WHAT IS VERTIGO?Vertigo is the illusion of movement throughout space.
TYPES OF VERTIGOPhysiologic - in normal people, like cinetosis, or heights´ vertigo – in this case true vertigo is minimal while autonomic symptoms predominate (sudoresis, nausea, vomit, salivation, yawning and malaise).Benign Positional Paroxystic – the commonest cause. Short episodes of bertigo (less than 1 min longer), when the patient changes position, tipically when turning, waking up or leaning down on bed, or with head extension to look to a higher place. It happens when otolyths enter semicircular channels after cranial trauma, inner ear infection or spontaneously in elderlies. Can be healed by a simple bedside maneuver.Peripheral benign Vestibulopathy – triggered by high airway infection or idiopathic. Vertigo, nausea and vomiting that last for several days and are not associated with neurologic or hearing symptoms. A viral ethiology has been suggested but not completely proven. Occasionaly occurs in na epidemic fashion.
TYPES OF VERTIGOMeniére´s syndrome – severe episodic crisis of vertigo with floating hearing levels at the audiometric test, starting at the low frequencies, associated to a fullness or pressure sensation at the ear. Recurrent endolymphatic hypertension (hydropsis) seems to cause the episodes. Generally is unilateral but in 20 to 40% of cases can be bilateral.Migraine – vertigo can precede or accompany the headache. The so-called paroxystic positional benign vertigo of the childhood can be the first symptom of migraine. The mechanism is not fully understood but inner ear damage might occur in a quarter of the patients, and some can develop symptoms of the Meniére´s syndrome.Post traumatic and post concussionCervical vertigo – due to loss of proprioceptive function of the cervical articular receptors in people with traumatic or degenerative osteomuscular disorders.Vascular insufficiency – vertebrobasilar ischemiaTumors – pontocerebelar angleMiscelanea
HOW TO EVALUATEComplete anamnesisComplete neurologic examHead thrust maneuverhttp://www.medscape.com/viewarticle/710698Depending on the results of the previous items: audiometry or MRI + angio MRI of the neck and head.Approach to cervical vertigo: http://www.dizziness-and- balance.com/disorders/central/cervical.html
MANAGEMENT1.Specific:Repositioning maneuvers for BPPV - Epleyhttp://www.dizziness-and-balance.com/disorders/bppv/bppv.htmlSteroids – for vestibular neuritis – methil prednisolone 100 mg x 3 days tapering down the dose through the next 22 days – should be started within 3 days of the clinical picture´s beginning.No salt diet with hydrochlorotiazide 25-50 mg daily in the Meniére syndrome2.Symptomatic:Meclizine 25 mg daily for a limited number of days, avoiding chronic use3.Rehabilitation:Moving the eyes and staring at the direction that causes the greatest dizzinessWalking and turning around slowlyMoving slowly the head while the patient is standing and walking
SOURCES AND ACKNOWLEDGEMENTSDr. Timothy Hain - http://www.dizziness-and-balance.com/legal/quoting.htmlDr. David Newman-Toker http://www.medscape.com/viewarticle/710698