Uploaded byDr. Anita Bhandari
Vertigo a practical approach
The document discusses various causes of dizziness and balance problems, including peripheral vestibular disorders like benign paroxysmal positional vertigo (BPPV) and vestibular neuritis, central causes like multiple sclerosis and migraines, and systemic issues. It provides details on evaluating patients, potential diagnoses based on history and exam findings, and management strategies for different conditions.
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Vertigo a practical approach
- 1. VERTIGO- A PRACTICAL APPROACH DR.ANITA BHANDARI
- 2. MAINTENANCE OF BALANCE PROPRIOCEPTIVE EYES INNER EAR SYSTEM BRAIN
- 3. According to theNational Institute of Health, 42% of the population is said to suffer from balance problems some time in their life.
- 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. Challenging for thephysician Vague history Vague complaints Investigations ? Etiology ?
- 6.
- 7. • DURATION OFILLNESS • DURATION OF ATTACKS • TRIGGERS • ASSOCIATED SYMPTOMS
- 10. SECONDS – LATEOTOTOXICITY MINUTES –BPPV, TIA HOURS – MENIERE’S DISEASE , MIGRAINE DAYS – VESTIBULAR NEURITIS MONTHS TO YEARS- HYSTERICAL
- 11. CHANGE IN POSITION– BPPV URI – VESTIBULAR NEURITIS RAISED INTRATHORACIC PRESSURE – PERILYMPH FISTULA
- 12. AUDIOMETRY CRANIOCORPOGRAPHY -HELPS IN ELECTRONYSTAGMOGRAP DIFFERENTIATING HY PERIPHERAL & CENTRAL DISORDERS
- 14. 28 YEAR OLDFEMALE INTENSE SPINNING ON GETTING UP IN MORNING LASTING SEVERAL HRS. CANNOT GET UP FROM BED N/V ++ NO HEARING LOSS
- 15. • TYMP. MEMBRANE– WNL • NYSTAGMUS – LEFT BEATING SPONTANEOUS • CRANIAL NERVES WNL • GAIT –COULD NOT BE TESTED • NO NEUROLOGICAL DEFICIT
- 18. Pathogenesis – viralinfection 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
- 19. • CONTROL OFSYMPTOMS • 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
- 20. 41 YR. OLDMALE RECURRENT EPISODES OF VERTIGO SINCE 4 MONTHS WHICH LAST FOR FEW HRS. N/V+ HEARING LOSS AND RINGING IN RT.EAR DURING THE ATTACK
- 21. TM – N NONYSTAGMUS STEPPING TEST – 90* ROTATION TO RT AUDIOMETRY – LOW FREQ. HEARING LOSS RE ENG – HYPERACTIVE CALORIC RESPONSE ON RT
- 24. MENIERE’S DISEASE Pathogenesis- endolymphatic hydrops Dilated membranous Normal membranous labyrinth labyrinth in Meniere's disease (Hydrops)
- 25. SYMPTOMS • Fluctuating hearing loss TRIAD • Tinnitus • Vertigo
- 26. DURING ACUTE PHASE, VEST.SEDATIVESMAY BE GIVEN – MECLIZINE ,CINNARIZINE LOW SALT ,HIGH K DIET CARBONIC ANHYDRASE BETAHISTINE
- 27. 23 YR. OLDFEMALE PERSISTANT FEELING OF UNSTEADINESS OFTEN EPISODES OF SPINNING FREQ. HEADACHES WITH SENSORY AMPLIFICATION NO AURAL SYMPTOMS HIGH STRUNG PERSONALITY
- 28. ENT – WNL GAIT,STEPPING TEST – WNL AUDIO – WNL ENG - WNL
- 29. • D/D –PHOBIAS,HYSTERIA • ABORTIVE THERAPY - TRIPTANS • PREVENTIVE THERAPY • BETA BLOCKERS • FLUNERIZINE
- 31.
- 32. • 60 YR.MALE • INTENSE SPINNING ON GETTING UP FROM BED • N/V ++ • NO AURAL SYMPTOMS
- 33. TM- WNL NO SPONTANEOUSNYSTAGMUS GAIT WNL NO NEUROLOGICAL DEFECIT DIX-HALLPIKE MANEUVRE – NYSTAGMUS ON LT
- 34. BENIGN- self- limiting POSITIONAL PAROXYSMAL VERTIGO – sudden onset
- 35.
- 36.
- 37. 55 YR.OLD MALE CHR.UNSTEADINESS SINCE SEVERAL MONTHS INCREASED ON CHANGE OF POSITION DECREASED HEARING BE HYPERTENSIVE,DIABETIC H/O ATT 10 YRS. AGO WITH STREPTOMYCIN
- 38. AUDIOMETRY – MODERATE SNHLBE CCG – WIDE BASED ATAXIC GAIT ENG –BILATERAL CANAL PARESIS NO NYSTAGMUS
- 39. ALONG WITH SYSTEMIC DISORDERS STARTVESTIBULAR REHABILITATION CONTROL HTN,DM START NOOTROPIC AGENTS AVOID VESTIBULAR SEDATIVES