This document discusses dizziness and vertigo from an otoneurological perspective. It begins by outlining key questions to ask patients regarding the nature and characteristics of their dizziness. It then describes potential otologic and neurological symptoms. Specific balance and vestibular tests are discussed, including nystagmus patterns, bedside tests like head thrust and positional maneuvers for BPPV. Common causes of vertigo like BPPV, vestibular neuritis, Meniere's disease, migraines, and strokes are explained. Appropriate use of anti-vertigo medications is emphasized.
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.
A 40-year-old man presented with worsening episodes of rotational vertigo for the last 2 weeks. He reports a history of similar episodes starting 8 years ago, initially occurring every 2-3 months and lasting 1-2 hours, resolving with sleep. Recently the episodes increased in frequency to weekly, then daily, and were no longer resolving with sleep. Examination findings were normal. He was referred to neurology for suspected vestibular migraine based on his history and lack of improvement with previous treatments. Vestibular migraine is one of the most common causes of vertigo and can present with episodic vertigo, positional vertigo, and constant imbalance. Diagnosis is based on history in the absence of abnormal examination findings
Vertigo is a type of dizziness caused by dysfunction of the vestibular system in the inner ear that leads to a perception of motion, often spinning. It can cause nausea, vomiting, and difficulties with balance and walking. Vertigo is classified as either peripheral, arising from problems in the inner ear, or central, caused by issues in the brain. Common causes include benign paroxysmal positional vertigo, Ménière's disease, and vestibular neuritis. Treatment depends on the underlying cause but may include medications, repositioning maneuvers, injections, or surgery.
This document summarizes a case study of a 72-year-old man admitted to the hospital with recurrent neurological symptoms including numbness, slurred speech, diplopia, and vertigo. Examination revealed slight gait imbalance. Imaging and tests did not reveal a cause. He was discharged on anticoagulants but readmitted a few days later with worsening symptoms. A temporal artery biopsy led to a diagnosis of giant cell arteritis. His condition continued to deteriorate and he passed away. The document then provides an overview of balance disorders, types of vertigo, approaches to diagnosis of dizziness, and treatments.
Vertigo refers to illusions of movement and is caused by problems in the vestibular system. Common causes of vertigo include BPPV, Meniere's disease, sudden hearing loss, vestibular neuritis, and labyrinthitis. Peripheral vertigo tends to be episodic with intense but brief symptoms, while central vertigo is often continuous with less intense symptoms. Treatment depends on the underlying cause but may include medications, repositioning maneuvers, physical therapy, or surgery.
This document provides information on differential diagnoses and evaluations for dizziness and vertigo. It discusses potential causes related to the cochleovestibular system, nervous system, cardiovascular system and other systems. Specific conditions covered include BPPV, vestibular neuronitis, labyrinthitis, Meniere's disease, and central vertigo. It also outlines the history, physical exam, office tests, and diagnostic studies used to evaluate patients experiencing dizziness and vertigo.
This document discusses different types of vertigo and how to distinguish between peripheral and central causes. [1] Peripheral vertigo refers to issues in the inner ear or vestibular nerve, is more common, and clues include signs of ear involvement and nystagmus that beats in one direction. [2] Central vertigo is rarer and involves the brain, with clues being vascular risk factors and inability to stand. [3] Benign positional vertigo is a common cause after ear damage, producing vertigo when changing position, and is treated with maneuvers like the Epley maneuver to move debris.
This document discusses dizziness and vertigo from an otoneurological perspective. It begins by outlining key questions to ask patients regarding the nature and characteristics of their dizziness. It then describes potential otologic and neurological symptoms. Specific balance and vestibular tests are discussed, including nystagmus patterns, bedside tests like head thrust and positional maneuvers for BPPV. Common causes of vertigo like BPPV, vestibular neuritis, Meniere's disease, migraines, and strokes are explained. Appropriate use of anti-vertigo medications is emphasized.
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.
A 40-year-old man presented with worsening episodes of rotational vertigo for the last 2 weeks. He reports a history of similar episodes starting 8 years ago, initially occurring every 2-3 months and lasting 1-2 hours, resolving with sleep. Recently the episodes increased in frequency to weekly, then daily, and were no longer resolving with sleep. Examination findings were normal. He was referred to neurology for suspected vestibular migraine based on his history and lack of improvement with previous treatments. Vestibular migraine is one of the most common causes of vertigo and can present with episodic vertigo, positional vertigo, and constant imbalance. Diagnosis is based on history in the absence of abnormal examination findings
Vertigo is a type of dizziness caused by dysfunction of the vestibular system in the inner ear that leads to a perception of motion, often spinning. It can cause nausea, vomiting, and difficulties with balance and walking. Vertigo is classified as either peripheral, arising from problems in the inner ear, or central, caused by issues in the brain. Common causes include benign paroxysmal positional vertigo, Ménière's disease, and vestibular neuritis. Treatment depends on the underlying cause but may include medications, repositioning maneuvers, injections, or surgery.
