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VERTIGO- A PRACTICAL     APPROACH    DR.ANITA BHANDARI
MAINTENANCE OF BALANCE                    PROPRIOCEPTIVEEYES    INNER EAR                       SYSTEM        BRAIN
According to the National Institute ofHealth, 42% of the population is said tosuffer from balance problems some timein the...
Vertigo, imbalance, dizziness, disequilibrium –these are all terms used by the pt. to describe   a sensation of altered or...
Challenging for the physicianVague historyVague complaintsInvestigations ?Etiology ?
OTOLOGICAL CENTRAL SYSTEMICUNKNOWN
• DURATION OF ILLNESS• DURATION OF ATTACKS• TRIGGERS• ASSOCIATED SYMPTOMS
SECONDS – LATE OTOTOXICITYMINUTES –BPPV, TIAHOURS – MENIERE’S DISEASE ,MIGRAINEDAYS – VESTIBULAR NEURITISMONTHS TO YEARS- ...
CHANGE IN POSITION – BPPVURI – VESTIBULAR NEURITISRAISED INTRATHORACICPRESSURE – PERILYMPHFISTULA
AUDIOMETRY        CRANIOCORPOGRAPHY                            -HELPS INELECTRONYSTAGMOGRAP     DIFFERENTIATING         HY...
28 YEAR OLD FEMALE INTENSE SPINNING ON GETTING UPIN MORNING LASTING SEVERAL HRS.   CANNOT GET UP FROM BED            N/V +...
• TYMP. MEMBRANE – WNL• NYSTAGMUS – LEFT BEATING SPONTANEOUS• CRANIAL NERVES WNL• GAIT –COULD NOT BE TESTED• NO NEUROLOGIC...
Pathogenesis – viral infection of superior division of                     vestibular N.History – sudden onset of severe v...
• CONTROL OF SYMPTOMS• INITIALLY STRONG VEST. SEDATIVES – MECLIZINE ,  PROCLOPERAZINE ,ALPRAZOLAM,• ONDANSTERON – NOT MORE...
41 YR. OLD MALERECURRENT EPISODES OF VERTIGOSINCE 4 MONTHS WHICH LAST FOR FEWHRS.N/V+HEARING LOSS AND RINGING IN RT.EARDUR...
TM – NNO NYSTAGMUSSTEPPING TEST – 90* ROTATION TORTAUDIOMETRY – LOW FREQ.HEARING LOSS REENG – HYPERACTIVE CALORICRESPONSE ...
MENIERE’S DISEASE Pathogenesis- endolymphatic hydrops                            Dilated membranousNormal membranous laby...
SYMPTOMS        • Fluctuating          hearing loss  TRIAD • Tinnitus        • Vertigo
DURING ACUTE PHASE,VEST.SEDATIVES MAY BE GIVEN –MECLIZINE ,CINNARIZINELOW SALT ,HIGH K DIETCARBONIC ANHYDRASEBETAHISTINE
23 YR. OLD FEMALEPERSISTANT FEELING OFUNSTEADINESSOFTEN EPISODES OF SPINNINGFREQ. HEADACHES WITH SENSORYAMPLIFICATIONNO AU...
ENT – WNLGAIT, STEPPING TEST –WNLAUDIO – WNLENG - WNL
• D/D –PHOBIAS, HYSTERIA• ABORTIVE THERAPY -  TRIPTANS• PREVENTIVE THERAPY• BETA BLOCKERS• FLUNERIZINE
Multiple sclerosisCerebrovascular disordersMigraineEpilepsy
• 60 YR. MALE• INTENSE SPINNING ON GETTING UP  FROM BED• N/V ++• NO AURAL SYMPTOMS
TM- WNLNO SPONTANEOUS NYSTAGMUSGAIT WNLNO NEUROLOGICAL DEFECITDIX-HALLPIKE MANEUVRE –NYSTAGMUS ON LT
BENIGN- self-                   limiting                 POSITIONALPAROXYSMAL                                 VERTIGO– sud...
Canalolithiasis Theory
The Dix-Hallpike test
55 YR.OLD MALECHR. UNSTEADINESS SINCE SEVERAL MONTHSINCREASED ON CHANGE OF POSITIONDECREASED HEARING BEHYPERTENSIVE,DIABET...
AUDIOMETRY –MODERATE SNHL BECCG – WIDE BASED  ATAXIC GAIT ENG –BILATERAL CANAL PARESIS NO NYSTAGMUS
ALONG WITH SYSTEMICDISORDERSSTART VESTIBULARREHABILITATIONCONTROL HTN,DMSTART NOOTROPIC AGENTSAVOID VESTIBULAR SEDATIVES
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
Vertigo  a practical approach
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Vertigo a practical approach

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Vertigo a practical approach

