1) The document discusses various approaches to evaluating and treating vertigo, including distinguishing between peripheral and central causes.
2) Diagnostic tests like Dix-Hallpike, VNG, and HINTS can help determine if vertigo is peripheral or central in nature and identify specific causes.
3) Treatment depends on the underlying cause but may include medications, repositioning maneuvers, vestibular rehabilitation, and in rare cases surgery.
The document discusses the vestibular system, which detects angular and linear acceleration of the head. It has two main parts: the semicircular canals and otolith organs. The semicircular canals contain hair cells that detect rotational movement and signal the brain. The otolith organs contain hair cells and calcium crystals that detect gravity and linear acceleration. The vestibular system provides input to areas of the brainstem, cerebellum and cortex that are important for balance, posture, eye movements and awareness of head position. It discusses the anatomy and function of the vestibular system and several reflexes it controls like the vestibulo-ocular reflex.
Vertigo is caused by disorders that affect the central or peripheral vestibular systems. Peripheral vertigo tends to be intermittent and associated with nystagmus, while central vertigo may occur with or without nystagmus and can include additional neurological signs. Common causes of peripheral vertigo include benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, and labyrinthitis. Central causes include strokes, tumors, and migraines. A thorough history and physical exam is needed to localize the lesion and establish the likely diagnosis.
Vestibular neuritis is inflammation of the inner ear and vestibular nerve that causes severe dizziness, vertigo, and balance issues. It is mainly caused by viral infections like herpes, influenza, or autoimmune diseases. Symptoms include severe dizziness, vertigo, nausea, balance issues, and sometimes hearing loss or vision problems. Treatment options include chiropractic treatments, acupuncture, and medications like Antivert. The condition varies in duration but can last from 3 weeks to several months.
This document provides an overview of central vestibular disorders. It discusses how the vestibular system senses head motion and distributes signals to control eye movements, posture, and balance. Central vestibular disorders can cause pathological sensations of self-motion and conflicts between visual and vestibular inputs. Common causes include vascular issues like strokes, inflammation, tumors, inherited conditions, and migraines. Central vestigular disorders are challenging to diagnose but it is important to differentiate them from peripheral disorders due to their potential medical urgency and risk of long-term neurological effects.
This document provides an overview of approaches to deafness, including types and causes of hearing loss, diagnosing hearing loss through various tests, and managing different types of hearing loss. It discusses conductive hearing loss due to defects in the outer or middle ear, sensorineural hearing loss due to inner ear or nerve problems, and mixed hearing loss. Common causes include presbycusis, noise exposure, meningitis, and ototoxic drugs. Diagnostic tests include tuning fork tests, pure tone audiometry, impedance testing, and brainstem response audiometry. Management involves hearing aids, cochlear implants, assistive devices, and training programs.
This document discusses tests used to assess vestibular function, including nystagmus, caloric testing, fistula testing, optokinetic testing, and galvanic testing. It also covers peripheral vestibular disorders like BPPV and vestibular neuronitis, as well as central causes of nystagmus. Diagnosis and treatment of BPPV is discussed, including Epley's maneuver and surgical options.
Approach to Dizziness and Vertigo in Emergency DepartmentFaez Toushiro
This document provides an overview of the approach to dizziness and vertigo in the emergency department. It begins with definitions and classifications of vertigo, including true vertigo versus non-vertiginous dizziness and peripheral versus central causes. The approach involves taking a thorough history to determine type and characteristics of symptoms and rule out life-threatening conditions. A physical exam includes testing of vestibular function, cranial nerves, and gait. Certain exam findings like the HINTS protocol can help differentiate peripheral from central causes. Common peripheral causes like BPPV are managed with repositioning maneuvers while other treatments include pharmacotherapy and imaging for suspected central causes.
The document discusses the vestibular system, which detects angular and linear acceleration of the head. It has two main parts: the semicircular canals and otolith organs. The semicircular canals contain hair cells that detect rotational movement and signal the brain. The otolith organs contain hair cells and calcium crystals that detect gravity and linear acceleration. The vestibular system provides input to areas of the brainstem, cerebellum and cortex that are important for balance, posture, eye movements and awareness of head position. It discusses the anatomy and function of the vestibular system and several reflexes it controls like the vestibulo-ocular reflex.
Vertigo is caused by disorders that affect the central or peripheral vestibular systems. Peripheral vertigo tends to be intermittent and associated with nystagmus, while central vertigo may occur with or without nystagmus and can include additional neurological signs. Common causes of peripheral vertigo include benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, and labyrinthitis. Central causes include strokes, tumors, and migraines. A thorough history and physical exam is needed to localize the lesion and establish the likely diagnosis.
Vestibular neuritis is inflammation of the inner ear and vestibular nerve that causes severe dizziness, vertigo, and balance issues. It is mainly caused by viral infections like herpes, influenza, or autoimmune diseases. Symptoms include severe dizziness, vertigo, nausea, balance issues, and sometimes hearing loss or vision problems. Treatment options include chiropractic treatments, acupuncture, and medications like Antivert. The condition varies in duration but can last from 3 weeks to several months.
This document provides an overview of central vestibular disorders. It discusses how the vestibular system senses head motion and distributes signals to control eye movements, posture, and balance. Central vestibular disorders can cause pathological sensations of self-motion and conflicts between visual and vestibular inputs. Common causes include vascular issues like strokes, inflammation, tumors, inherited conditions, and migraines. Central vestigular disorders are challenging to diagnose but it is important to differentiate them from peripheral disorders due to their potential medical urgency and risk of long-term neurological effects.