This document summarizes a case study of a 72-year-old man admitted to the hospital with recurrent neurological symptoms including numbness, slurred speech, diplopia, and vertigo. Examination revealed slight gait imbalance. Imaging and tests did not reveal a cause. He was discharged on anticoagulants but readmitted a few days later with worsening symptoms. A temporal artery biopsy led to a diagnosis of giant cell arteritis. His condition continued to deteriorate and he passed away. The document then provides an overview of balance disorders, types of vertigo, approaches to diagnosis of dizziness, and treatments.
Vertigo refers to illusions of movement and is caused by problems in the vestibular system. Common causes of vertigo include BPPV, Meniere's disease, sudden hearing loss, vestibular neuritis, and labyrinthitis. Peripheral vertigo tends to be episodic with intense but brief symptoms, while central vertigo is often continuous with less intense symptoms. Treatment depends on the underlying cause but may include medications, repositioning maneuvers, physical therapy, or surgery.
This document provides information on differential diagnoses and evaluations for dizziness and vertigo. It discusses potential causes related to the cochleovestibular system, nervous system, cardiovascular system and other systems. Specific conditions covered include BPPV, vestibular neuronitis, labyrinthitis, Meniere's disease, and central vertigo. It also outlines the history, physical exam, office tests, and diagnostic studies used to evaluate patients experiencing dizziness and vertigo.
This document discusses different types of vertigo and how to distinguish between peripheral and central causes. [1] Peripheral vertigo refers to issues in the inner ear or vestibular nerve, is more common, and clues include signs of ear involvement and nystagmus that beats in one direction. [2] Central vertigo is rarer and involves the brain, with clues being vascular risk factors and inability to stand. [3] Benign positional vertigo is a common cause after ear damage, producing vertigo when changing position, and is treated with maneuvers like the Epley maneuver to move debris.
This document discusses the history, presentation, diagnosis and management of Meniere's disease. Some key points:
- Meniere's disease was first described in 1861 and is characterized by hearing loss, tinnitus, and vertigo due to endolymphatic hydrops (fluid buildup) in the inner ear.
- Diagnosis is based on recurrent vertigo spells lasting 20 minutes to 24 hours, fluctuating hearing loss, tinnitus and aural fullness. Tests like electrocochleography and VEMPs can provide supportive evidence.
- Treatment includes dietary sodium restriction, diuretics, medications and surgical options like intratympanic injections if conservative measures fail. The
Dizziness is a common complaint in older adults that increases in prevalence with age. It is a nonspecific term used to describe various sensations including vertigo, lightheadedness, and imbalance. Dizziness can be caused by disturbances in various body systems including the vestibular system, visual pathways, proprioceptive fibers, and brain. Common causes include benign positional vertigo, orthostatic hypotension, cerebrovascular disease, and medication side effects. A thorough history and physical exam is needed to evaluate dizziness due to its subjective nature and multiple potential causes.
This document discusses the differential diagnosis of dizziness, listing various potential causes such as benign paroxysmal positional vertigo (BPPV), infections of the inner ear, migraines, Meniere's disease, neurological conditions, and medications as common causes. It provides details on evaluating dizziness through patient history and physical exam, focusing on tests like the Dix-Hallpike maneuver to diagnose BPPV. Treatment options are also outlined, including repositioning maneuvers like the Epley maneuver to treat BPPV.
The document discusses various types of vertigo, dizziness, and imbalance that patients may experience and how medical personnel should evaluate and classify these symptoms. It covers peripheral causes like benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, labyrinthitis, and Meniere's disease. It also discusses central/neurological causes and compares features of peripheral vs. central vestibular lesions. Evaluation involves taking a history, physical exam including nystagmus tests, and potentially imaging or other tests.
1. Sudden sensorineural hearing loss (SSHL) is defined as hearing loss of at least 30 dB over 3 consecutive frequencies within 72 hours. Clinicians should assess for bilateral SSHL, recurrent episodes, or focal neurological findings which may indicate specific underlying disorders.
2. A thorough history, physical exam including Weber and Rinne tests, and audiometry are used to distinguish SSHL from conductive hearing loss and identify potential causes such as viral infection, autoimmune disease, or vascular issues.
3. Modifying factors like bilateral SSHL, recurrent episodes, or neurological signs suggest conditions including meningitis, autoimmune inner ear disease, Lyme disease, or vertebrobasilar insufficiency that
The document discusses vestibular disorders and the anatomy and function of the inner ear's role in balance. It describes how the semicircular canals and otolith organs detect movement and orientation. Common causes of dizziness include Meniere's disease, BPPV, vestibular neuritis, and migraines. Diagnosis involves a case history and vestibular testing like VNG, rotary chair, and VEMPs. Treatment options depend on the underlying cause but may include medications, repositioning maneuvers, surgery, or vestibular rehabilitation therapy.
