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Lakshan's vertigo presentation rcs


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Lakshan's vertigo presentation rcs

  1. 1. Vertigo Dr. MTD lakshanMBBS, MS(ORL), DOHNS(Eng), FEB ORL HNS, FRCS ORL-HNS(Edin) Consultant ENT and Head and Neck Surgeon DGH Hambantota Ruhunu Clinical Society Annual Sessions 2012 1
  2. 2. Objectives1.Define Vertigo2.Essential Clinical Evaluation of patients3.Common Vertiginous Syndromes4.Common Management strategies
  3. 3. Definition• Illusion of Movement (Rotatory & Postural)• Differentiate from • Light headedness, • Imbalance, • Visual phenomenon, • faintish-ness
  4. 4. Basic Sciences• Systems involved : • Vestibular • Ocular • Proprioception • Central Nervous System
  5. 5. Basic Sciences
  6. 6. Anatomy
  7. 7. Schematic drawing of the vestibular epithelium showingthe two cell types and the nerve connections made on each.
  8. 8. The position of the crista ampularis and cupula within a cross sectionof the ampulla of one semicircular canal. Also shown is the movement of the cupula and its embedded cilia during rotation first in one direction and then in the opposite direction.
  9. 9. Shearing force in vestibular organs. Upper diagram shows arrangement of cilia on a hair cell as seen from above; position of kinocilium indicated by larger dot. Dashed line indicates direction of effective shearing forces; forces at right angles are ineffective. Lower diagram shows section through hair cell along dashed line (upper diagram) with cilia at rest (center) and tilted right and left. Tilt toward kinocilium excites, tilt away deceases excitation.
  10. 10. Brainstem pathways forcontrol of eyemovements by the left horizontal semicircular canal.
  11. 11. Clinical Evaluation
  12. 12. Aetiology• BPPV• Phobic Postural Vertigo• Central Vertigo• Vestibular Migraine• Meniere’s disease• Vestibular Neuronitis• B/L Vestibulopathy• PLF• Superior Semicircular Canal Dehiscence
  13. 13. History• Key Question: True Vertigo or Not
  14. 14. Type• Rotatory : “Merry go round’• Postural : “Boat ride” - B/L vetibulopathy• Lightheaded ness
  15. 15. Episode Duration• Episodic / Continuous• Episode duration - Seconds, Minutes/Hours, Days
  16. 16. Precipitations• At rest without any precipitation• Walking• Coughing, loud sounds• Turning in the bed• Turning head to a side• Certain social / environmental conditions
  17. 17. Accompanying• Inner Ear Symptoms• Diplopia Sensory symptoms, dysphagia, dysarthria• Headache - Migraine
  18. 18. Other-History• Recent Respiratory Infection• RTA• PMHx• Disability• Previous treatments and success
  19. 19. Examination Neuro-otological• Complete Ear Examination• Nystagmus• VII• Other Cranial Nerves• Romberg’s
  20. 20. Examination Neuro-otological Neuro-otological• Tandem gait• Stepping test• Head thrust test
  21. 21. VOR• Video
  22. 22. Investigations• Directed• Inner Ear Test Battery : FBC, ESR, TSH, VDRL, Lipids, FBS• Calorics ENG - video• Electrocochleography, ABR,VEMP• MRI
  23. 23. Four CD of Vertigo Management• Correct Diagnosis• Correct Drugs• Correct Dosage• Correct Duration
  24. 24. Pharmacotherapy 7 A’s• Anti Emetics - Dimenhydronate• Anti Inflammatory - Steroids• Anti - Migraine - Beta-blockers, topiramate• Anti Menieres - Betaserc• Anti Depressants - SSRI• Anti Convulsants - Carbamezepine• Amino Pyridines - for cerebellar gait disorders
  25. 25. BPPV• canalolithiasis theory• Dix Hallpike test +• Epley Manoeuvre
  26. 26. Dix Hallpike Test
  27. 27. Epley Manoeuvre
  28. 28. Meniere’s Disease• Saccin Theory / Dark Cell theory• Aural fullness vertigo tinnitus hearing loss fluctuating• Diagnosis of exclusion• treatment : salt restriction, diuretics, betahistine, Intratympanic gentamicin, Grommet, Meniett, ELS Surgery, Vestibular nerve section, labirynthectomy
  29. 29. Vestibular Neuronitis• Medical Management• self improving
  30. 30. Summary• True Vertigo or Not• Central vs Peripheral• Clinical Evaluation and Judicious Investigations• Medications and Physical treatment modalities• Satisfying to properly assess and treat a vertigo patient
  31. 31. Questions?• Thank You!• email questions to:•