This document provides an overview of approaches to deafness, including types and causes of hearing loss, diagnosing hearing loss through various tests, and managing different types of hearing loss. It discusses conductive hearing loss due to defects in the outer or middle ear, sensorineural hearing loss due to inner ear or nerve problems, and mixed hearing loss. Common causes include presbycusis, noise exposure, meningitis, and ototoxic drugs. Diagnostic tests include tuning fork tests, pure tone audiometry, impedance testing, and brainstem response audiometry. Management involves hearing aids, cochlear implants, assistive devices, and training programs.
This document discusses tests used to assess vestibular function, including nystagmus, caloric testing, fistula testing, optokinetic testing, and galvanic testing. It also covers peripheral vestibular disorders like BPPV and vestibular neuronitis, as well as central causes of nystagmus. Diagnosis and treatment of BPPV is discussed, including Epley's maneuver and surgical options.
Approach to Dizziness and Vertigo in Emergency DepartmentFaez Toushiro
This document provides an overview of the approach to dizziness and vertigo in the emergency department. It begins with definitions and classifications of vertigo, including true vertigo versus non-vertiginous dizziness and peripheral versus central causes. The approach involves taking a thorough history to determine type and characteristics of symptoms and rule out life-threatening conditions. A physical exam includes testing of vestibular function, cranial nerves, and gait. Certain exam findings like the HINTS protocol can help differentiate peripheral from central causes. Common peripheral causes like BPPV are managed with repositioning maneuvers while other treatments include pharmacotherapy and imaging for suspected central causes.
Vertigo is a common symptom that affects approximately 30% of people at some point in their life. There are many potential causes of vertigo, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and less commonly central nervous system disorders. A thorough history, physical exam including tests of ocular motor function and positional maneuvers, and occasionally neuroimaging can help identify the underlying cause in most patients. The most common peripheral vestibular disorders like BPPV and vestibular neuritis are usually self-limited and the main treatment is symptomatic.
This document provides an overview of vestibular physical therapy in an inpatient setting. It discusses the anatomy and physiology of the vestibular system, common vestibular disorders and their clinical presentations, tools for screening and assessment including tests for nystagmus and balance, diagnosis of benign paroxysmal positional vertigo (BPPV) and treatment techniques, and considerations for referring patients to outpatient vestibular therapy. The presentation aims to equip physical therapists with knowledge of the vestibular system and skills for working with patients experiencing dizziness and imbalance.
This document discusses the evaluation of vertigo. It defines vertigo and classifies it according to duration. It describes the characteristics of peripheral vertigo such as associated hearing loss, episodic nature, and association with head movement. The document outlines tests used to investigate peripheral vertigo, including the caloric test and Fitzgerald-Hallpike test, and how to differentiate between peripheral vertigo and central vertigo based on features like nystagmus characteristics and neurological deficits.
Approach to evaluation and management of acute vertigoDr. Munish Kumar
This document provides an overview of the approach to evaluating a patient presenting with dizziness or vertigo. It discusses classifying dizziness into subtypes based on timing, triggers, and symptoms. The neuroanatomy of the vestibular system is reviewed. A targeted examination approach called TiTrATE is outlined that considers the timing, triggers, and targeted physical exam findings to help narrow the possible causes. Key aspects of the physical exam like blood pressure, gait, head impulse test, and nystagmus are discussed to help differentiate peripheral from central causes of vertigo.
Here are the answers to the quiz questions:
1. Nystagmus is away from the lesion side in peripheral vertigo.
2. Fitzgerald-Hallpike Test
3. Canalith repositioning maneuvers like Epley maneuver or Semont maneuver.
4. Vestibular neuronitis
5. Aminoglycoside antibiotics, quinine, aspirin, etc. can be vestibulotoxic.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
The document defines vertigo and discusses its causes and treatment. It begins by defining vertigo as a hallucination of self- or environmental movement due to a disturbance in the vestibular system. It then discusses the anatomy and physiology of the inner ear and vestibular system. Several potential causes of vertigo are outlined, including problems in the peripheral vestibular system, central nervous system, visual system, and medications. Tests used in evaluation and potential treatments like medications, surgery, and physical maneuvers like the Epley maneuver are summarized. Benign paroxysmal positional vertigo (BPPV) and Meniere's disease are highlighted as specific vestibular causes.
Different types and categoroes of compressive myelopathy have been explained.
Their clinical findings, investgating features and radiological features have been discussed.
The document discusses the anatomy and physiology of the inner ear balance system. It describes how the vestibular system in the inner ear, including the semicircular canals and otolith organs, helps maintain equilibrium and sense head movement and acceleration. It outlines various peripheral and central causes of dizziness or vertigo, such as BPPV, Meniere's disease, and stroke. Evaluation involves taking a history and performing a neurological exam and vestibular tests like the Dix-Hallpike maneuver and caloric testing. Treatment depends on the underlying cause but commonly involves rest, fluids, and medications to reduce symptoms during an acute episode.
This document discusses assessments of the vestibular system. It begins by describing the peripheral and central components of the vestibular system. It then explains the functions of the vestibular system and disorders that can affect it, which are divided into peripheral and central categories. The document proceeds to describe several clinical methods used to investigate the vestibular system, including tests of spontaneous nystagmus, the fistula test, Romberg test, gait, past-pointing and falling, and the Hallpike maneuver. It also discusses laboratory methods like the caloric test.