Meniere's disease is a disorder of the inner ear that causes spontaneous episodes of vertigo accompanied by fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. The exact cause is unknown but may involve viral infection, hereditary factors, or autoimmune issues. Pathologically, it involves endolymphatic hydrops or a buildup of fluid in the inner ear. Diagnosis is based on recurrent vertigo spells lasting 20 minutes to 24 hours along with hearing loss, tinnitus, and fullness. Treatment aims to reduce vertigo and includes dietary sodium restriction, diuretics, vestibular sedatives for acute attacks, intratympanic injections of gentamicin
1. Vertigo is caused by problems with the inner ear or vestibular system and results in a feeling that one is moving or spinning even when stationary.
2. It can be classified as peripheral vertigo, caused by issues with the inner ear, or central vertigo, caused by problems in the brain.
3. Common causes of peripheral vertigo include benign positional vertigo, Meniere's disease, labyrinthitis, and acoustic neuroma. Diagnosis involves examining symptoms, medical history, and tests like the Dix-Hallpike maneuver or caloric testing. Treatment depends on the underlying cause but may include repositioning maneuvers, medication, or surgery.
Vertigo is a sensation of rotational or linear movement that is not actually occurring. It is caused by disturbances in the vestibular system of the inner ear. Benign paroxysmal positional vertigo (BPPV) and labyrinthitis are two common causes of peripheral vertigo. BPPV involves detached calcium crystals in the inner ear that cause vertigo with certain head movements and is treated with repositioning maneuvers. Labyrinthitis is an inner ear infection that causes both vertigo and hearing loss. It is usually viral in origin and causes sudden onset vertigo, nausea, and unilateral hearing loss.
The document discusses various causes of vertigo including peripheral causes like benign positional vertigo and Meniere's disease, as well as central causes like stroke and migraine. It outlines the diagnostic approach including taking a history of symptoms, performing a physical exam with tests like the Dix-Hallpike maneuver, and considering audiometric testing, imaging, or other workup based on findings. The goal is to distinguish between peripheral and central causes of vertigo based on characteristics of the nystagmus, hearing loss, imbalance, and other associated neurological symptoms.
This document provides information on Meniere's disease, including its pathology, symptoms, diagnosis and treatment. Some key points:
- Meniere's disease is caused by endolymphatic hydrops, or a distension of the inner ear's fluid-filled spaces. This mainly affects the cochlea and saccule.
- Classical symptoms include episodic vertigo, fluctuating hearing loss, tinnitus and aural fullness. Diagnosis involves ruling out other causes and showing these characteristic symptoms.
- Treatment focuses on relieving acute attacks medically and managing symptoms long-term. Lifestyle changes like low salt are recommended. Vestibular sedatives and vasodil
The document discusses the evaluation and management of dizziness and vertigo. It outlines the main categories of dizziness including otologic, central, medical, and unlocalized causes. Evaluation involves taking a thorough history, performing a physical exam including tests of nystagmus, and ordering investigations like an audiogram or MRI. Common diseases discussed in more detail include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and migraine-associated vertigo. Treatment focuses on treating the underlying cause, patient education, rehabilitation, and medications in some cases.
The document discusses various causes of dizziness including vertigo, presyncope, disequilibrium, and non-specific dizziness. Vertigo is characterized by illusions of motion and is commonly caused by peripheral vestibular disorders. Positional vertigo can be distinguished from presyncope by provoking dizziness with changes in head position rather than lowering blood pressure. Disequilibrium causes an unsteady feeling when walking and may result from neurological or musculoskeletal disorders. Non-specific dizziness is difficult for patients to describe and has a broad differential diagnosis. Evaluation of dizziness involves distinguishing these subtypes and identifying potential causes based on associated symptoms, physical exam findings, and test results.
Definition
Classification
Causes of tinnitus
Treatment of tinnitus
Definition
Classification
Causes of tinnitus
Treatment of tinnitus
Definition of vertigo
It’s Causes
Specific Question for History
Differential diagnosis
Investigation
Management Plan
This document discusses vertigo and disorders of equilibrium. It begins by defining equilibrium and its neural pathways. Vertigo is defined as an illusion of movement and is distinguished from non-vertiginous dizziness. A history, physical exam, and testing can help localize the cause as either peripheral or central. Peripheral causes like benign positional vertigo typically produce intermittent vertigo and nystagmus in one direction, while central causes may involve neurologic signs and multidirectional nystagmus. Specific peripheral disorders discussed in detail include benign positional vertigo and Meniere's disease.
Ménière’s disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus, and aural fullness. It is caused by endolymphatic hydrops, or a distension of the endolymphatic duct. Key features include recurrent vertigo attacks lasting minutes to hours accompanied by nystagmus, nausea, and vomiting. Hearing loss is also present and often fluctuates, initially affecting low frequencies but becoming permanent over time. Diagnostic tests include electrocochleography and caloric testing. Management involves lifestyle modifications, medical treatment with vestibular sedatives and vasodilators during attacks, and potentially surgery for refractory cases.
