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Vertigem - como abordar e manejar. Vertigo - how to manage.

Vertigem - como abordar e manejar. Vertigo - how to manage.



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    Vertigo Vertigo Presentation Transcript

    • 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