Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Vertigo

11,085 views

Published on

Uploading it with the hope that someone out there will find it useful:)

Published in: Health & Medicine

Vertigo

  1. 1. Objectives • Vertigo Defintion, Types, Causes • Central & Peripheral Vertigo • Clinical Tests • Laboratory Tests • BPPV • Vestibular Neuronitis • Dizziness and Vertigo • Quiz What will I Learn Today ?
  2. 2. FAQ’s in RGUHS Examination • Fistula Test • Caloric Test • BPPV • Vestibular Neuronitis • Aural causes of Vertigo • Evaluation Of Vertigo
  3. 3. Vertigo- Definition • Not a disease, But a symptom. A feeling in which the external world seems to revolve around the individual or in which the individual itself seems to revolve in space.
  4. 4. Types Rotation Rotatory Non-rotatory Patient’s perception Subjective Objective Stimulus involved Spontaneous Induced
  5. 5. Physiological Vertigo • Balance between 3 stabilising sensory systems is lost. • Non-adaptation of vestibular system to unfamiliar head movements. • Unusual head & neck positions
  6. 6. Pathological Vertigo Pathological Vestibular Peripheral Intermediate Central Non- vestibular Occular Other
  7. 7. Peripheral & Central Vertigo Peripheral: Lesions of vestibular end organs ( 85% of all cases of vertigo) Intermediate: Lesions in vestibular nerve Central: Lesions of central nervous system(vestibular nuclei) ( 15% of all cases)
  8. 8. Peripheral & Central Vertigo
  9. 9. Central Vertigo Vascular causes: Hypertension, Basilar artery insufficiency Epilepsy: both disease & its treatment Road Traffic Accident: Head trauma Tumor: of brainstem, 4th ventricle & cerebellum Infection: Meningitis, Encephalitis Glial diseases: Multiple sclerosis Others: Parkinsonism, Psychogenic
  10. 10. Peripheral Causes for Vertigo • BPPV • Vestibular Neuronitis • Meniere’s disease • Labrynthitis • Vestibulotoxic Drugs • Perilymph Fistula • Head injuries & Surgical trauma • Syphillis • Acoustic Neuroma
  11. 11. Evaluation of Vertigo Tests for assessment of Vestibular functions Clinical tests Laboratory tests
  12. 12. Clinical Tests of Vestibular Function 1. Spontaneous Nystagmus 2. Fistula test 3. Romberg Test 4. Gait 5. Past-Pointing & Falling 6. Dix Hallpike Maneuver 7. Test of Cerebellar Dysfunction
  13. 13. Nystagmus • Involuntary rhythmical oscillatory movement of the eyes. • Triggered by inner ear stimulation. • Slow pursuit movement initially, fast rapid resetting phase . • Nystagmus is always named after direction of the fast phase Nystagmus Based on Direction Rotatory/ Tortional Horizontal Vertical
  14. 14. Nystagmus Nystagmus Peripheral Lesion of Labyrinth/8Th nerve Supressed by Optic fixation Enhanced in darkness Central Lesion in Vestibular nuclei, Brainstem, Cerebellum
  15. 15. Nystagmus
  16. 16. Nystagmus- Types Nystagmus Spontaneous Looking straight ahead, sides & focusing Not induced by any stimulus Presence always indicates an ORGANIC LESION Induced Caloric Positional(Head) Rotational Optokinetic
  17. 17. Rt gaze Lt gaze Degrees of Nystagmus (Alexander’s Law) Grade I Grade III Grade II Primary position
  18. 18. Fistula Test • Principle: To induce nystagmus by producing pressure changes in the EAC which are transmitted to the labyrinth. Stimulation of Labyrinth causes nystagmus & vertigo. • E.A.C. pressure is increased by intermittent tragal pressure or Siegelization • Normally : Negative Fistula present Fistula sign + Cholesteatoma True Positive Fistula absent Fistula sign + Congenital syphillis False positive Fistula present Fistula sign - Dead ear False negative
  19. 19. Fistula Test
  20. 20. Laboratory Tests 1. Caloric Test 2. Electronystagmography 3. Optokinetics 4. Rotational Test 5. Galvanic Test 6. Posturography
  21. 21. Caloric test • Principle: To induce nystagmus by thermal stimulation of the vestibular system • Advantages: o Each labryinth can be tested separately o Also checks for labrynthine origin of vertigo
