This document provides an overview of vertigo and dizziness. It defines different types like vertigo, dysequilibrium, and lightheadedness. It describes the anatomy of the vestibular system and its role in stabilizing gaze, controlling posture, and sensing orientation. Common causes of vertigo are then outlined, like benign paroxysmal positional vertigo (BPPV), migraine, and Meniere's disease. The diagnosis process is discussed as being acute, recurrent, or chronic. Tests include checking for nystagmus. Treatment options covered include pharmacological approaches, physical rehabilitation techniques like the Epley maneuver, and potential surgical interventions.

1. Vertigo or Dizziness
Dr.Mohamed Elshafei
Dr.link147@yahoo.com

2. Outlines
• Definition
• Anatomy
• Classification
• Red flags
• Diagnosis
• Treatment

3. Presyncope
Vertigo Dysequilibrium
Lightheadedness

4. Definitions
• Dizziness : broad term
• Vertigo : sense of motion or spinning
• Dysequilibrium : feeling of balance ,
unsteady
• Lightheadedness : woozy or disconnected
form environment
• Presyncope : feeling of losing
consciosuness

5. Anatomical hints
• Orienting sensory
information is derived
from :
 Paired vestibular labyrinths,
 Visual input
 Somato‐sensory afferents (joint,
tendon and muscle position
sense, and superficial
sensation).

6. Kinetic labyrinth
Static labyrinth
Vestibular
sensory
endorgans

8. Vestibular system functions
1. To stabilise gaze in space during head
movement (e.g. reading a sign while
walking).
2. To control posture when the head and
body are static (e.g. while standing and
during passive motion).
3. To facilitate perception of orientation and
motion.

9. Causes of vertigo

10. Diagnosis
Acute Recurrent Chronic
↓
↓ ↓
• BPPV
• migraine
• rule out central
• check nystagmus
• vestibulocerebell
ar
• sensori-motor

11. central vs peripheral

12. associated symptoms

14. Conditions
• Vestibular neuritis
• Migraine (basilar, vestibular, benign
recurrenr vertigo)
• BPPV
• Vestibular paroxysmia
• Ménière’s disease
• Bilateral vestibular failure
• Motion sickness

15. vestibular neuritis
• Acute rotary vertigo (sense of movement
away from the side of the lesion)
• Blurred vision/oscillopsia (fast phase of
nystagmus directed contralaterally)
• Postural imbalance (positive Romberg and
falling towards the side of lesion), and
• Nausea and vomiting
• recent viral infection

16. Benign paroxysmal positional vertigo

17. Ménière’s disease
( )
• Prolonged attacks of :
Deafness
Tinnitus
Vertigo
Ear fullness

18. migraine
1. Basilar
2. Vestibular
3. Recurrent benign vertigo

19. IHS criteria for migraine with dizziness

20. bilateral vestibular failure
• Definition : the absence of a nystagmic
response to both caloric and rotary stimuli
• Characterised by : unsteadiness,
particularly in the dark, and oscillopsia
• Causes. Some cases have associated
neurological disease, such as a
progressive cerebellar syndrome, or other
cranial neuropathies. Gentamicin
ototoxicity, vasculitis and malignant
meningitis are also causes. Some cases
follow bacterial meningitis.

21. vestibular paroxysmia
• Short intense attacks of rotational or
to‐and‐fro vertigo lasting seconds to
minutes
• Attacks frequently provoked by particular
head positions
• Impaired hearing permanently or during an
attack
• Audio‐vestibular deficits on testing, and
• Exclusion of a central cause
• Prompt response to carbamazepine

23. motion sickness
• Nausea, sweating, dizziness, vertigo and
profuse vomiting develop over several
hours or less, accompanied by an
irresistible desire either to stop moving or
return to land. Prostration and
• Intense incapacitating malaise frequently
follow, seen typically in seasickness.
• During travel by sea or car esp. in children

24. Stroke
• Cerebellar
• Lateral medullary infaction

25. Red flags
• Age > 50 yrs with vascular risk factors
• Progression in severity or frequency
• New onset headache or changing character of
previous headache in pateint w risk factor
• diplopia
• dysarthria
• central features of nystagmus
• deafness
• Abnormal neurological examination (DCL, focal
deficit, seizures...)
• unable to walk or swaying on walking

26. when to refer to neurologist
• Physician has inadequate level of comfort
in daignosing or treating dizziness
• Physician can`t classify patient as primary
vs secondary dizziness
• Patient with intractable dizziness not
responding to treatment
• Patient with red flags

27. Treatment
• pharmacological
• Physical rahabilitation
• Surgical intervention

28. Pharmacological
1. Vestibular suppressant drugs for acute vertigo >>
anticholinergics (hyoscine, scopolamine), antihistamines
(promethazine, prochlorperazine, cyclizine and
metoclopramide) and the calcium‐channel antagonists
(cinnarizine, flunarizine), diazepam.
2. Specific treatment of vestibular disorders
(e.g. Ménière’s disease >> thiazide? steroid? decopression
, Migrainous vertigo >> BB, CCB, TCA, acetazolamide and
central vestibular disorders as episodic ataxia >> acetazolamide
. 3-4 diaminopyridine )
3. Drugs used to treat systemic diseases that cause vertigo
4. Experimental drugs (e.g. drugs that may accelerate
compensation).

29. Physical rahabilitation
• particle repositiononig maneuvers :
• epley manoeuver
• semont manoeuver
• brandt-daroff manoeuver

30. epley`s manoeuver

31. surgical intervention
• ttt of the cause : otitis media , CPA tumor,
perilymph fistula
• ttt of pathophysiology : as meniere
decompression, destructive

32. THANK YOU