This document provides an overview of vertigo, including its definition, causes, approaches to diagnosis, and common vestibular disorders. Vertigo is an abnormal sense of movement or spinning. Causes can be peripheral (inner ear) or central (brain). Common peripheral causes include BPPV, vestibular neuritis, and Meniere's disease. Central causes include seizures, MS, and stroke. Diagnosis involves assessing history, symptoms, and performing tests like Hallpike maneuver and caloric testing. Common disorders discussed are BPPV, vestibular neuritis, labyrinthitis, Meniere's disease, and vestibular migraine.
Vertigo is a common condition characterized by a sensation of rotation or spinning. Common causes include BPPV, vestibular neuritis, Meniere's disease, and acoustic neuromas. BPPV is the most common cause and involves detached inner ear crystals that move within the semicircular canals and stimulate cupulae. Diagnosis is made using the Dix-Hallpike maneuver which provokes nystagmus. Treatment involves repositioning procedures like the Epley maneuver to move the crystals back into the vestibule. Vestibular neuritis is an inflammation of the vestibular nerve and causes violent vertigo on head movement that improves with time. Acoustic neuromas present with unilateral
Vertigo is the illusion of movement throughout space. There are several types of vertigo including benign positional paroxysmal vertigo (BPPV), which causes short episodes of vertigo when changing head position; peripheral vestibulopathy, triggered by infections; and Meniere's disease, with episodes of vertigo and hearing loss. Evaluation involves exams and tests like audiometry and MRI, while management consists of repositioning maneuvers for BPPV, medications like steroids, and rehabilitation exercises.
The document discusses dizziness, its types (vertigo, disequilibrium, pre-syncope, syncope), common causes, diagnostic approach, examination findings, investigations, and treatment. The diagnostic approach involves taking a thorough history and conducting physical examinations like neurological and vestibular tests. Common causes include peripheral vestibular disorders, central nervous system issues, and psychiatric conditions. Treatment is directed at the underlying cause, which may include medication, repositioning procedures, rehabilitation therapy, or lifestyle changes.
This document discusses the history, presentation, diagnosis and management of Meniere's disease. Some key points:
- Meniere's disease was first described in 1861 and is characterized by hearing loss, tinnitus, and vertigo due to endolymphatic hydrops (fluid buildup) in the inner ear.
- Diagnosis is based on recurrent vertigo spells lasting 20 minutes to 24 hours, fluctuating hearing loss, tinnitus and aural fullness. Tests like electrocochleography and VEMPs can provide supportive evidence.
- Treatment includes dietary sodium restriction, diuretics, medications and surgical options like intratympanic injections if conservative measures fail. The
Dizziness is a common complaint in older adults that increases in prevalence with age. It is a nonspecific term used to describe various sensations including vertigo, lightheadedness, and imbalance. Dizziness can be caused by disturbances in various body systems including the vestibular system, visual pathways, proprioceptive fibers, and brain. Common causes include benign positional vertigo, orthostatic hypotension, cerebrovascular disease, and medication side effects. A thorough history and physical exam is needed to evaluate dizziness due to its subjective nature and multiple potential causes.
This document discusses the differential diagnosis of dizziness, listing various potential causes such as benign paroxysmal positional vertigo (BPPV), infections of the inner ear, migraines, Meniere's disease, neurological conditions, and medications as common causes. It provides details on evaluating dizziness through patient history and physical exam, focusing on tests like the Dix-Hallpike maneuver to diagnose BPPV. Treatment options are also outlined, including repositioning maneuvers like the Epley maneuver to treat BPPV.
The document discusses various types of vertigo, dizziness, and imbalance that patients may experience and how medical personnel should evaluate and classify these symptoms. It covers peripheral causes like benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, labyrinthitis, and Meniere's disease. It also discusses central/neurological causes and compares features of peripheral vs. central vestibular lesions. Evaluation involves taking a history, physical exam including nystagmus tests, and potentially imaging or other tests.
1. Sudden sensorineural hearing loss (SSHL) is defined as hearing loss of at least 30 dB over 3 consecutive frequencies within 72 hours. Clinicians should assess for bilateral SSHL, recurrent episodes, or focal neurological findings which may indicate specific underlying disorders.
2. A thorough history, physical exam including Weber and Rinne tests, and audiometry are used to distinguish SSHL from conductive hearing loss and identify potential causes such as viral infection, autoimmune disease, or vascular issues.
3. Modifying factors like bilateral SSHL, recurrent episodes, or neurological signs suggest conditions including meningitis, autoimmune inner ear disease, Lyme disease, or vertebrobasilar insufficiency that
The document discusses vestibular disorders and the anatomy and function of the inner ear's role in balance. It describes how the semicircular canals and otolith organs detect movement and orientation. Common causes of dizziness include Meniere's disease, BPPV, vestibular neuritis, and migraines. Diagnosis involves a case history and vestibular testing like VNG, rotary chair, and VEMPs. Treatment options depend on the underlying cause but may include medications, repositioning maneuvers, surgery, or vestibular rehabilitation therapy.
