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DIZZINESS Alina Valdes, M.D.
Causes   <ul><li>Vertigo  – rotational sensation </li></ul><ul><ul><li>Peripheral or central  vestibular  disorders </li><...
Diagnosis   <ul><li>Causes of presyncope </li></ul><ul><ul><li>Cardiac arrhythmia </li></ul></ul><ul><ul><li>Outflow obstr...
<ul><li>Cardiac causes </li></ul><ul><ul><li>Events occurring when patient laying down or exercising </li></ul></ul><ul><l...
Vertigo   <ul><li>Illusory sense of  unidirectional rotational movement </li></ul><ul><li>With  eyes open </li></ul><ul><u...
<ul><li>Peripheral disorders </li></ul><ul><ul><li>Sudden onset </li></ul></ul><ul><ul><li>May be disabling, e.g., vomitin...
<ul><li>Nystagmus </li></ul><ul><ul><li>Present if vertigo is peripheral in origin </li></ul></ul><ul><ul><li>Fast phase d...
Peripheral Vertigo <ul><li>Acute peripheral vestibular disorders </li></ul><ul><ul><li>Vertigo, nausea, and vomiting </li>...
<ul><li>Vestibular neuronitis </li></ul><ul><ul><li>Repetitive attacks of peripheral vertigo without auditory dysfunction ...
<ul><li>Positional vertigo </li></ul><ul><ul><li>Extremely common position or rolling over in bed </li></ul></ul><ul><ul><...
<ul><li>Benign paroxysmal positional nystagmus </li></ul><ul><ul><li>Most common type of  positional nystagmus </li></ul><...
Central Vertigo <ul><li>Cerebrovascular disease </li></ul><ul><ul><li>Vertebral vascular ischemia : MRI may show ischemia ...
Treatment   <ul><li>Peripheral vestibular suppressants </li></ul><ul><ul><li>Meclizine </li></ul></ul><ul><ul><li>Dimenhyd...
<ul><li>Meniere’s disease </li></ul><ul><ul><li>Treated with diuretics </li></ul></ul><ul><ul><li>Spontaneous remissions c...
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Dizziness

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Transcript of "Dizziness"

  1. 1. DIZZINESS Alina Valdes, M.D.
  2. 2. Causes <ul><li>Vertigo – rotational sensation </li></ul><ul><ul><li>Peripheral or central vestibular disorders </li></ul></ul><ul><li>Presyncope – lightheadedness, impending fainting, dimming of vision </li></ul><ul><ul><li>Systemic or cardiovascular disorders producing impaired cerebral blood flow </li></ul></ul><ul><li>Instability </li></ul><ul><li>Disequilibrium – impaired balance or gait </li></ul><ul><ul><li>Neurologic disorders producing disordered sensory input into the brain </li></ul></ul><ul><li>Hyperventilation </li></ul>
  3. 3. Diagnosis <ul><li>Causes of presyncope </li></ul><ul><ul><li>Cardiac arrhythmia </li></ul></ul><ul><ul><li>Outflow obstruction </li></ul></ul><ul><ul><li>Orthostatic hypotension </li></ul></ul><ul><li>Symptoms of presyncope </li></ul><ul><ul><li>Wooziness, giddiness </li></ul></ul><ul><ul><li>Disequilibrium without true vertigo </li></ul></ul><ul><ul><li>Global weakness </li></ul></ul><ul><ul><li>Dimming of vision </li></ul></ul>
  4. 4. <ul><li>Cardiac causes </li></ul><ul><ul><li>Events occurring when patient laying down or exercising </li></ul></ul><ul><li>Orthostatic hypotension </li></ul><ul><ul><li>Positional BP exam </li></ul></ul><ul><li>Hyperventilation </li></ul><ul><ul><li>Induce symptoms by hyperventilating for 3 minutes </li></ul></ul>
  5. 5. Vertigo <ul><li>Illusory sense of unidirectional rotational movement </li></ul><ul><li>With eyes open </li></ul><ul><ul><li>Environment moves in direction opposite slow component of nystagmus </li></ul></ul><ul><li>With eyes closed </li></ul><ul><ul><li>Feel turning or whirling sensation in space </li></ul></ul>
  6. 6. <ul><li>Peripheral disorders </li></ul><ul><ul><li>Sudden onset </li></ul></ul><ul><ul><li>May be disabling, e.g., vomiting </li></ul></ul><ul><ul><li>Nystagmus always present </li></ul></ul><ul><ul><li>Rarely life-threatening </li></ul></ul><ul><li>Central nervous system disorders </li></ul><ul><ul><li>Nonparoxysmal onset </li></ul></ul><ul><ul><li>Symptoms may be mild </li></ul></ul><ul><ul><li>Nystagmus may be present or absent </li></ul></ul><ul><ul><li>Symptoms may progress to CNS dysfunction (e.g. MS) or death (e.g. basilar artery stroke) </li></ul></ul>
