Check out the presentation on Vertigo at lightening fast and clear all doubts at full pelt

1. Vertigo & Dizzziness
S. Arul Selvan
Third Professional Bachelor of Siddha Medicine & Surgery
Government Siddha Medical College & Hospital
Tirunelveli, Tamilnadu

2. Dizziness & Balance Vertigo

4. Vertigo & Dizziness
 Prevalence;
* 1 in 5 adults report dizziness
* Increases in elderly
* Worsened by decreased visual acuity,
proprioception and vestibular input.

5. Vertigo & Dizziness
 Dizziness :
* True vertigo
* Pre-syncope
* Syncope
* Lightheadedness( wooziness)
* Motion sensitivity
* Unsteadiness
* Weakness
* Depression
* Anxiety
True Vertigo:
* Perception of movement
* Peripheral or central.

6. Common Causes of Non specific Dizziness
* Referred more frequently than patients with true
vertigo
Drops in blood pressure :
* Dehydration
* Vsaovagal attacks
* Autonomic neuropathy
Side effects or toxicity from medications
* Medication itself or the result of lowering blood
pressure

7.  Panic Attack;
* Non specific dizziness
* sense of fear or doom
* palpitation
* Sweating
* Shortness of breath
* Paresthesia
Cardiac arrhythmias;
Metabolic disturbances;

8. For differential diagnosis we must know the
ways :
 vestibular labyrinth
 vestibular nerve
 vestibular nucleus (brain stem)
 inferior, mid, superior cerebellar peduncle
 cerebellum
 cerebral connections

9. Vestibular Labyrinth
 Pathophysiology;
complex interaction of visual, vestibular and
proprioceptive inputs that the CNS integrates as motion
and spatial orientation
Three semicircular canals:
Rotational movements cupula

10. Two otolithic organs :
 Linear acceralation :
 Urticle ;
* responsible for horizontal acceleration.
 Saccule;
* responsible for
vertical acceleration

12. Vertigo-Differential Diagnosis
Etiologies of Vertigo
 Peripheral vertigo:
* Cerumen impaction
* BPPV
* Perilymphatic fistula
* Labyrintitis
Acute suppurative
Serous
Toxic
Chronic
* Meniere’s
* Vestibular nueronitis
* Vestibular ganglionitis
* Acoustic neuroma
 central vertigo :
* CNS infection (both brain stem &
cerebellum)
* Cerebellar infract
* Cerebellar haemorrhage
(hemorrhage of the right cerebellar
peduncle extended to the eighth
nerve through the subpial space,
causing hearing loss and tinnitus)
* Tumour (benign or neoplastic);
Ear Canal Cancer
Glomus Tumor
Acoustic neuroma

13. Central vertigo :
* Vertebrobasilar Insufficinecy (Beauty parlor stroke
syndrome (BPSS) is a rare condition characterized by
mechanical impingement of a vertebral artery (VA) during neck
rotation and/or hyperextension followed by vertebrobasilar
insufficiency.)
- AICA syndrome
- PICA syndrome
* Multiple sclerosis
* Basilar artery migraine
* Hypoglycemia
* Hypothyroidism(causes hearing loss, vertigo, tinnitus.
Approximately 40% of adults with hypothyroidism have the
involvement of sensorineural hearing loss in both ears)

20. Physiologic vertigo :
 Motion sickness;
* A mismatch between visual, proprioception and
vestibular inputs
* Not a diseased cochleovestibular system or CNS
* Rare under 2 years
* Vision focused on stationary with body in motion
Height Vertigo;
* Usually seen above 3 metres.
* Caused by a conflict between vision, vestibular and
somatosensory senses. This occurs when vestibular and
somatosensory systems sense a body movement that is not
detected by the eyes.

21. Vertigo History;
 Is it true vertigo?
 Autonomic symptoms?
 Pattern of onset and duration
 Auditory disturbances?
 Neurologic disturbances?
 Was there syncope?
 Is triggered by movement?
 Unusual eye movements?
 Any past head or neck trauma?
 Past medical history?
 Previous symptoms?
 Drug and alcohol intake?

22. Vertigo-Physical Exam
 Ear wax / foreign bodies in External Auditory Canal
 Otitis media
 Pneumatic otoscopy
 Tympanic Membrane perforation
 Nystagmus(uncontrollable rhythmic movement of the eyes)
 Pupillary abnormalitis
 Cranial nerves
 Internuclear ophthalmoplegia
 Auscultate for carotid bruits(vascular murmur sound (bruit)
heard over the carotid artery area on auscultation during
systole)
 BP and pulse in both arms

23. Vertigo-Physical Exam
 Dix-Hallpike maneuver( standard clinical test for BPPV)
 Weber-Rinne test
 Viral infections
 Giat and cerebellar function
 Caloric testing

27. Vertigo-Ancillary Tests
 MRI
 CT- If Cerebellar mass, haemorrhage or infraction
suspected
 Audiometery

29. To Learn
 Try to differentiate central from peripheral
 Ensure you understand, what the patient means by dizzy.