  1. 1. VERTIGO- A PRACTICAL APPROACH DR.ANITA BHANDARI
  2. 2. MAINTENANCE OF BALANCE PROPRIOCEPTIVEEYES INNER EAR SYSTEM BRAIN
  3. 3. According to the National Institute ofHealth, 42% of the population is said tosuffer from balance problems some timein their life.
  4. 4. Vertigo, imbalance, dizziness, disequilibrium –these are all terms used by the pt. to describe a sensation of altered orientation to the environment. Affects day to day life Who to consult?
  5. 5. Challenging for the physicianVague historyVague complaintsInvestigations ?Etiology ?
  6. 6. OTOLOGICAL CENTRAL SYSTEMICUNKNOWN
  7. 7. • DURATION OF ILLNESS• DURATION OF ATTACKS• TRIGGERS• ASSOCIATED SYMPTOMS
  8. 8. SECONDS – LATE OTOTOXICITYMINUTES –BPPV, TIAHOURS – MENIERE’S DISEASE ,MIGRAINEDAYS – VESTIBULAR NEURITISMONTHS TO YEARS- HYSTERICAL
  9. 9. CHANGE IN POSITION – BPPVURI – VESTIBULAR NEURITISRAISED INTRATHORACICPRESSURE – PERILYMPHFISTULA
  10. 10. AUDIOMETRY CRANIOCORPOGRAPHY -HELPS INELECTRONYSTAGMOGRAP DIFFERENTIATING HY PERIPHERAL & CENTRAL DISORDERS
  11. 11. 28 YEAR OLD FEMALE INTENSE SPINNING ON GETTING UPIN MORNING LASTING SEVERAL HRS. CANNOT GET UP FROM BED N/V ++ NO HEARING LOSS
  12. 12. • TYMP. MEMBRANE – WNL• NYSTAGMUS – LEFT BEATING SPONTANEOUS• CRANIAL NERVES WNL• GAIT –COULD NOT BE TESTED• NO NEUROLOGICAL DEFICIT
  13. 13. Pathogenesis – viral infection of superior division of vestibular N.History – sudden onset of severe vertigo without hearing loss. Usually preceded by URI. Investigations Audiometry – WNL ENG – canal paresis CCG – rotation to the affected side
  14. 14. • CONTROL OF SYMPTOMS• INITIALLY STRONG VEST. SEDATIVES – MECLIZINE , PROCLOPERAZINE ,ALPRAZOLAM,• ONDANSTERON – NOT MORE THAN 5 DAYS• IF PT. SEEN WITHIN 2 DAYS OF ONSET – STEROIDS• START VESTIBULAR REHABILITATION ASAP
  15. 15. 41 YR. OLD MALERECURRENT EPISODES OF VERTIGOSINCE 4 MONTHS WHICH LAST FOR FEWHRS.N/V+HEARING LOSS AND RINGING IN RT.EARDURING THE ATTACK
  16. 16. TM – NNO NYSTAGMUSSTEPPING TEST – 90* ROTATION TORTAUDIOMETRY – LOW FREQ.HEARING LOSS REENG – HYPERACTIVE CALORICRESPONSE ON RT
  17. 17. MENIERE’S DISEASE Pathogenesis- endolymphatic hydrops Dilated membranousNormal membranous labyrinth labyrinth in Menieres disease (Hydrops)
  18. 18. SYMPTOMS • Fluctuating hearing loss TRIAD • Tinnitus • Vertigo
  19. 19. DURING ACUTE PHASE,VEST.SEDATIVES MAY BE GIVEN –MECLIZINE ,CINNARIZINELOW SALT ,HIGH K DIETCARBONIC ANHYDRASEBETAHISTINE
  20. 20. 23 YR. OLD FEMALEPERSISTANT FEELING OFUNSTEADINESSOFTEN EPISODES OF SPINNINGFREQ. HEADACHES WITH SENSORYAMPLIFICATIONNO AURAL SYMPTOMSHIGH STRUNG PERSONALITY
  21. 21. ENT – WNLGAIT, STEPPING TEST –WNLAUDIO – WNLENG - WNL
  22. 22. • D/D –PHOBIAS, HYSTERIA• ABORTIVE THERAPY - TRIPTANS• PREVENTIVE THERAPY• BETA BLOCKERS• FLUNERIZINE
  23. 23. Multiple sclerosisCerebrovascular disordersMigraineEpilepsy
  24. 24. • 60 YR. MALE• INTENSE SPINNING ON GETTING UP FROM BED• N/V ++• NO AURAL SYMPTOMS
  25. 25. TM- WNLNO SPONTANEOUS NYSTAGMUSGAIT WNLNO NEUROLOGICAL DEFECITDIX-HALLPIKE MANEUVRE –NYSTAGMUS ON LT
  26. 26. BENIGN- self- limiting POSITIONALPAROXYSMAL VERTIGO– sudden onset
  27. 27. Canalolithiasis Theory
  28. 28. The Dix-Hallpike test
  29. 29. 55 YR.OLD MALECHR. UNSTEADINESS SINCE SEVERAL MONTHSINCREASED ON CHANGE OF POSITIONDECREASED HEARING BEHYPERTENSIVE,DIABETICH/O ATT 10 YRS. AGO WITH STREPTOMYCIN
  30. 30. AUDIOMETRY –MODERATE SNHL BECCG – WIDE BASED ATAXIC GAIT ENG –BILATERAL CANAL PARESIS NO NYSTAGMUS
  31. 31. ALONG WITH SYSTEMICDISORDERSSTART VESTIBULARREHABILITATIONCONTROL HTN,DMSTART NOOTROPIC AGENTSAVOID VESTIBULAR SEDATIVES

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