Meniere's disease is a disorder of the inner ear that causes spontaneous episodes of vertigo accompanied by fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. The exact cause is unknown but may involve viral infection, hereditary factors, or autoimmune issues. Pathologically, it involves endolymphatic hydrops or a buildup of fluid in the inner ear. Diagnosis is based on recurrent vertigo spells lasting 20 minutes to 24 hours along with hearing loss, tinnitus, and fullness. Treatment aims to reduce vertigo and includes dietary sodium restriction, diuretics, vestibular sedatives for acute attacks, intratympanic injections of gentamicin
1. Vertigo is caused by problems with the inner ear or vestibular system and results in a feeling that one is moving or spinning even when stationary.
2. It can be classified as peripheral vertigo, caused by issues with the inner ear, or central vertigo, caused by problems in the brain.
3. Common causes of peripheral vertigo include benign positional vertigo, Meniere's disease, labyrinthitis, and acoustic neuroma. Diagnosis involves examining symptoms, medical history, and tests like the Dix-Hallpike maneuver or caloric testing. Treatment depends on the underlying cause but may include repositioning maneuvers, medication, or surgery.
Vertigo is a sensation of rotational or linear movement that is not actually occurring. It is caused by disturbances in the vestibular system of the inner ear. Benign paroxysmal positional vertigo (BPPV) and labyrinthitis are two common causes of peripheral vertigo. BPPV involves detached calcium crystals in the inner ear that cause vertigo with certain head movements and is treated with repositioning maneuvers. Labyrinthitis is an inner ear infection that causes both vertigo and hearing loss. It is usually viral in origin and causes sudden onset vertigo, nausea, and unilateral hearing loss.
The document discusses various causes of vertigo including peripheral causes like benign positional vertigo and Meniere's disease, as well as central causes like stroke and migraine. It outlines the diagnostic approach including taking a history of symptoms, performing a physical exam with tests like the Dix-Hallpike maneuver, and considering audiometric testing, imaging, or other workup based on findings. The goal is to distinguish between peripheral and central causes of vertigo based on characteristics of the nystagmus, hearing loss, imbalance, and other associated neurological symptoms.
This document provides information on Meniere's disease, including its pathology, symptoms, diagnosis and treatment. Some key points:
- Meniere's disease is caused by endolymphatic hydrops, or a distension of the inner ear's fluid-filled spaces. This mainly affects the cochlea and saccule.
- Classical symptoms include episodic vertigo, fluctuating hearing loss, tinnitus and aural fullness. Diagnosis involves ruling out other causes and showing these characteristic symptoms.
- Treatment focuses on relieving acute attacks medically and managing symptoms long-term. Lifestyle changes like low salt are recommended. Vestibular sedatives and vasodil
The document discusses the evaluation and management of dizziness and vertigo. It outlines the main categories of dizziness including otologic, central, medical, and unlocalized causes. Evaluation involves taking a thorough history, performing a physical exam including tests of nystagmus, and ordering investigations like an audiogram or MRI. Common diseases discussed in more detail include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and migraine-associated vertigo. Treatment focuses on treating the underlying cause, patient education, rehabilitation, and medications in some cases.
The document discusses various causes of dizziness including vertigo, presyncope, disequilibrium, and non-specific dizziness. Vertigo is characterized by illusions of motion and is commonly caused by peripheral vestibular disorders. Positional vertigo can be distinguished from presyncope by provoking dizziness with changes in head position rather than lowering blood pressure. Disequilibrium causes an unsteady feeling when walking and may result from neurological or musculoskeletal disorders. Non-specific dizziness is difficult for patients to describe and has a broad differential diagnosis. Evaluation of dizziness involves distinguishing these subtypes and identifying potential causes based on associated symptoms, physical exam findings, and test results.
Definition
Classification
Causes of tinnitus
Treatment of tinnitus
Definition
Classification
Causes of tinnitus
Treatment of tinnitus
Definition of vertigo
It’s Causes
Specific Question for History
Differential diagnosis
Investigation
Management Plan
This document discusses vertigo and disorders of equilibrium. It begins by defining equilibrium and its neural pathways. Vertigo is defined as an illusion of movement and is distinguished from non-vertiginous dizziness. A history, physical exam, and testing can help localize the cause as either peripheral or central. Peripheral causes like benign positional vertigo typically produce intermittent vertigo and nystagmus in one direction, while central causes may involve neurologic signs and multidirectional nystagmus. Specific peripheral disorders discussed in detail include benign positional vertigo and Meniere's disease.
Ménière’s disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus, and aural fullness. It is caused by endolymphatic hydrops, or a distension of the endolymphatic duct. Key features include recurrent vertigo attacks lasting minutes to hours accompanied by nystagmus, nausea, and vomiting. Hearing loss is also present and often fluctuates, initially affecting low frequencies but becoming permanent over time. Diagnostic tests include electrocochleography and caloric testing. Management involves lifestyle modifications, medical treatment with vestibular sedatives and vasodilators during attacks, and potentially surgery for refractory cases.