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
This document discusses Meniere's disease, a disorder of the inner ear that causes spontaneous episodes of vertigo, hearing loss, and tinnitus. It outlines the potential causes, clinical features, diagnostic tests, treatment options including medications, intratympanic injections, and surgical procedures like endolymphatic sac decompression or vestibular nerve sectioning. Surgical intervention is considered for patients with severe, treatment-resistant vertigo. The goal of treatment is to control vertigo attacks while preserving hearing if possible.
Horner's syndrome results from interruption of the sympathetic nerve supply to the eye, causing the classic triad of ptosis, miosis, and anhidrosis. It can occur from lesions anywhere along the three-neuron sympathetic pathway from the brainstem to the eye. Testing includes evaluating pupil response to light and pharmacologic tests like cocaine and apraclonidine to localize the lesion and guide further workup and treatment of the underlying cause when possible. The goal is to identify potentially serious underlying conditions causing Horner's syndrome.
The document provides information on evaluating patients presenting with dizziness. It discusses the different types of dizziness including vertigo, presyncope, and dysequilibrium. For evaluation, the history should explore the type of dizziness, onset, triggers, and age of the patient. Examination focuses on eye movements, nystagmus, gait, and the HINTS exam. The TiTrATE approach categorizes dizziness syndromes as acute episodic vestibular syndrome, spontaneous acute vestibular syndrome, or chronic vestibular syndrome based on timing and triggers. This helps distinguish dangerous mimics like stroke from more benign causes like BPPV or vestibular migraine.
This document discusses dysphagia (difficulty swallowing) in pseudobulbar palsy. It begins by defining bulbar palsy and pseudobulbar palsy, noting that bulbar palsy involves lower motor neuron lesions affecting bulbar muscles, while pseudobulbar palsy involves upper motor neuron lesions. It then describes the anatomy and physiology of swallowing, including the four phases. It discusses the causes, signs, and treatments of dysphagia. Key assessment tools mentioned include a video swallow study and 3-ounce water swallow test. The document provides an overview of dysphagia for health professionals.
1) Dizziness and vertigo are common, with vertigo defined as a perception of movement and dizziness having various meanings.
2) Vertigo can be peripheral or central in origin, with peripheral vertigo arising from problems in the inner ear and central vertigo from problems in the brain or brainstem.
3) A thorough history, physical exam including tests like Dix-Hallpike, and sometimes ancillary testing can help differentiate between peripheral causes like benign paroxysmal positional vertigo or Ménière's disease versus central causes like vertebrobasilar insufficiency.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
The vestibulo-ocular reflex (VOR) is a reflex eye movement that stabilizes images on the retina during head movements. It causes the eyes to move in the opposite direction of head movement, preserving the image at the center of the visual field. The VOR is stimulated by the vestibular system in the inner ear, which contains motion sensors that detect rotational head movements. When the head moves, the vestibular system activates nerves that control the extraocular muscles to move the eyes in the opposite direction, keeping images stable on the retina.
Guillain-Barre Syndrome is an acute immune-mediated inflammatory disorder of the peripheral nervous system. It has several subtypes defined by the location of damage within the nerves. Treatment involves immunotherapy such as plasmapheresis or intravenous immunoglobulins to reduce immune attack on nerves. Rehabilitation focuses on preventing complications, gradually increasing mobility and strength as recovery occurs, and managing symptoms like pain and fatigue. Outcomes vary but many patients are left with some degree of permanent weakness or disability.
Sk. Saleha Begum, a 37-year-old female, was admitted to the hospital for seizures. She has a history of two grand mal seizures in the past 6 months and weakness in her lower limbs for 6 months. Her neurological exam was normal. She was diagnosed with seizures and her management included anti-seizure medications, lifestyle modifications, and patient education on seizure first aid and management. Her prognosis depends on treatment response and number/type of seizures.
Vertigo is a common symptom that affects approximately 30% of people at some point in their life. There are many potential causes of vertigo, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and less commonly central nervous system disorders. A thorough history, physical exam including tests of ocular motor function and positional maneuvers, and occasionally neuroimaging can help identify the underlying cause in most patients. The most common peripheral vestibular disorders like BPPV and vestibular neuritis are usually self-limited and the main treatment is symptomatic.
This document provides an overview of vestibular physical therapy in an inpatient setting. It discusses the anatomy and physiology of the vestibular system, common vestibular disorders and their clinical presentations, tools for screening and assessment including tests for nystagmus and balance, diagnosis of benign paroxysmal positional vertigo (BPPV) and treatment techniques, and considerations for referring patients to outpatient vestibular therapy. The presentation aims to equip physical therapists with knowledge of the vestibular system and skills for working with patients experiencing dizziness and imbalance.
This document discusses the evaluation of vertigo. It defines vertigo and classifies it according to duration. It describes the characteristics of peripheral vertigo such as associated hearing loss, episodic nature, and association with head movement. The document outlines tests used to investigate peripheral vertigo, including the caloric test and Fitzgerald-Hallpike test, and how to differentiate between peripheral vertigo and central vertigo based on features like nystagmus characteristics and neurological deficits.
Approach to evaluation and management of acute vertigoDr. Munish Kumar
This document provides an overview of the approach to evaluating a patient presenting with dizziness or vertigo. It discusses classifying dizziness into subtypes based on timing, triggers, and symptoms. The neuroanatomy of the vestibular system is reviewed. A targeted examination approach called TiTrATE is outlined that considers the timing, triggers, and targeted physical exam findings to help narrow the possible causes. Key aspects of the physical exam like blood pressure, gait, head impulse test, and nystagmus are discussed to help differentiate peripheral from central causes of vertigo.
