Vertigo

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Vertigo

  1. 1. Vertigo The Dizzy Patient
  2. 2. Vertigo <ul><li>Latin origin: vertere , to spin </li></ul><ul><li>the illusion that the environment is spinning </li></ul><ul><li>distinct from “dizziness” </li></ul><ul><ul><li>light-headed faintness </li></ul></ul><ul><ul><li>off-balanced feeling </li></ul></ul><ul><ul><li>feeling of floating </li></ul></ul>
  3. 3. Acute Vertigo <ul><li>Determine whether it represents a peripheral or a central problem </li></ul><ul><ul><li>peripheral (99:100) refers to the inner ear or vestibular nerve up to the root entry zone in the brain stem </li></ul></ul><ul><ul><li>central (1:100) refers to the brain, usually associated with focal neurologic findings, may be from cerebellar infarct </li></ul></ul>
  4. 4. Acute Vertigo clues from history and physical <ul><li>peripheral - look for signs of ear involvement: unilateral hearing loss, tinnitus, fullness, or pain </li></ul><ul><li>central - most patients have vascular risk factors: age >60, HTN, smoking, known atherosclerotic cardiac or or peripheral vascular disease </li></ul>
  5. 5. Clues from History and Physical degree of imbalance <ul><li>peripheral - patients prefer to lie down, they can get up and walk if asked but tend to veer to one side </li></ul><ul><li>central - patients with cerebellar lesions usually have such severe imbalance that they cannot stand up </li></ul>
  6. 6. Clues from History and Physical nystagmus <ul><li>Most often found in patients with peripheral vestibular lesions </li></ul><ul><li>peripheral - always beats in one direction; inhibited with fixation; usually disappears within a few days </li></ul><ul><li>central - typically changes direction toward the direction of gaze; not inhibited with fixation; last > 1-2 days </li></ul>
  7. 7. Clues from History and Physical double vision <ul><li>usually suggests central brainstem involvement, but may occur in peripheral inner-ear or vestibular nerve damage </li></ul><ul><li>peripheral lesions </li></ul><ul><ul><li>siemicircular canal  nystagmus </li></ul></ul><ul><ul><li>otolith organs  slight static eye displacement, use cover-uncover test </li></ul></ul>
  8. 8. Acute Vestibulopathy of unknown cause <ul><li>other diagnostic labels: </li></ul><ul><ul><li>vestibular neuritis </li></ul></ul><ul><ul><li>vestibular neuronitis </li></ul></ul><ul><ul><li>viral labyrinthitis </li></ul></ul><ul><ul><li>viral neurolabyrinthitis </li></ul></ul><ul><li>vascular occlusion of inner ear </li></ul>
  9. 9. Acute Vestibulopathy treatment <ul><li>hydration and promethazine </li></ul><ul><li>vestibular rehabilitation </li></ul><ul><ul><li>begin with onset of symptoms </li></ul></ul><ul><ul><li>make head movements that provoke vertigo, walk, bend, straighten up </li></ul></ul><ul><ul><li>recovery occurs as the brain compensates for loss of function </li></ul></ul><ul><li>meclizine - for short term use only </li></ul>
  10. 10. Benign Positional Vertigo <ul><li>vertigo produced by change in position </li></ul><ul><li>the most common cause of vertigo after head trauma, or other damage to the ear, such as infections </li></ul><ul><li>results from the free movement of dislodged utricle particulate debris - calcium carbonate crystals - in the semicircular canals </li></ul>
  11. 11. Benign Positional Vertigo diagnostic testing <ul><li>Dix-Hallpike test </li></ul><ul><ul><li>positional testing using the head-hanging technique </li></ul></ul><ul><ul><li>patients with benign positional vertigo will show a burst of nystagmus after a delay of 5 to 10 seconds, the nystagmus lasts about 30 seconds </li></ul></ul><ul><ul><li>the test is never subtly positive </li></ul></ul>
  12. 12. Benign Positional Vertigo treatment <ul><li>Epley maneuver the patient’s head is systematically rotated to move the loose particles out of the posterior semicircular canal back into the utricle ( see reference ) </li></ul>Otolaryngol Head Neck Surg 1992;107:399
  13. 13. Vertigo of Central Origin <ul><li>Diagnotic clues </li></ul><ul><ul><li>risk factors, focal neurologic findings </li></ul></ul><ul><li>Diagnostic tests </li></ul><ul><ul><li>MRI brain scan </li></ul></ul><ul><ul><li>MRI angiography </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>aspirin 325 mg a day </li></ul></ul>
  14. 14. References <ul><li>Dizzy Patients: The Varieties of Vertigo Baloh RW, Baringer JR. Hosp Practice 1998;33(6):55-77. </li></ul><ul><li>Dizziness, Hearing Loss, and Tinnitus Baloh RW. FA Davis, Philadelphia, 1998. </li></ul>

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