a visit otolaryngologist if I feel my body swerve or see the home runs!
Then a neurological examination and brain CT investigation to exclude stroke or
vascular disease cerebri. And why not? A blood test to assess the sclerotic
group (cholesterol, HDL and triglycerides), blood counts, if they are anemic,
your blood sugar, so if there is diabetes. c
.......
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