Here are the answers to the quiz questions:
1. Nystagmus is away from the lesion side in peripheral vertigo.
2. Fitzgerald-Hallpike Test
3. Canalith repositioning maneuvers like Epley maneuver or Semont maneuver.
4. Vestibular neuronitis
5. Aminoglycoside antibiotics, quinine, aspirin, etc. can be vestibulotoxic.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
The document defines vertigo and discusses its causes and treatment. It begins by defining vertigo as a hallucination of self- or environmental movement due to a disturbance in the vestibular system. It then discusses the anatomy and physiology of the inner ear and vestibular system. Several potential causes of vertigo are outlined, including problems in the peripheral vestibular system, central nervous system, visual system, and medications. Tests used in evaluation and potential treatments like medications, surgery, and physical maneuvers like the Epley maneuver are summarized. Benign paroxysmal positional vertigo (BPPV) and Meniere's disease are highlighted as specific vestibular causes.
Different types and categoroes of compressive myelopathy have been explained.
Their clinical findings, investgating features and radiological features have been discussed.
The document discusses the anatomy and physiology of the inner ear balance system. It describes how the vestibular system in the inner ear, including the semicircular canals and otolith organs, helps maintain equilibrium and sense head movement and acceleration. It outlines various peripheral and central causes of dizziness or vertigo, such as BPPV, Meniere's disease, and stroke. Evaluation involves taking a history and performing a neurological exam and vestibular tests like the Dix-Hallpike maneuver and caloric testing. Treatment depends on the underlying cause but commonly involves rest, fluids, and medications to reduce symptoms during an acute episode.
This document discusses assessments of the vestibular system. It begins by describing the peripheral and central components of the vestibular system. It then explains the functions of the vestibular system and disorders that can affect it, which are divided into peripheral and central categories. The document proceeds to describe several clinical methods used to investigate the vestibular system, including tests of spontaneous nystagmus, the fistula test, Romberg test, gait, past-pointing and falling, and the Hallpike maneuver. It also discusses laboratory methods like the caloric test.
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
This document discusses Meniere's disease, a disorder of the inner ear that causes spontaneous episodes of vertigo, hearing loss, and tinnitus. It outlines the potential causes, clinical features, diagnostic tests, treatment options including medications, intratympanic injections, and surgical procedures like endolymphatic sac decompression or vestibular nerve sectioning. Surgical intervention is considered for patients with severe, treatment-resistant vertigo. The goal of treatment is to control vertigo attacks while preserving hearing if possible.
Horner's syndrome results from interruption of the sympathetic nerve supply to the eye, causing the classic triad of ptosis, miosis, and anhidrosis. It can occur from lesions anywhere along the three-neuron sympathetic pathway from the brainstem to the eye. Testing includes evaluating pupil response to light and pharmacologic tests like cocaine and apraclonidine to localize the lesion and guide further workup and treatment of the underlying cause when possible. The goal is to identify potentially serious underlying conditions causing Horner's syndrome.
The document provides information on evaluating patients presenting with dizziness. It discusses the different types of dizziness including vertigo, presyncope, and dysequilibrium. For evaluation, the history should explore the type of dizziness, onset, triggers, and age of the patient. Examination focuses on eye movements, nystagmus, gait, and the HINTS exam. The TiTrATE approach categorizes dizziness syndromes as acute episodic vestibular syndrome, spontaneous acute vestibular syndrome, or chronic vestibular syndrome based on timing and triggers. This helps distinguish dangerous mimics like stroke from more benign causes like BPPV or vestibular migraine.
This document discusses dysphagia (difficulty swallowing) in pseudobulbar palsy. It begins by defining bulbar palsy and pseudobulbar palsy, noting that bulbar palsy involves lower motor neuron lesions affecting bulbar muscles, while pseudobulbar palsy involves upper motor neuron lesions. It then describes the anatomy and physiology of swallowing, including the four phases. It discusses the causes, signs, and treatments of dysphagia. Key assessment tools mentioned include a video swallow study and 3-ounce water swallow test. The document provides an overview of dysphagia for health professionals.
1) Dizziness and vertigo are common, with vertigo defined as a perception of movement and dizziness having various meanings.
2) Vertigo can be peripheral or central in origin, with peripheral vertigo arising from problems in the inner ear and central vertigo from problems in the brain or brainstem.
3) A thorough history, physical exam including tests like Dix-Hallpike, and sometimes ancillary testing can help differentiate between peripheral causes like benign paroxysmal positional vertigo or Ménière's disease versus central causes like vertebrobasilar insufficiency.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
The vestibulo-ocular reflex (VOR) is a reflex eye movement that stabilizes images on the retina during head movements. It causes the eyes to move in the opposite direction of head movement, preserving the image at the center of the visual field. The VOR is stimulated by the vestibular system in the inner ear, which contains motion sensors that detect rotational head movements. When the head moves, the vestibular system activates nerves that control the extraocular muscles to move the eyes in the opposite direction, keeping images stable on the retina.
Guillain-Barre Syndrome is an acute immune-mediated inflammatory disorder of the peripheral nervous system. It has several subtypes defined by the location of damage within the nerves. Treatment involves immunotherapy such as plasmapheresis or intravenous immunoglobulins to reduce immune attack on nerves. Rehabilitation focuses on preventing complications, gradually increasing mobility and strength as recovery occurs, and managing symptoms like pain and fatigue. Outcomes vary but many patients are left with some degree of permanent weakness or disability.
