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.

1. Vertigo

2. วัตถุประสงค์
 1.ระบุอาการและอาการแสดงของกลุ่มอาการเวียนศีรษะที่
พบบ่อย ๆ ได้
 2.วินิจฉัยและวินจฉัยจำาแนกโรคได้จากประวัติและการ
ิ
ตรวจร่างกาย แยก peripheral vertigo ออกจาก
central vertigo ได้
 3.อธิบายแนวทางการส่งตรวจทางห้องปฏิบัติการเพือให้
่
ได้การวินิจฉัยโรคได้
 4.อธิบายหลักการและแนวทางในการรักษากลุ่มอาการ
เวียนศีรษะได้
 5.ประเมินขีดความสามารถในการดูแลผู้ป่วย และส่งต่อ

3.  การรักษาการสมดุลย์ของการทรงตัวต้อง
อาศัย
visual system
Proprioception
 vestibular system

4. Vertigo
 Illusionor hallucination of movement
 Vestibular system

5. Vertigo
 History taking
 Character of disorientation
 Time course of vertigo , duration
 Precipitating factors
 Associated symptoms : hearing loss , tinnitus , nausea ,
vomiting , diplopia , CNS symptoms
 Predisposing symptoms : general condition, trauma ,
drugs

6. Vertigo
 Physical examination
 ENT examination
 CNS examination
 Vestibular system examination :
 Unterberger test
 Caloric test
 Dix-Hallpike maneuver
 Evaluation of pathologic nystagmus

7. Vertigo
 Investigation
 Audiometry
 ABR : Auditory Brainstem Response
 ENG : Electronystagmography
 Others : CBC,U/A,FBS,electrolyte,cholesterol,
triglyceride,TFT,VDRL,CT scan ,MRI

8. Peripheral Central
 1.Onset sudden insidious
 2.Pattern episodic continuous
 3.Sensation frequent infrequent
of rotation
 4.Severity often intense seldom intense
 5.Duration min.,hr. mo. to yr.

9. Peripheral Central
 6.Influence of marked slight or none
head movement
 7.Syncope never rare
 8.Convulsion never rare
 9.Tinnitus common rare
 10.Deafness common rare

10. Peripheral Central
 11.Spontaneous may be may be
nystagmus present present
 12.Type of horizontal horizontal,
nystagmus vertical
 13.Other CNS rare common
involvement

11. Peripheral Cause of Vertigo
 BPPV
 Meniere’s disease
 Sudden hearing loss
 Vestibular neuritis
 Labyrinthitis

12. BPPV
 Benign paroxysmal positional vertigo
 The most common vestibular disorder
 Age range 11-84 yr. Mean age at onset 54 yr
 Cupulolithiasis
 Canalithiasis

15. BPPV
 Signs and Symptoms
 Vertigo and nystagmus
 Latency of onset , usually 2-6 sec.
 Short duration , usually less than 30 sec.
 Reversibility
 Fatigability
 Nausea , vomiting
 Dix-Hallpike maneuver

17. BPPV
 Cause
 Idiopathic
 Trauma
 Otitismedia
 Vestibular neuritis
 Meniere’s disease
 Otosclerosis

18. BPPV
 Cause
 Sudden SNHL
 CNS disease
 Vertebral basilar insufficiency
 Acoustic neuroma

19. BPPV
 Treatment
 Reassurance
 Medication : minor transquilizer
 Vestibular rehabilitation
Repositioning maneuver
 Surgery

22. Meniere’s disease
 Idiopathic endolymphatic hydrop
 Signs and symptoms
 Episodic vertigo lasting min to hr.
 Fluctuating hearing loss
 Tinnitus , fullness

23. Meniere’s disease
 Audiogram : low tone hearing loss
 ABR
 ENG
 Radiography

24. Meniere’s disease
 Treatment
 Vasodilator
 Cinnarizine , Dramamine
 K-sparing diuretic drug
 Stellate ganglion block
 Intratympanic gentamicin therapy
 Vestibular neurectomy

25. Sudden hearing loss
 Hearing loss : hr or day
 Vertigo
 Tinnitus
 Others : headache , URI symptoms
 Nystagmus
 Tuning fork
 Audiogram : unilateral SNHL