  22. 22. Caloric Test- Types 1. Modified Kobrak Test: 60°, 60 s, Ice water 2. Fitzgerald-Hallpike Test/Bithermal Caloric Test: • Supine position • Water at 30° & 44° • Head tilt: 30° forward • 5 mins gap b/w 2 ears • Direction of Nystagmus:COWS Cold- Same Warm- Opposite 3. Cold air caloric test: Done in TM perforation
  23. 23. Caloric Test
  24. 24. Electronystagmography • Detects both Spontaneous and Induced nystagmus. • Depends on presence of Corneo-retinal potentials
  25. 25. Other tests Optokinetic Test Useful to diagnose a Central lesion Rotation Test Barany’s Revolving chair, 30° forward head tilt
  26. 26. Other tests Galvanic test • Only test which helps in differentiating end organ lesion from that of nerve lesion. Posturography
  27. 27. Treatment of Vertigo 1. Reassurance/Psychological Support 2. Pharmacotherapy 3. Adaptation exercises 4. Intratympanic antibiotic injections 5. Surgery • Conservative • Destructive
  28. 28. Benign Paroxysmal Positional Vertigo • Most common cause. • Described by Barany • Definition: Abnormal sensation of motion that is elicited by certain provocative positions. • These provocative positions usually trigger specific eye movements i.e. Nystagmus Rotational Geotropic Latency: 1- 5 s Duration: 20-30 s Fatiguable Associated with Vertigo Reversible
  29. 29. BPPV Canalithiasis: (Canal stones) • Otoconial debris are floating freely in the canal portion of the SCC • Free floating • Most common • Posterior SCC m/c involved. Cupulolithiasis: (cupula stones) • Otoconial debris are adhered to the cupula of the crista ampullaris. • Not free floating • Not common
  30. 30. Benign Paroxysmal Positional Vertigo • Sex: F>M • Age: Old age (6th decade) • Predisposing factors: MAC • Causes: TIM • Associations: Cervical diseases, Ear diseases, Vertibrobasilar insufficiency , CNS Disease • Differential Diagnosis:
  31. 31. Signs & Symptoms Symptoms • Sudden Onset • Have few asymptomatic periods in between • Dizziness triggered by head movements • Classic BPPV: erect to supine, 45° • During attacks, Rolling spin • Symptoms dissipate within 20-30 s after a violent start. Signs • Neurological examination: Normal • Dix-Hallpike maneuver: • Caloric Test: Normal or Hypofunctional
  32. 32. Investigations • Electronystagmography(ENG) • Caloric Test • Audiometry • Posturography
  33. 33. Treatment Medical 1. WAIT & WATCH 2. Vestibulo-suppressant medication 3. Vestibular Rehabilitation: Cawthorne exercises 4. Canalith repositioning (CRP): • Epley Maneuver • Semont maneuver Surgical (failure of CRP) 1. Labyrinthectomy 2. Posterior canal Occlusion 3. Singular neurectomy 4. Vestibular nerve section 5. Transtympanic Aminoglycoside application
  34. 34. Vestibular Neuronitis • Sudden onset of vertigo, nausea, vomiting w/o tinnitus and deafness. • Etiology: Labrynthine Stimulation by: Virus, Idiopathic Age(>adolescents) Sex(M=F) • Pathophysiology: Inflammatory process in vestibular nerve, self-limiting
  35. 35. Vestibular Neuronitis • Clinical Features:1. Vertigo 2. Nausea and Vomiting 3. Normal Hearing 4. Nystagmus • Investigations: PTA, Caloric Test, ENG Treatment: 1. Bed Rest and Reassurance 2. Drugs
  36. 36. Vertigo-like symptoms  Faintness  Light-headedness  Unsteadiness  Motion intolerance  Imbalance  Floating sensation
  37. 37. Vertigo & Dizziness Vertigo Specific term Includes only Vertigo More common in elderly Dizziness Broad term Includes vertigo, syncope, unsteadiness All age groups
  38. 38. Question 1 • Nystagmus pattern in peripheral Vertigo
  39. 39. Question 2 • Other name of Bithermal Caloric Test
  40. 40. Question 3 • Treatment of Choice in BPPV?
  41. 41. Question 4 • Vestibular disease in which patient presents with vertigo & normal hearing?
  42. 42. Question 5 • Vestibulotoxic Drugs

×