Sk. Saleha Begum, a 37-year-old female, was admitted to the hospital for seizures. She has a history of two grand mal seizures in the past 6 months and weakness in her lower limbs for 6 months. Her neurological exam was normal. She was diagnosed with seizures and her management included anti-seizure medications, lifestyle modifications, and patient education on seizure first aid and management. Her prognosis depends on treatment response and number/type of seizures.
This document provides a one-page summary of exam procedures for evaluating a patient experiencing dizziness. It outlines key history questions, tests of eye movements and balance, and positioning maneuvers to assess the vestibular system. Tests include spontaneous and gaze nystagmus, smooth pursuit, saccades, head thrust, gait observation, CTSIB, Dix-Hallpike maneuver, and roll test. Normal and abnormal responses are defined to help localize potential peripheral or central vestibular lesions. The summary is intended to guide examiners through a targeted vestibular assessment for dizziness.
This document contains a neurologist's presentation on epilepsy. It discusses:
1) The causes, risk factors, classification, diagnosis, and management of seizures. The three main causes of transient loss of consciousness are syncope, psychogenic non-epileptic seizures, and epilepsy.
2) The importance of taking a detailed history from both the patient and collateral sources. Features of the pre-ictal, ictal, and post-ictal periods are important for diagnosis.
3) Treatment involves lifestyle counseling, first aid, anti-epileptic medications, and consideration of surgical options if medications fail. Managing epilepsy requires a holistic approach and partnership between the patient and care providers.
Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
The document discusses various clinical and laboratory methods used to assess the vestibular system. Clinical methods include tests of spontaneous nystagmus, the fistula test, Romberg test, gait, past-pointing and falling, and the Hallpike maneuver. Laboratory methods include the caloric test, electronystagmography, optokinetic test, rotation test, and posturography. The document then provides detailed descriptions of procedures and indications for spontaneous nystagmus, the fistula test, Romberg test, past-pointing and falling test, and the Hallpike maneuver. Characteristics of peripheral and central nystagmus are also compared.
Status epilepticus is a medical emergency that requires prompt treatment to prevent irreversible brain damage. It is defined as continuous seizure activity lasting more than five minutes, or two or more seizures between which consciousness is not regained. Status epilepticus can be classified as generalized convulsive or non-convulsive and has various etiologies including low anti-epileptic drug levels, stroke, electrolyte imbalances, and infections. Treatment involves airway protection, treatment of underlying causes, administration of benzodiazepines or phenytoin to stop seizures, and induction of anesthesia with thiopental or propofol if seizures persist. Outcomes depend on factors like age, etiology, and degree of impaired consciousness,
This document provides guidelines for the management of epilepsy in India. It notes that epilepsy is a common neurological disorder in India, affecting about 10 million people. Treatment is often suboptimal as most cases are seen by non-specialists. The Indian Epilepsy Society developed guidelines called GEMIND to standardize treatment across India based on expert consensus. The guidelines cover diagnosing epilepsy, investigating seizures, treating with antiepileptic drugs, managing drug interactions and treatment in special populations like women. The goal of treatment is controlling seizures safely using the most appropriate AED.
Understanding & Managing Vertigo : Dr Vijay SardanaVijay Sardana
The document discusses vertigo, including its prevalence, causes, mechanisms, types, clinical evaluation, and treatment. Vertigo is a common symptom that can be caused by disturbances in the peripheral or central vestibular system. Treatment involves identifying the specific cause and providing symptomatic relief through vestibular suppression or rehabilitation to aid compensation. Medications like antihistamines and betahistine that affect the vestibular system can help manage vertigo symptoms.
Assessments of vestibular system 150630051939-lva1-app6891-convertedDrAbdulQawiPgr
This document discusses assessments of the vestibular system. It begins by describing the peripheral and central components of the vestibular system. It then explains various functions of the vestibular system including providing information about gravity, rotation, and acceleration. The document goes on to describe different disorders of the vestibular system like Meniere's disease and acoustic neuroma. It also outlines various clinical and laboratory tests used to investigate the vestibular system, such as spontaneous nystagmus, caloric testing, and optokinetic testing.
This case report discusses the evaluation and treatment of a 51-year-old male patient presenting with bilateral benign paroxysmal positional vertigo (BPPV) following a head injury. Examination revealed positive Hallpike-Dix maneuvers bilaterally, indicating involvement of both posterior semicircular canals. The patient underwent canalith repositioning techniques (CRTs) on each side separately, which resolved his vertigo symptoms. He was also given gaze stabilization and balance exercises, which further improved his visual and postural deficits. The case demonstrates that bilateral BPPV can be successfully treated with sequential CRTs on each affected canal.
Dr. Dilraj Singh Sokhi gave a presentation on epilepsy to trainees. He discussed causes like infections, head trauma, and neurocysticercosis. Seizures are classified as focal or generalized. Diagnosis involves a detailed history and physical exam. Treatment involves lifestyle management, medication like phenobarbital or phenytoin, and gradual dose adjustments. The goal is complete seizure control with as few side effects as possible.
Vestibular disorders and rehabilitationRuchika Gupta
This document discusses vestibular disorders, specifically Benign Paroxysmal Positional Vertigo (BPPV). It defines BPPV as the most common cause of vertigo, triggered by certain head positions. Physical therapists are well-suited to diagnose and treat BPPV using positional tests to identify affected semicircular canals, followed by repositioning maneuvers like the Epley maneuver to guide loose crystals back to their proper position. Proper diagnosis and treatment of BPPV by a physical therapist can resolve symptoms and address related functional impairments.
