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Romberg thử nghiệm: rơi xuống bên phải đi bộ một đường thẳng: độ lệch để kiểm tra phải bước Unterberger: hơn 45% chuyển sang bên phải sau 40 bước kiểm tra vị trí Arm: độ lệch để kiểm tra phải chỉ B'r'ny: pastaa trỏ sang phải | 692 9 Diseases Affecting the Cranial Nerves Table 9.14 Differentiation of peripheral and central vestibular disturbances Test Peripheral lesion on the Central right Nystagmus Rapid component to the left May be vertical rotatory or dissociated i.e. only detectable in one eye in particular positions may be accompanied by other brainstem signs Excitability of labyrinth Diminished or none on right Normal Other Romberg test fall to right These tests yield variable and Walking a straight line often mutually inconsistent deviation to right findings with respect to late- Unterberger stepping test rality and direction so-called more than 45 turn to dysharmonie vestibulaire right after 40 steps Arm position test deviation to right Barany pointing test past- pointing to right tion cf. positional nystagmus p. 695 . The various types of nystagmus and their localizing significance are described on p. 643. The features that distinguish central from peripheral vestibular disorders are important to know and are summarized in Table 9.14. Various tests of stance and gait are useful in the demonstration of vestibular disturbances and other types of disturbances causing dysequilib-rium particularly the Unterberger step test and the Babinski-Weil walking test. In the Barany pointing test see Fig. 9.31 the patient extends his arms and points with his index fingers to the examiner s index fingers. He is then asked to close his eyes and advance his index fingers straight forward to touch the examiner s fingers. In the presence of a vestibular lesion the patient s fingers deviate to the side of the lesion. The brain has multiple sources of information that help it to maintain the body s balance and orientation in space Figs. 9.27 9.28 the vestibular apparatus the visual system and the proprioceptive system in which impulses from the peripheral nerves are relayed to the spinal cord and upward to the cerebellum. If one of these systems should cease to function the body can remain in balance .