This document provides an overview of vertigo, including its definition, causes, approaches to diagnosis, and common vestibular disorders. Vertigo is an abnormal sense of movement or spinning. Causes can be peripheral (inner ear) or central (brain). Common peripheral causes include BPPV, vestibular neuritis, and Meniere's disease. Central causes include seizures, MS, and stroke. Diagnosis involves assessing history, symptoms, and performing tests like Hallpike maneuver and caloric testing. Common disorders discussed are BPPV, vestibular neuritis, labyrinthitis, Meniere's disease, and vestibular migraine.
Vertigo is a common condition characterized by a sensation of rotation or spinning. Common causes include BPPV, vestibular neuritis, Meniere's disease, and acoustic neuromas. BPPV is the most common cause and involves detached inner ear crystals that move within the semicircular canals and stimulate cupulae. Diagnosis is made using the Dix-Hallpike maneuver which provokes nystagmus. Treatment involves repositioning procedures like the Epley maneuver to move the crystals back into the vestibule. Vestibular neuritis is an inflammation of the vestibular nerve and causes violent vertigo on head movement that improves with time. Acoustic neuromas present with unilateral
Vertigo is the illusion of movement throughout space. There are several types of vertigo including benign positional paroxysmal vertigo (BPPV), which causes short episodes of vertigo when changing head position; peripheral vestibulopathy, triggered by infections; and Meniere's disease, with episodes of vertigo and hearing loss. Evaluation involves exams and tests like audiometry and MRI, while management consists of repositioning maneuvers for BPPV, medications like steroids, and rehabilitation exercises.
The document discusses dizziness, its types (vertigo, disequilibrium, pre-syncope, syncope), common causes, diagnostic approach, examination findings, investigations, and treatment. The diagnostic approach involves taking a thorough history and conducting physical examinations like neurological and vestibular tests. Common causes include peripheral vestibular disorders, central nervous system issues, and psychiatric conditions. Treatment is directed at the underlying cause, which may include medication, repositioning procedures, rehabilitation therapy, or lifestyle changes.
Similar to Vertigo presentation for 1st year ms program (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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1. Dizziness and Vertigo
Gail Ishiyama, M.D.
Assistant Professor
Department of Neurology,
Division of Neurotology
UCLA School of Medicine
2. Dizziness
Vertigo: illusion of movement
Ataxia: inability to co-ordinate movements (walking or of
extremities), “feel as if drunk”
Non-specific dizziness: lightheadedness, swimming
sensation inside of head
Gait imbalance: feeling unsure when walking, okay if sitting
or lying down
3. Evaluation of the
Dizzy Patient
What type of dizziness is it?
How long does it last? Continuous or episodic
Spontaneous or positional
Duration of vertigo if episodic
Are there otologic symptoms?
Are there focal neurological symptoms?
4. Otologic Symptoms in the
Dizzy Patient
Hearing Loss: progressive, sudden
SNHL,congenital, fluctuating
Tinnitus: continuous or episodic
Aural fullness
Ear pain, or chronic drainage
History of ear surgeries/infection
5. Focal Neurological Symptoms
Vertigo if secondary to cerebrovascular insufficiency is
indicative of posterior circulatory problems
Visual loss
Loss of consciousness
Numbness especially if on one side
Weakness especially if on one side
Incoordination as if drunk, esp if in spells
Difficulty swallowing
Slurring of the speech
6. Evaluation of the
Dizzy Patient
Family History:
Hearing Loss
Vertigo Spells
Headaches or visual auras
Gait ataxia or imbalance
7. Nystagmus: Features of Peripheral
Spontaneous nystagmus from imbalance of signals
from the right and left vestibular periphery
The resulting nystagmus is a combined torsional,
horizontal.
Alexander’s law: Increased frequency and amplitude of
nystagmus with gaze in direction of fast component,
reverse effect with gaze opposite to the fast
component.
Inhibited by fixation
8. Features of Central Nystagmus
Prominent with and without fixation
Can be purely vertical (always central), horizontal, or
torsional, of have some combination
The rule is if the nystagmus is vertical (upbeat or
downbeat), it is central i.e. not coming from the inner
ear
Cerebellar: spontaneous downbeat with vertical
amplitude increasing with horizontal gaze deviation
or brought out when placed in supine position
9. Bedside Tests of Vestibular Function:
Dynamic Visual Acuity
Oscillopsia : perception of environment jumping up and
down when walking.
Ask the patient: “Can you read the print on the cans while
walking down the grocery store aisle?”
May be a sign of bilateral loss of VOR function
Horizontal passive rotation at 2 Hz. Normal is loss of 1 line of
Snellen acuity card, bilateral vestibular loss will lose 5
lines.
10. Bedside Tests of
Horizontal VOR: Head Thrust Test
Rapid, high-acceleration head thrust with patient fixating on
examiner’s nose
Corrective saccade (catch-up saccade) when head is rotated
toward the affected vestibular periphery is positive
Positive in vestibular neuritis, gentamicin ototoxicity
(bilateral), idiopathic and autoimmune vestibulopathy
May be normal to have slight VOR hypometria bilaterally in
older patients
12. Ataxia Syndromes
• Patient may present with unsteadiness, limb incoordination,
dysarthria.