Neonatal seizures are the most common neurological manifestation in newborns and can be difficult to recognize. They are often caused by hypoxic-ischemic encephalopathy, hypoglycemia, hypocalcemia or infections. When a neonatal seizure is observed, the newborn must be stabilized, underlying causes should be investigated through bloodwork and imaging, and seizures treated aggressively with anticonvulsants like phenobarbital. Identifying and correcting the underlying etiology is important for management and prognosis.
The document discusses vestibular rehabilitation and benign paroxysmal positional vertigo (BPPV). It notes that 90 million Americans experience dizziness each year, with the costs of treatment exceeding $1 billion annually. BPPV is one of the most common causes of dizziness, involving debris in the inner ear causing vertigo with certain head movements. Treatment options discussed include physical therapy, occupational therapy, and vestibular rehabilitation exercises and maneuvers like the Epley maneuver to reposition the debris.
West syndrome, also known as infantile spasms, is a severe epilepsy syndrome in infants characterized by infantile spasms, a specific EEG pattern called hypsarrhythmia, and developmental problems. It was first described in 1841 and is caused by various conditions that damage the brain such as tuberous sclerosis, infections, or unknown causes. Treatment involves corticosteroids, vigabatrin, pyridoxine, and anti-seizure medications with the goal of stopping spasms and normalizing the EEG to improve developmental outcomes, though prognosis varies depending on the underlying cause.
This document discusses various types of seizures that can occur in children. It describes how seizures may be localized to one part of the body or widespread. Seizures in newborns and toddlers can present differently. Characteristics of seizures include abrupt onset, brief duration, altered mental status and postictal state. Causes of seizures in children include infections, developmental problems, head trauma and unknown causes. The most common type is febrile seizures associated with fever. Other causes, treatments, and types like tonic, clonic, absence and myoclonic seizures are outlined as well. Status epilepticus and its management are also discussed.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 50 million people worldwide. Seizures occur due to abnormal electrical activity in the brain and can vary from brief lapses of awareness to severe and prolonged convulsions. Management involves anti-seizure medications and lifestyle modifications. Nurses play an important role in patient education and safety during seizures.
This presentation decodes all cases of Acute Vestibular syndrome. It includes any patient presenting to Emergency department with complaints of Giddiness or Vertigo. It runs through all the possible causes of Central and Peripheral Vertigo and how to differentiate them. It also teaches HINTS test which forms the basis of differentiation between Central and Peripheral Vertigo.
Neonatal-Seizures diagnosis and managementFelixBoamah3
This document discusses neonatal seizures. It begins by defining seizures and describing the different types seen in neonates. The most common cause is hypoxic ischemic encephalopathy. Other common causes include intraventricular hemorrhage and acute metabolic disorders. Phenobarbital is the first-line treatment, with phenytoin and benzodiazepines as subsequent options. Prognosis depends on the underlying etiology, with focal clonic seizures and those from subarachnoid hemorrhage or late hypocalcemia having better outcomes. Anti-seizure medications should be tapered slowly after seizure control is achieved.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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APPROACH TO VERTIGO
1. Approach to Vertigo
APICON, Kochi
7.2.2019
Dr V G Nadagouda. MD, MNAMS, FACP, FICP etc.
Consultant Physician & Echocardiologist
Hubballi (Karnataka)
I am thankful to Dr .G Narsimulu Dean ICP / API & his team
2/3/2019 1
2. Contents
• Introduction
• Causes & Evaluation of vertigo
• Special Tests
• Medical &
• Surgical measures
• Physical therapy
• Take Home
2/3/2019 2
3. Dizziness
Dizziness is a non-specific term;
Comprising 4 sub types ;
1. Dizziness/lightheadedness: A distorted sense of one’s spatial
relationship.
2. Vertigo: Hallucination of rotatory motion either of the
surroundings or himself in relation to the surroundings. The
chronic form is entitled “disequilibrium”
3. Unsteadiness: Difficulty with gait/Tendency to fall to one side.
4. Blackouts: Loss of consciousness
2/3/2019 3
4. Normal balance
● Requires –
I. Normally functioning vestibular system,
II. Visual system (called vestibulo-ocular reflex-VOR),
III. Proprioceptive system ( called vestibulo-spinal reflex-VSR).
2/3/2019 4
5. Prevalence -Vertigo
1.8% in young adults to > 30% in the elderly
Psychiatric causes make up the majority (55-70%).
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7. Involvement of labyrinth and vestibular nerve is
categorised as PV (peripheral vertigo),
while involvement of VN (vestibular nucleus) and
projections from the nucleus to cerebellum,
thalamus and cortical areas are CV (central vertigo).
2/3/2019 7
8. 1. Peripheral Causes 2. Central Causes
Benign paroxysmal positional vertigo(BPPV) --
18.6%
Vestibular migraine 11.2%; Basilar Migraine
Vestibular neuritis 7.7% Disorders of Mitochondria
Herpes zoster oticus (Ramsay Hunt syndrome) Cerebellar infarction and hemorrhage, TIA’s
Meniere's disease (Endolymphatic hydrops)-
Tumarkin’s otolithic crisis or Drop attacks seen.