  7. 7. <ul><li>Nystagmus </li></ul><ul><ul><li>Present if vertigo is peripheral in origin </li></ul></ul><ul><ul><li>Fast phase directed away from affected ear </li></ul></ul><ul><ul><li>Not present if vertigo is central in origin </li></ul></ul><ul><ul><li>If present but disassociation of nystagmoid movements between two eyes or if purely vertical, central cause present </li></ul></ul>
  8. 8. Peripheral Vertigo <ul><li>Acute peripheral vestibular disorders </li></ul><ul><ul><li>Vertigo, nausea, and vomiting </li></ul></ul><ul><ul><li>Ill-appearing </li></ul></ul><ul><ul><li>Lie on one side with affected ear up </li></ul></ul><ul><ul><li>Reluctant to move head </li></ul></ul><ul><ul><li>Horizontal nystagmus with fast phase away from affected ear always present </li></ul></ul>
  9. 9. <ul><li>Vestibular neuronitis </li></ul><ul><ul><li>Repetitive attacks of peripheral vertigo without auditory dysfunction </li></ul></ul><ul><li>Labyrinthitis </li></ul><ul><ul><li>Severe acute vertigo with autonomic symptoms in setting of otitis or viremia </li></ul></ul><ul><li>Peripheral vestibulopathy </li></ul><ul><ul><li>Recurrent attacks of vertigo in any age group with other neuro symptoms but a normal neuro exam </li></ul></ul>
  10. 10. <ul><li>Positional vertigo </li></ul><ul><ul><li>Extremely common position or rolling over in bed </li></ul></ul><ul><ul><li>Caused by freely moving debris within </li></ul></ul><ul><ul><li>Moving from upright to recumbent semicircular canals of vestibular system </li></ul></ul><ul><ul><li>Can be treated by repositioning maneuvers </li></ul></ul><ul><li>Meniere’s disease </li></ul><ul><ul><li>Uncommon disorder </li></ul></ul><ul><ul><li>Vertigo, progressive unilateral hearing loss, and tinnitus </li></ul></ul>
  11. 11. <ul><li>Benign paroxysmal positional nystagmus </li></ul><ul><ul><li>Most common type of positional nystagmus </li></ul></ul><ul><ul><li>Vertigo and nystagmus disappear with repeated positioning </li></ul></ul><ul><ul><li>Diagnosis made clinically: abrupt-onset positional vertigo, nausea, and disequilibrium </li></ul></ul><ul><li>Acoustic neuromas </li></ul><ul><ul><li>Extremely rare </li></ul></ul><ul><ul><li>Vertigo, hearing loss, tinnitus, and unsteadiness </li></ul></ul>
  12. 12. Central Vertigo <ul><li>Cerebrovascular disease </li></ul><ul><ul><li>Vertebral vascular ischemia : MRI may show ischemia in brain stem or cerebellum </li></ul></ul><ul><ul><li>Cerebellar hemorrhage or infarction : sudden onset dizziness, vomiting, disequilibrium, and truncal ataxia; nystagmus uncommon </li></ul></ul><ul><ul><li>Cerebellar swelling : can produce brain stem compression and death; surgical decompression may be life-saving </li></ul></ul><ul><li>Other conditions </li></ul><ul><ul><li>Demyelinating disease, mass lesions, basilar migraines, and epilepsy </li></ul></ul>
  13. 13. Treatment <ul><li>Peripheral vestibular suppressants </li></ul><ul><ul><li>Meclizine </li></ul></ul><ul><ul><li>Dimenhydrinate </li></ul></ul><ul><ul><li>Promethazine </li></ul></ul><ul><li>Central vestibular suppressants </li></ul><ul><ul><li>Low-dose diazepam or oxazepam </li></ul></ul><ul><ul><li>Antiemetics as needed </li></ul></ul>
  14. 14. <ul><li>Meniere’s disease </li></ul><ul><ul><li>Treated with diuretics </li></ul></ul><ul><ul><li>Spontaneous remissions common </li></ul></ul><ul><ul><li>Surgical ablation only in severe persistent cases </li></ul></ul><ul><li>Migraine </li></ul><ul><ul><li>Respond to antimigraine therapy </li></ul></ul><ul><li>Vertebrobasilar insufficiency </li></ul><ul><ul><li>Aspirin or ticlopidine </li></ul></ul>
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