Vertigem - como abordar e manejar. Vertigo - how to manage.

2. WHAT IS VERTIGO?
Vertigo is the illusion of movement throughout space.

3. TYPES OF VERTIGO
Physiologic - in normal people, like cinetosis, or heights´ vertigo – in this case
true vertigo is minimal while autonomic symptoms predominate (sudoresis,
nausea, vomit, salivation, yawning and malaise).
Benign Positional Paroxystic – the commonest cause. Short episodes of bertigo
(less than 1 min longer), when the patient changes position, tipically when
turning, waking up or leaning down on bed, or with head extension to look to
a higher place. It happens when otolyths enter semicircular channels after
cranial trauma, inner ear infection or spontaneously in elderlies. Can be
healed by a simple bedside maneuver.
Peripheral benign Vestibulopathy – triggered by high airway infection or
idiopathic. Vertigo, nausea and vomiting that last for several days and are
not associated with neurologic or hearing symptoms. A viral ethiology has
been suggested but not completely proven. Occasionaly occurs in na
epidemic fashion.

4. TYPES OF VERTIGO
Meniére´s syndrome – severe episodic crisis of vertigo with floating hearing levels at
the audiometric test, starting at the low frequencies, associated to a fullness or
pressure sensation at the ear. Recurrent endolymphatic hypertension (hydropsis)
seems to cause the episodes. Generally is unilateral but in 20 to 40% of cases can
be bilateral.
Migraine – vertigo can precede or accompany the headache. The so-called paroxystic
positional benign vertigo of the childhood can be the first symptom of migraine.
The mechanism is not fully understood but inner ear damage might occur in a
quarter of the patients, and some can develop symptoms of the Meniére´s
syndrome.
Post traumatic and post concussion
Cervical vertigo – due to loss of proprioceptive function of the cervical articular
receptors in people with traumatic or degenerative osteomuscular disorders.
Vascular insufficiency – vertebrobasilar ischemia
Tumors – pontocerebelar angle
Miscelanea

5. HOW TO EVALUATE
Complete anamnesis
Complete neurologic exam
Head thrust maneuver
http://www.medscape.com/viewarticle/710698
Depending on the results of the previous items: audiometry or MRI + angio
MRI of the neck and head.
Approach to cervical vertigo: http://www.dizziness-and-
balance.com/disorders/central/cervical.html

6. MANAGEMENT
1.Specific:
Repositioning maneuvers for BPPV - Epley
http://www.dizziness-and-balance.com/disorders/bppv/bppv.html
Steroids – for vestibular neuritis – methil prednisolone 100 mg x 3 days tapering
down the dose through the next 22 days – should be started within 3 days of
the clinical picture´s beginning.
No salt diet with hydrochlorotiazide 25-50 mg daily in the Meniére syndrome
2.Symptomatic:
Meclizine 25 mg daily for a limited number of days, avoiding chronic use
3.Rehabilitation:
Moving the eyes and staring at the direction that causes the greatest dizziness
Walking and turning around slowly
Moving slowly the head while the patient is standing and walking

7. SOURCES AND ACKNOWLEDGEMENTS
Dr. Timothy Hain - http://www.dizziness-and-balance.com/legal/quoting.html
Dr. David Newman-Toker http://www.medscape.com/viewarticle/710698