26. Sudden hearing loss
 Cause
 Known cause : Syphilis, Meniere’s disease,multiple
sclerosis , acoustic neuroma
 Unknown : เชื่อว่าเกิดจากvirus,ความผิดปกติของหลอด
เลือด autoimmune disease, labyrinthine membrane
rupture ( LMR)

27. Sudden hearing loss
 Treatment
 Bed rest
 Repeat audiogram
 Steroid
 Vasodilator
 Heparin

28. Vestibular neuritis
 Vertigo เป็นทันทีทนใดและเป็นอยู่นาน
ั
 Spontaneous nystagmus
 มักมีไข้หวัดนำามาก่อน
 มักเดินเซข้างทีมี lesion
่
 Audiogram : normal
 Caloric test : canal paresis or nonresponsive

29. Vestibular neuritis
 Treatment
 Rest
 Dramamine , diazepam
 Steroid
 Physical therapy : Cawthorne-Cooksey exercise

30. Labyrinthitis
 Virus : mump, measles, Herpes
 Bacteria : syphilis , OM ,meningitis
 TB more often a complication of Tubercuolus
meningitis than of Tuberculous otitis media.
 Syphilis : congenital , acquire
Fluctuating episodes of hearing loss and vertigo

31. Acoustic neuroma
 Acoustic schwannoma
 Schwann cell tumor of vestibular part of CN VIII มักเกิด
บริเวณ Internal acoustic canal แล้วยื่นเข้าไปบริเวณ CP
angle
 Initially,slowly progressive hearing loss and tinnitus .
 Postural imbalance or disequilibrium.

32. Acoustic neuroma
 Once the lesion compress the brainstem and
vestibulocerebellum ,central compensation becomes
impaired : vertigo , ataxia.
 Audiogram : unilateral SNHL
 ABR
 Caloric test : hypofunction
 MRI
 Treatment : surgery, radiation

33. Central cause of vertigo
 1.Vertebrobasilar insufficiency
 Elderly
 Atherosclerosis
 Vertigo
 Nausea,vomiting
 Ataxia
 Visual illusion ,visual field defect, diplopia, headache

34. Central cause of vertigo
 1.1Brainstem TIA
 1.2Wallenberg’s syndrome ( Lateral medullary
infartion )
 1.3Acute posterior cerebellar infarction
 1.4Acute inferior cerebellar infarction

35. Central cause of vertigo
 2.Cerebellar hemorrhage
 Vertigo
 Nausea, vomiting
 Headache
 Stiffness of neck, incoordination
 50% loss of consciousness in 24 hr.

36. Central cause of vertigo
 3.Vestibular migraine
 Episodes of vertigo
 Increased sensitivity to motion during the attack and
increased susceptibility to motion sickness in between
attacks
 In 33% of pt episodic vertigo is not associated with
headache.

37. Central cause of vertigo
 3.Vestibular migraine
 In 33% vertigo is associated with visual symptoms ,
dysarthria , tinnitus, decreased hearing , diplopia,
ataxia, bilateral paraesthesia, bilateral paresis or
decreased level of consciousness

38. Central cause of vertigo
 3.Vestibular migraine
 Treatment
Acute attack : analgesic , antiemetic
Prophylaxis for migraine attack : beta-blocker,
calcium antagonist

39. Central cause of vertigo
 4. Multiple sclerosis
 Vertigo without hearing loss
 Optic neuritis, transverse myelitis, others brainstem
signs

40. Central cause of vertigo
 5.Vestibular epilepsy
 Dysequilibrium with rotational or linear vertigo
 Accompany by body , head and eye rotation with or
without nystagmus
 May associated with mild nausea(vomiting not typical )

41. Medical treatment
 1.Labyrinthine suppressant
 Decreased vertigo , nausea, vomiting
 1.1 Antihistamine : dimenhydrinate,meclizine
 1.2 Antiemetic : prochlorperazine (Compazine),
diphenidol
 1.3 Anticholinergic : scopolamine
 1.4 Minor tranquilizer : diazepam

42. Medical treatment
 2.Vasodilator
 B-histine , cinnarizine
 3.Steroid