9.6%
Cranio –vertebral (CV) junction lesions , Chiari
malformation
Perilymphatic fistula 0.6% Episodic ataxia type 2. It is a Calcium
channelopathy .Responds to Acetazolamide
Semicircular canal dehiscence syndrome
Tullio phenomenon +.(vertigo by loud sounds)
/Multiple sclerosis
Cogan's syndrome, Otitis media Epileptic vertigo
Acoustic neuroma Vestibular Schwannoma (Malignant CP angle
tumor)
; Vestibular Paroxysmia ( Also termed
vestibular neuralgia.
Medulloblastoma (Malignant tumor in children)
8
11. The first step includes a complete history,
Physical Examination for Anemia , nystagmus, Blood Pressure, Otological
examination, herpetic lesion, & thorough Cardio vascular examination.
CNS examination:
Assessment of presence of vestibular dysfunction: vestibular ocular reflex –VOR; &
(Head impulse test, HIT),
Vestibulospinal assessment –VSR;(finger nose coordination for past pointing,
Romberg test,
Tandem walking / Gait : ie;(walking in a straight line;-heel to toe walking),
Fukuda stepping test : (FST-measures asymmetrical vestibulospinal reflex tone
resulting from labyrinthine dysfunction),
Assessment of nystagmus, and skew deviation.
- These tests will help to differentiate between central and peripheral vertigo.
Evaluation for Vertigo
2/3/2019 11
13. Nystagmus Diagnosis Peripheral Central
Direction Unidirectional, never reverses
direction
Sometimes reverses direction
when patient looks in the
direction of slow movement
Type Horizontal with a torsional
component,
Can be any direction-
Horizontal (reverses
direction), torsional or vertical
Visual fixation Suppressed Not suppressed
Neurologic signs Absent Often present
Postural instability walking preserved Severe instability, patient often
falls when walking
Deafness or tinnitus May be present Absent
Head Impulse Sign “(H.I.T
Test”).
Skew deviation of eyes –
Present
Absent
Absent
Present2/3/2019 13
14. Nystagmus Peripheral Disorders Central Disorders
Latent period before onset
of nstagmus
2 to 20 seconds None
Duration of nystagmus Less than 1 minute Greater than 1 minute
Fatigability Present on repetition No fatigue
Intensity of vertigo Severe Less severe, sometimes none
2/3/2019 14
15. Nystagmus
Usually, there is slow drift of the eyes in one direction
followed by quick jerk in the opposite direction. Nystagmus
is named after the direction of the fast component.
Alexander's law: Primary position nystagmus may be evident
with fast component opposite to the side of lesion, does
not change direction & it increases with an attempted gaze
towards the side of fast component
2/3/2019 15
16. BPPV , Canal pathology & Nystagmus
• Rotational / Torsional /Up beating Nystagmus: is caused by
Posterior canal pathology (Commonest-85%) & diagnosed
by EPLEY manoeuvre.
• Lateral or Horizontal Nystagmus : caused by Lateral canal
pathology (seen in 10% of cases)& diagnosed by Lambert
manoeuvre or the Pagnini- McClure supine test.
• Vertical /Down beating Nystagmus : caused by Superior or
Anterior canal pathology), least common incidence(5%) &
diagnosed by Deep head hanging manoeuvre.
2/3/2019 16
17. Diagnosis and Treatment
Benign Paroxysmal Positional Vertigo (BPPV)
It is idiopathic in nature & follows head injury ,or following
labrynthitis
Diagnosis -- Dix –Hallpike Test: or Nylen Barany Test .
Principle:
Severe nystagmus develops after assuming a particular head position
depending on the type of semi circular canal being involved.
These tests are carried on both sides of the head, first on the normal side
& then on the abnormal side.
Pts with severe neck disabilities should refrain from these test & instead
can undertake the Brandt daroff test.
2/3/2019 17
18. HINT’S Test.(Halmagyi-Curthoys test or the Halmagyi
test).
• HINTS is a 3 part Occulomotor test & stands for Head
Impulse test (HIT), Nystagmus & test of Skew . It helps in
detecting a central lesion with a sensitivity of 90%,which
is higher than MRI brain with diffusion sequences.
If any of these tests are positive , neurological evaluation
is warranted.
HIT can be quantitatively measured using video HIT.
A 5 step approach is more sensitive than 3 step HINTS,
which also includes looking for saccadic and pursuit eye
movements & use of Frenzels glasses.
2/3/2019 18
19. HINT’s Test---Step 1
Principle
Horizontal head impulse testing involves
rapid head rotation by the examiner
with the subjects vision fixed on a
nearby object (often the examiners
nose), the patients eyes should remain
fixed on the target. –Sitting Position
In case of Peripheral Vertigo
(PV), in which the VOR (vestibulo-ocular
Reflex) is impaired, rapid rotation of the
head towards the affected side will
result in loss of fixation and movement
of the eyes away from the target. This is
followed by a corrective saccades (jerky
movements) as the subject looks back
towards the target.
This is not seen in patients with central
vertigo.
2/3/2019 19
20. HINTS Test . Step 2 & 3
• Assess the type of Vertigo as discussed before, whether
peripheral or central , based on Nystagmus.
• Alternate eye cover testing may reveal skew deviation in
patients with central vertigo but not in peripheral vertigo .
2/3/2019 20
22. ENG or VNG
ENG (which uses electrodes) or VNG (which uses
small cameras) can help determine if dizziness
is due to inner ear disease (PV) by measuring
eye movements while the head is placed in
different positions or the balance organs are
stimulated with water or air.
2/3/2019 22
24. Triage- titrate Approach to vertigo.
Presently it is a common practise to Triage a patient
with red flag signs that warrants early intervention
& accordingly take necessary steps in managing any
given condition.