• On examination, there may be dysmetria on FTN testing
• On ENG testing, hypermetric saccades, abnormalities of OKN, or
of smoooth pursuit.
• MRI : atrophy of the cerebellar vermis and / or hemispheres
13. Spinocerebellar Ataxia
Familial SCA 6
Accounts for 5-15% of SCA autosomal dominant in U.S. (higher
% in Japan)
Onset of symptoms usually 3rd to 6th decade
Usually complain of episodic vertigo and oscillopsia,
» especially immediately after lying supine from the sitting
position, or quick turn of the head
Chromosome 19p VGCC (CAG repeat)
» highly expressed in the cerebellum
Down-beat nystagmus in supine position
–
14. Benign Paroxysmal Positional Vertigo
Otolithic calcium carbonate crystals become loose, and fall into the
posterior semicircular canal
Common with head trauma, older age, inner ear disease
One of the most common cause of vertigo seen in neurotology clinics,
estimated at 20-30% of patients
15. Benign Paroxysmal Positional Vertigo
Typical complaint: spells of vertigo when turning over in bed, “top shelf
vertigo”
Examine the patient for nystagmus and vertigo in the Dix-Hallpike
position : head-hanging R and L
Vertigo lasts shorter than 1 minute
Geotropic, torsional nystagmus
with upbeat component
Brought on only by positional changes
Latency of few seconds up to 45 sec
Fatigues with repeated testing
17. Epidemiology of BPPV
• Lifetime prevalence of 3.2% in females and 1.6% in males
• Of 100 unselected elderly patients, a prevalence of 9% was
reported
• Median duration of two weeks
• Female preponderance likely reflects the association of migraine
with BPPV
• Association of BPPV with hypertension and hyperlipidemia
• Vascular damage to the inner ear facilitates detachment of the
otoconia
• Von Brevern et al., 2006
18. Benign Paroxysmal Positional Vertigo
Can be presentation of acoustic / inner ear disease: screening
audiogram is preferred
Etiology of BPPV in 240 patients (Baloh et al., 1987)
Idiopathic in 49%
Traumatic in 18%
Viral Labyrinthitis in 15%
VBI in 5%
Meniere’s in 2%
Surgery in 4%
Ototoxicity in 2%
Idiopathic young patients: 3x incidence of migraine vs. in those with
BPPV with known cause (e.g. head trauma) Ishiyama et al., 2000
19. Positional and Spontaneous
Vertigo:
Multiple Sclerosis
Vertigo is the initial symptom of MS in 5%, and presents in 50%
of MS patients at some time in the course.
25% of patients with MS have caloric paresis
80% have eye movement abnormalities
Oftentimes abnormalities on ABR and occasionally retrocochlear
hearing loss from involvement at the root entry zone near pons
20. Positional and Spontaneous Vertigo:
Multiple Sclerosis
Demyelinating disease of unknown etiology
Onset usually in 3rd and 4th decade of life
Common associated signs and symptoms: INO (internuclear
ophthalmoplegia), optic neuritis, Llermitte’s sign, vibratory
loss, spasticity, sensitivity to temperature
MRI with FLAIR: plaques
21. Meniere’s Disease
Symptoms: Fluctuating hearing loss, tinnitus, ear fullness, and
vertigo. May have initially only hearing loss or only vertigo
spells.
Possibly sudden falls (Tumarkin crisis)
Hearing loss, tinnitus, and aural fullness increase during the
vertigo attack
Typically lasts 20 minutes or more in duration
22. Meniere’s Disease
On temporal bone histopathology, there is a distension of the
entire endolymphatic system
Audiogram: often low-frequency sensorineural hearing loss
that increases during attacks.
