Symptom analysis - Vertigo

2. SYMPTOM ANALYSIS -VERTIGO
Dr. Jyothi Reshma S

3. VERTIGO
17.1
15
12.3
11.4
10.1
8.3
CAUSES
BPPV
Phobic postural vertigo
Central vestibular
syndromes
Vestibular migraine
Meniere's disease
Vestibular neuronitis

4. HISTORY
• Vertigo/dizziness/unsteadiness
• Onset
• Episodic or persistent
• Aggravating and relieving factors
• Other associated symptoms
• Family history

5. Examination
• Eye examination :
Nystagmus – significant – occurs in primary position, aymmetric
or more pronounced on one side, gaze evoked, positional,
latenct present, rotational, fixation suppression
Pursuits and saccades
• Ear examination and hearing tests
• Brain stem signs (staggering ataxic gait, diplopia, facial palsy,
weakness, sensory loss, numbness of face)
• Postural instability and cerebellar signs
• Special tests: head thrust test, caloric test, Dix-Hallpike test,
supine lateral head turns; head impulse, nystagmus, test of
skew (HINTS)

6. Central Peripheral
Vertigo Constant, less severe Intermittent, severe
Nystagmus +/-, uni or bidirectional +, unidirectional, fatigable
Ear symptoms +/- +
Brain stem signs + -
Eye signs Abnormal pursuit,
saccades
Abnormal but spares other
eye movements

7. EXAMINATION vestibular tests
• Electrooculography or electronystagmography : corneoretinal
potential
• Videooculography : record eye movements in 3 D
• Vestibular evoked myogenic potentials : evaluate saccular and
utricular function
• Video head impulse testing: eye velocity during head rotation
• Posturography: evaluate vestibular visual and somatosensory
systems
• Rotatory chair testing: SCC, bilateral vestibular hypofunction,
children

8. Treatment
CLASS DRUG DOSE
Antihistamines Promethazine
Meclizine
15-25mg PO/IM BD/TID
25-50mg TID
Histamine analog Betahistine 48-96mg
BZD Diazepam
Lorazepam
2-5mg
0.5-2mg PO/IV TID
Antiemetic Prochlorperazine
Metoclopramide
Dimenhydrinate
5-10mg PO/IM TID
10-20mg
50-100mg TDS
Calcium antagonists Cinnarizine 25-75mg TDS
Anticholinergic Scopolamine 0.6mg

9. • Presyncope : prodomal symptom of fainting or
near faint
• Graying out/black out
• Related to posture: postural hypotension
• Not related to posture: cardiac arrhythmia
(cardiac disease, CAD, CHD)
• Vasovagal attacks