- Timing: Denotes onset, duration and recurrent
nature of vertigo.
- Trigger : denotes the activity and the circumstances
under which vertigo develops and targeted
examination to identify the possible etiology.
2/3/2019 24
25. Medical Treatment:
It is tailored to the specific causes of vertigo.
Betahistine; Oral Adult: As betahistine HCl: Initially, 8-16 mg
tid. Maintenance: 24-48 mg daily.
These medications should not be used long term as they are
known to disrupt central compensatory mechanisms that
develop de-novo after chronic vertigo.
Patients should be warned about the side effects of drowsiness,
dry mouth and blurred vision.
2/3/2019 25
26. Other Medications
Antihistamines
• Meclizine :25-50mg ,TID
Dimenhydrinate :50mg, 1-2 times a daily
Promethazine: 25mg, 2-3 times daily(also can be given rectally &IM)
Benzodiazepines
• Diazepam : 2.5mg, 1-3 times daily
Clonazepam: 0.25mg, 1-3 times daily
Anticholinergic
• Scopolamine transdermal Patch
• Diuretics
Selective serotonin reuptake inhibitors:
Citalopram & Escitalopram, act by increasing serotonergic activity.
2/3/2019 26
27. Low –sodium (1000mg/d) diet
• Antimigrainous drugs (Ergot preparations, cinnarazine,
Flunarizine,ets)
• Methylprednisolone:( for 3 weeks)
--- 100mg daily , tapered to 10 mg in 3weeks.
Anti virals : Acyclovir or Valacyclovir for Herpes Zoster Oticus
Cabamazepine or Oxcarbazepine – Vestibular Paroxysmia (Also called
Vestibular Neuralgia),similar to Trigeminal neuralgia)
Beta blockers ,Topiramate & Valproic acid ----For Vestibular
Migraine.
Acetazolamide : ----- For, Episodic Ataxia syndrome 2.
2/3/2019 27
29. BPPV– Repositioning treatment
Particular Repositioning Maneuvers (PRM)
– Epley maneuver (most commonly practiced)
– Brandt Daroff exercises (for those who have neck
problems)
– Also available are Semont ,Lempert, Gufoni, Foster
maneuver etc.
2/3/2019 29
30. Canalith repositioning.
It consists of several simple and slow movements of head
which moves particles from the fluid filled semicircular canals of
the inner ear into an open area the vestibule, where these
particles remain silent. are resorbed & vertigo disappears.
Each position is held for about 30 seconds after any symptoms
or abnormal eye movements stop.
This procedure is usually effective after one or two treatments.
( This is different from canal plugging)
2/3/2019 30
31. Surgical options in Vertigo:
• Is undertaken in intractable cases of vertigo. They are;
• Reparative surgery:
• • Middle ear surgery:---- For Perilymph Fistula
• • Sac decompression & Endolymphatic shunt.---- Meniere’s
• Ablative surgery :
• • Labyrinthectomy
• • Vestibular Nerve Section
• • Canal Plugging
• • Chemical destruction of vestibular nerve by injecting Trans
tympanic Gentamycin or steroids around the round window .
2/3/2019 31
32. Canal Plugging surgery
Plugging produces single canal paresis.
Success above 95%. It is alternative to singular neurectomy
2/3/2019 32
33. Vestibular Rehabilitation therapy
The three modes of rehabilitation are habituation,
adaptation and substitution (HAS).
In habituation, repeated stimuli decreases vertigo
Substitution utilises visual and proprioceptive cues to
combat vertigo.
Adaptation aims to improve VOR (vestibulo ocular reflex)
gain.
However In one study vestibular rehabilitation did not
score over chemotherapy for treating vertigo.
2/3/2019 33
35. These exercises should be performed for two weeks, three times
per day. This will add up to 52 sets. In most persons, complete
relief from symptoms is obtained after 30 sets or about 10
days.
Suggested schedule for exercise.
Suggested precautions during the days of exercise.
Sleeping Position:
Sleep semi recumbent for the next two nights. This means sleep with your
head halfway between being flat and upright (a 45 degree angle).this is
most easily done by using a recline chairs or cushions.
Time Exercise Duration
Morning 5 repetitions 10 Minutes
Noon 5 repetitions 10 Minutes
Evening 5 repetitions 10 Minutes
2/3/2019 35
37. Other important Precautions:
- During the day try to keep your head vertical
- Do not go to hairdresser or dentist when on exercise.
- Avoid exercise that require lot of head movement
- While men shave under their chin, only bend the body
forward and keep head vertical.
- Use two pillows when you sleep
- Avoid sleeping on the side that causes vertigo or dizziness
- Don’t turn your head far up or far down.
At one week after treatment, put yourself in the position that
usually makes you dizzy. Take precaution that you don’t get
hurt in the bargain.
2/3/2019 37
41. Chiropraxy (upper cervical care)
• It is a non pharmacological therapy which uses heat,
massage , acupuncture , spinal manipulation
exercises & physical therapy, to treat vertigo.
2/3/2019 41
42. Take Home
• Beset with vertigo, focus on the timing and triggers of
symptoms, particularly if episodic, persisting or provoked by
positional head changes to diagnose the cause.
• Differentiate between central and peripheral vertigo.
• An audiogram is useful.
• All patients with vertigo need definitive diagnosis & appropriate
treatment, but do benefit from vestibular sedatives ( short
courses preferred) & Physical therapy.
• Surgery is rarely required.
2/3/2019 42