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Vertigo a practical approach

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    Vertigo  a practical approach Vertigo a practical approach Presentation Transcript

    • VERTIGO- A PRACTICAL APPROACH DR.ANITA BHANDARI
    • MAINTENANCE OF BALANCE PROPRIOCEPTIVEEYES INNER EAR SYSTEM BRAIN
    • According to the National Institute ofHealth, 42% of the population is said tosuffer from balance problems some timein their life.
    • Vertigo, imbalance, dizziness, disequilibrium –these are all terms used by the pt. to describe a sensation of altered orientation to the environment. Affects day to day life Who to consult?
    • Challenging for the physicianVague historyVague complaintsInvestigations ?Etiology ?
    • OTOLOGICAL CENTRAL SYSTEMICUNKNOWN
    • • DURATION OF ILLNESS• DURATION OF ATTACKS• TRIGGERS• ASSOCIATED SYMPTOMS
    • SECONDS – LATE OTOTOXICITYMINUTES –BPPV, TIAHOURS – MENIERE’S DISEASE ,MIGRAINEDAYS – VESTIBULAR NEURITISMONTHS TO YEARS- HYSTERICAL
    • CHANGE IN POSITION – BPPVURI – VESTIBULAR NEURITISRAISED INTRATHORACICPRESSURE – PERILYMPHFISTULA
    • AUDIOMETRY CRANIOCORPOGRAPHY -HELPS INELECTRONYSTAGMOGRAP DIFFERENTIATING HY PERIPHERAL & CENTRAL DISORDERS
    • 28 YEAR OLD FEMALE INTENSE SPINNING ON GETTING UPIN MORNING LASTING SEVERAL HRS. CANNOT GET UP FROM BED N/V ++ NO HEARING LOSS
    • • TYMP. MEMBRANE – WNL• NYSTAGMUS – LEFT BEATING SPONTANEOUS• CRANIAL NERVES WNL• GAIT –COULD NOT BE TESTED• NO NEUROLOGICAL DEFICIT
    • Pathogenesis – viral infection of superior division of vestibular N.History – sudden onset of severe vertigo without hearing loss. Usually preceded by URI. Investigations Audiometry – WNL ENG – canal paresis CCG – rotation to the affected side
    • • CONTROL OF SYMPTOMS• INITIALLY STRONG VEST. SEDATIVES – MECLIZINE , PROCLOPERAZINE ,ALPRAZOLAM,• ONDANSTERON – NOT MORE THAN 5 DAYS• IF PT. SEEN WITHIN 2 DAYS OF ONSET – STEROIDS• START VESTIBULAR REHABILITATION ASAP
    • 41 YR. OLD MALERECURRENT EPISODES OF VERTIGOSINCE 4 MONTHS WHICH LAST FOR FEWHRS.N/V+HEARING LOSS AND RINGING IN RT.EARDURING THE ATTACK
    • TM – NNO NYSTAGMUSSTEPPING TEST – 90* ROTATION TORTAUDIOMETRY – LOW FREQ.HEARING LOSS REENG – HYPERACTIVE CALORICRESPONSE ON RT
    • MENIERE’S DISEASE Pathogenesis- endolymphatic hydrops Dilated membranousNormal membranous labyrinth labyrinth in Menieres disease (Hydrops)
    • SYMPTOMS • Fluctuating hearing loss TRIAD • Tinnitus • Vertigo
    • DURING ACUTE PHASE,VEST.SEDATIVES MAY BE GIVEN –MECLIZINE ,CINNARIZINELOW SALT ,HIGH K DIETCARBONIC ANHYDRASEBETAHISTINE
    • 23 YR. OLD FEMALEPERSISTANT FEELING OFUNSTEADINESSOFTEN EPISODES OF SPINNINGFREQ. HEADACHES WITH SENSORYAMPLIFICATIONNO AURAL SYMPTOMSHIGH STRUNG PERSONALITY
    • ENT – WNLGAIT, STEPPING TEST –WNLAUDIO – WNLENG - WNL
    • • D/D –PHOBIAS, HYSTERIA• ABORTIVE THERAPY - TRIPTANS• PREVENTIVE THERAPY• BETA BLOCKERS• FLUNERIZINE
    • Multiple sclerosisCerebrovascular disordersMigraineEpilepsy
    • • 60 YR. MALE• INTENSE SPINNING ON GETTING UP FROM BED• N/V ++• NO AURAL SYMPTOMS
    • TM- WNLNO SPONTANEOUS NYSTAGMUSGAIT WNLNO NEUROLOGICAL DEFECITDIX-HALLPIKE MANEUVRE –NYSTAGMUS ON LT
    • BENIGN- self- limiting POSITIONALPAROXYSMAL VERTIGO– sudden onset
    • Canalolithiasis Theory
    • The Dix-Hallpike test
    • 55 YR.OLD MALECHR. UNSTEADINESS SINCE SEVERAL MONTHSINCREASED ON CHANGE OF POSITIONDECREASED HEARING BEHYPERTENSIVE,DIABETICH/O ATT 10 YRS. AGO WITH STREPTOMYCIN
    • AUDIOMETRY –MODERATE SNHL BECCG – WIDE BASED ATAXIC GAIT ENG –BILATERAL CANAL PARESIS NO NYSTAGMUS
    • ALONG WITH SYSTEMICDISORDERSSTART VESTIBULARREHABILITATIONCONTROL HTN,DMSTART NOOTROPIC AGENTSAVOID VESTIBULAR SEDATIVES