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vertigo-150822143555-lva1-appgg6892.pptx
1.
2. Objectives
• Vertigo
Defintion, Types, Causes
• Central & Peripheral Vertigo
• Clinical Tests
• Laboratory Tests
• BPPV
• Vestibular Neuronitis
• Dizziness and Vertigo
• Quiz
What will
I Learn
Today ?
3. Vertigo- Definition
• Not a disease, But a
symptom.
A feeling in which the
external world seems to
revolve around the
individual or in which the
individual itself seems to
revolve in space.
5. Physiological Vertigo
• Balance between 3 stabilising sensory systems
is lost.
• Non-adaptation of vestibular system to
unfamiliar head movements.
• Unusual head & neck positions
7. Peripheral & Central Vertigo
Peripheral: Lesions of vestibular
end organs
( 85% of all cases of vertigo)
Intermediate: Lesions in
vestibular nerve
Central: Lesions of central
nervous system(vestibular nuclei)
( 15% of all cases)
12. Clinical Tests of Vestibular Function
1. Spontaneous Nystagmus
2. Fistula test
3. Romberg Test
4. Gait
5. Past-Pointing & Falling
6. Dix Hallpike Maneuver
7. Test of Cerebellar Dysfunction
13. Nystagmus
• Involuntary rhythmical oscillatory movement of the eyes.
• Triggered by inner ear stimulation.
• Slow pursuit movement initially, fast rapid resetting phase .
• Nystagmus is always named after direction of the fast phase
Nystagmus
Based on
Direction
Rotatory/
Tortional
Horizontal
Vertical
17. Rt gaze Lt gaze
Degrees of Nystagmus
(Alexander’s Law)
Grade I
Grade III
Grade II
Primary position
18. Fistula Test
• Principle: To induce nystagmus by producing pressure
changes in the EAC which are transmitted to the labyrinth.
Stimulation of Labyrinth causes nystagmus & vertigo.
• E.A.C. pressure is increased by intermittent tragal pressure or
Siegelization
• Normally : Negative
Fistula present Fistula sign + Cholesteatoma True Positive
Fistula absent Fistula sign + Congenital
syphillis
False positive
Fistula present Fistula sign - Dead ear False negative
20. Laboratory Tests
1. Caloric Test
2. Electronystagmography
3. Optokinetics
4. Rotational Test
5. Galvanic Test
6. Posturography
21. Caloric test
• Principle:
To induce nystagmus by thermal stimulation of the vestibular
system
• Advantages:
o Each labryinth can be tested separately
o Also checks for labrynthine origin of vertigo
22. Caloric Test- Types
1. Modified Kobrak Test: 60°, 60 s, Ice water
2. Fitzgerald-Hallpike Test/Bithermal Caloric Test:
• Supine position
• Water at 30° & 44°
• Head tilt: 30° forward
• 5 mins gap b/w 2 ears
• Direction of Nystagmus:COWS
Cold- Same
Warm- Opposite
3. Cold air caloric test: Done in TM perforation
26. Other tests
Galvanic test
• Only test which helps in
differentiating end
organ lesion from that
of nerve lesion.
Posturography
27. Treatment of Vertigo
1. Reassurance/Psychological Support
2. Pharmacotherapy
3. Adaptation exercises
4. Intratympanic antibiotic injections
5. Surgery
• Conservative
• Destructive
28. Benign Paroxysmal Positional Vertigo
• Most common cause.
• Described by Barany
• Definition: Abnormal sensation of motion that is
elicited by certain provocative positions.
• These provocative positions usually trigger specific
eye movements i.e. Nystagmus
Rotational Geotropic
Latency: 1-
5 s
Duration:
20-30 s
Fatiguable
Associated
with
Vertigo
Reversible
29. BPPV
Canalithiasis:
(Canal stones)
• Otoconial debris are
floating freely in the
canal portion of the SCC
• Free floating
• Most common
• Posterior SCC m/c
involved.
Cupulolithiasis:
(cupula stones)
• Otoconial debris are
adhered to the cupula
of the crista ampullaris.
• Not free floating
• Not common
30. Benign Paroxysmal Positional Vertigo
• Sex: F>M
• Age: Old age (6th decade)
• Predisposing factors: MAC
• Causes: TIM
• Associations: Cervical diseases, Ear diseases,
Vertibrobasilar insufficiency , CNS Disease
• Differential Diagnosis:
31. Signs & Symptoms
Symptoms
• Sudden Onset
• Have few asymptomatic
periods in between
• Dizziness triggered by head
movements
• Classic BPPV: erect to
supine, 45°
• During attacks, Rolling spin
• Symptoms dissipate within
20-30 s after a violent start.
Signs
• Neurological examination:
Normal
• Dix-Hallpike maneuver:
• Caloric Test: Normal or
Hypofunctional
37. Vertigo & Dizziness
Vertigo
Specific term
Includes only
Vertigo
More common in
elderly
Dizziness
Broad term
Includes vertigo,
syncope,
unsteadiness
All age groups