vertigo

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vertigo

• AHMED ALARFAJ

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DEFINITION TERMINOLOGIES

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DEFINITION TERMINOLOGIES

• VERTIGO (illusion of rotational, linear or
  tilting movement such as spinning, whirling
  or turning of the patient or the surrounding .
  DISEQUILBRIUM sensation of instability of the
  body positions, walking or standing described as
  off balanced or imbalanced.

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DEFINITION TERMINOLOGIES

• OSCILLOPSIA (inability to focus on objects with
  motion, such as reading a sign while walking).

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DEFINITION TERMINOLOGIES

• LIGHTHEADEDNESS (sense of impending faint,
  presyncope).
• PHYSIOLOGIC DIZZINESS (motion sickness, height
  vertigo),

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EVALUATION OF THE DIZZY PATIENT

• History
• Dizziness is a term used to describe any of a
  variety of sensation that produce spatial
  disorientation.
• Onset and Duration of Symptoms

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EVALUATION OF THE DIZZY PATIENT

• History
• Character of Dizziness
• Contributing Factors
• Associated Symptoms

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PHYSICAL EXAMINATION

• HN and General Physical Exam
• Otoscopy
• Vestibular Testing
• Neurological Exam

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General Characteristics of Peripheral and Central
Causes of Vertigo

• Characteristic Peripheral Central
• Intensity severe mild
• Fatigability fatigues, does not
• Associated adaptation fatigue

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General Characteristics of Peripheral and Central
Causes of Vertigo

• Characteristic Peripheral Central
• Symptoms nausea, weakness,
• hearing loss, numbness
• sweating falls more
• likely
• Eye closed symptom, symptoms
• worse with better with
• eyes closed eyes closed

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General Characteristics of Peripheral and Central
Causes of Vertigo

• Characteristic Peripheral Central
• Nystagmus horizontal, may vertical
• be unilateral bilateral
• rotary
• Ocular suppresses no effect
• Fixation nystagmus (may or enhances
• not suppress nystagmus
• during acute
• phase )

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CAUSES OF VERTIGO

• PERIPHERAL VERTIGO
• Benign Paroxysmal Positional Vertigo
• Meniere Disease
• Vestibular Neuronitis
• Perilymphatic Fistulas

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CAUSES OF VERTIGO

• PERIPHERAL VERTIGO
• Cerebellospontine Angle Tumuors
• Otitis Media
• Traumatic Vestibular Dysfunction

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CENTRAL AND SYSTEMIC CAUSES OF VERTIGO

• Multiple Sclerosis
• Other Neurological Disorder (stroke, seizures,
  middle cerebellar lesions, parkinsonism,
  psudobulbar palsy)
• Metabolic Disorders (hypo/hyper-
• thyroidism, diabetes)

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VESTIBULAR TESTING

• HALLPIKE TEST
• ELECTRONYSTAGMOGRAPHY
• POSTUGRAPHY
• CALORIC

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VESTIBULAR DISORDERS

• Menieres Disease (Endolymphatic
• Hydrops)

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DIAGNOSIS

• Based on clinical history, physical examination
  and audiological findings (initial low-frequency
  SNHL) with exclusion of other causes of hearing
  loss and vertigo is adequate for diagnosis and
  initiating empirical therapy.

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MANAGEMENT CONCEPT

• Safety
• Acute Vestibular Suppression
• Vestibular Rehabilitation
• Surgical Management

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MEDICAL MANAGEMENT OF MENIERE DISEASE

• Dietary Restrictions
• Diuretics
• Vestibular Suppressants
• Corticosteroids
• Stress Reduction

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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV,
Cupulolithiasis)

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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV,
Cupulolithiasis)

• Most common cause of peripheral vertigo
• Causes pathophysiology
• Typically self limiting may have recurrent
  episodes
• SSx

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MANAGEMENT

• Education, reassurance and observation
• Particle Repositioning Maneuver (Epleys
  Maneuver)
• Home vestibular positional exercises
• Antivertiginous medications

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SURGICAL MANAGEMENT OF VERTIGO

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SURGICAL MANAGEMENT OF VERTIGO

• Singular Neurectomy
• Endolymphatic Sac Surgery
• Vestibular Nerve Section
• Transtympanic Or Intratympanic Aminoglycoside
  Injections
• Labyrinthectomy