2. 1.The vestibular system
2. T he visual system (retina to occipital cortex)
3. T he somatosensory system (conveys
peripheral information from skin, joint and
muscle receptors)
These three stabilizing systems overlap sufficiently to
compensate
(partially or completely) for each other’s deficiencies.
Vertigo may represent either physiologic stimulation or
pathologic dysfunctionin any of the three sensory systems.
3. • vertigo - sensation of
movement, often
rotary, indicating
disorder of the
vestibular system .
• Non-vertiginous
dizziness such as:
imbalance, light-
headedness, syncope,
faintness, and other
diseases.
4.
5. • Vertigo is an illusory or
hallucinatory sense of
movement of the body or the
environment, most often a
feeling of spinning.
• Disturbance of the vestibular
system(Vertigo is the
historical hallmark of a
vestibulopathy)
• central and peripheral
causes: Both
central(vestibular nucleus
and brainstem) and
peripheral (vestibular nerve
and labyrinth) lesions may
produce vertigo and
resultant nystagmus
The labyrinth of the inner ear, from the
left ear. It contains i) the cochlea - the
peripheral organ of our auditory system;
ii)
the three semi circular canals, which
transduce rotational movements; and iii)
the
otolithic organs (utricle and saccule),
which
transduce linear accelerations. The
pouch
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12. In Panel A, the examiner stands at the patient’s
right side and rotates the patient’s head 45
degrees to the right to align the right posterior
semicircular canal with the sagittal plane of
the body.
In Panel B, the examiner moves the patient,
whose eyes are open, from the seated to the
supine right-ear-down position and then
extends the patient’s neck slightly so that the
chin is pointed slightly upward. The latency,
duration, and direction of nystagmus, if present,
and the latency and durationof vertigo, if
present, should be noted. The arrows over the
eyesin the inset depict the direction of
nystagmus in patients withtypical benign
paroxysmal positional vertigo. The presumed
location in the labyrinth of the free-floating
debris thought to cause the disorder is also
shown.
13. Medical history
Physical examination (eye, ear and reflexes)
Laboratory tests
Clinical tests + assessment :
Dix-hallpike maneuver (positioning testing)
Roll test on either side
Caloric test (Vestibulo-ocular reflex)
Electro nystagmography
Rotational chair testing
Computerized dynamic posturography
Frenzied glasses for observation of Nystagmus
Gaze stability test
Balance & Co-ordination assessment
Head shaking Induce nystagmus with eyes closed
Dizziness handicap Inventory
14. Positional maneuvers :
1) Epleys maneuver (Canalith) In sitting, turn the head towards affected side
lying down roll over to left side lying sitting
2) Semont maneuver (Cupalolith) In sitting, head 45 towards the opposite side
side-lying to the same side (1 min) sitting other side side-lying with same
head position sitting/ collar
3) Canalith repositioning therapy (CRT) Head 45 towards the involved side
Hallpike-Dix position (affected ear down) Head 90 toward the opposite side +
30 neck extension side-lying sitting
4) 360 degree Rotation
5) Forced prolonged position on the Unaffected side
6) Brant-Daroff exercise (Cupalolith) In sitting turn head toward one side
side-lying to opposite side Hold for 30 seconds sitting procedure for
the other side (10-20 times/three set per day)
7) Vestibular re-training exercises (exposure to vertigo or Habituation training postures)
8) Gaze stability exercise
1- Move the head and target stable
2- Move the head and target in opposite direction
9) Postural stability and Balance exercises
10) Use two pillows for sleeping
- Avoid sleeping on bad side
11) CRT for horizontal SCC 90 toward involved side in ly ing wait for stopped
nystagmus rotate 90 to opposite side wait (15-30 secs) prone lying
12) Cervical vertigo/ VBI testing should be ruled out before maneuvers.