ENG: Vestibular paresis or directional preponderance to
bithermal caloric stimulation
23. Meniere’s Disease:
Tumarkin falls
In about 7-10% of Meniere’s disease, there are associated
sudden falls “drop attacks”
No warning, sudden, violent fall without loss of consciousness
Subjective sensation of being pushed by an external force
Recently noted to be associated with migraine
(Ishiyama et al., 2003)
Surgical ablation is curative of these dangerous and frightening
drop attacks
24. Meniere’s Disease Variant:
Delayed Endolymphatic Hydrops
Delayed hydrops develops in an ear that has h/o profound
SNHL years before (up to 70 years before)
Many years later: recurrent spells of vertigo of 20 minutes
duration or longer
Often without accompanying otologic symptoms of aural
fullness, increased tinnitus and hearing fluctuation
Can also have Tumarkin falls
25. Migraine-associated Vertigo
Vestibular Meniere’s, migraine-associated vestibulopathy, benign
paroxysmal vertigo
25% of patients with migraine have vertigo spells
Duration of the vertigo varies:
31% few min-2 hr
49% > 24 hrs
7% seconds
25% of patients with migraine have caloric paresis
Isolated vertigo without headache are termed migraine equivalent
26. Migraine-associated Vertigo
Migraine is an inherited, likely metabolic syndrome with
multiple causes, likely autosomal dominant with variable
penetrance
Always ask about the family history
Ask about h/o motion sickness (50%)
Ask about h/o altitude sickness
Ask about sensitivity to visual stimuli (bright lights/ patterns,
panoramic theater, computer work)
27. Migraine-associated Vertigo
Ask about h/o recurrent abdominal pains or cyclical vomiting
as child, which is usually migraine equivalent
Ask women specifically regarding menses: some will call
migraine headaches “PMS”
Migraine-associated vertigo often has a catamenial
component, or worsened by OCP in women
28. International Headache Society
Criteria for Migraine Headaches
• At least 5 attacks fulfilling B-D
• B. Headache lasting 4-72 hrs
• C. At least 2 of: unilateral, pulsating, moderate or severe,
aggravation by physical activity
• D. At least one of N/V, photophobia and phonophobia
• Other causes ruled out
29. Variants of Migraine
Migraine visual aura: Visual aura may occur isolated without
headache: fortification spectra, scotoma, stars, patterns of
colored lights lasting usually 15-20 minutes
Retinal migraine: retinal artery vasospasm which can cause
monocular blindness: prophylaxis with verapamil
Benign paroxysmal vertigo of childhood: recurrent spells of
vertigo in child is usually migraine, may or may not have H/A
30. Association between Migraine
and Vestibulopathy
Tumarkin falls may be associated with migraine
Out of 55 patients with Tumarkin falls, 6 had >1yr h/o normal
hearing
5 out of 6 had h/o migraine
Tumarkin falls are known to localize to the vestibular
periphery since surgery is curative
Ishiyama et al., 2003
31. Vestibular Neuritis
Subacute onset of vertigo, often with nausea and vomiting
Vertigo lasts a few days, and crescendos in few hours, and
decreases in severity with time
Suspicion for viral cause but evidence for ischemic causes
Temporal bone histopathology: Scarpa’s ganglion neuronal loss
32. Vertebrobasilar insufficiency
20% of all strokes are in the vertebrobasilar distribution
Usually from atherosclerotic disease, but 1/5 of infarcts may be
cardioembolic
Common cause of episodic, spontaneus vertigo of abrupt onset
in older patients
Grad and Baloh (1989): 62% had isolated vertigo without
associated neurological deficits, and 19% had isolated
vertigo as first TIA
Several minutes (3-4 min) duration is always suspicious for TIA
33. Vertebrobasilar insufficiency
Visual (diplopia/ illusions, field defects in 69%
Drop attacks in 33%
Imbalance/ incoordination in 21%
Extremity weakness in 21%
Confusion in 17%
Headache in 14%
Hearing loss in 14%
Loss of consciousness in 9.5%
Extremity numbness in 9.5%
Dysarthira in 9.5%
Tinnitus in 9.5%
Perioral numbness in 5%
34.
35. Stroke syndrome with vertigo:
Wallenberg syndrome
Dorsolateral medullary syndrome
PICA (posterior inferior cerebellar artery)
Vertebral atherosclerotic disease
(artery to artery emboli) prior to takeoff
Consider vertebral dissection
Look for h/o neck trauma or manipulation
36. Wallenberg symptoms
Right Dorsolateral medullary stroke
Nystagmus and vertigo (vestibular nuclei)
Difficulty swallowing, hoarse voice, absent gag on R (nucleus
ambiguus)
Difficulty limb coordination on the right FTN, HTS (right
cerebellum)
On walking, veers and falls to the right
Pain and temperature loss on right face and left leg, trunk, arm
(spinothalamic)
Right Horner’s: ptosis, miosis, anhydrosis (reticulospinal fibers
in lateral medulla)
37. Stroke syndrome with vertigo:
Anterior inferior cerebellar artery
Vertigo
Tinnitus, hearing loss secondary to infarct
of cochlea/nerve or cochlear nucleus
Ataxia
Facial paralysis and numbness
Ispilateral Horner’s
38. Stroke syndrome with vertigo:
Labyrinthine infarction
Occlusion of the internal auditory artery
Sudden, profound hearing loss
Acute onset of spontaneous vertigo lasting days
Consider the diagnosis in older patients with h/o TIA,
stroke, or atherosclerotic vascular disease
39. Cerebellar Hemorrhage
Etiology is hypertensive vascular disease in 2/3 of patients
Acute onset of vertigo, nausea, and vomiting and severe
headache, inability to stand
Spontaneous or gaze evoked nystagmus, dysmetria, truncal
ataxia
Often requires prompt evaluation and surgical decompression
to prevent progression to coma or even death from
herniation
40. Duration of vertigo
Duration
BPPV Seconds, always < 1 min
VBI Few minutes,
focal neurological signs
Migraine Varies sec, minutes, hours or days
Meniere’s 20 minutes to hours
Vest.neuritis Days
Stroke Days