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.
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
Peripheral Central 11.Spontaneous may be may be nystagmus present present 12.Type of horizontal horizontal, nystagmus vertical 13.Other CNS rare common involvement
Peripheral Cause of Vertigo BPPV Meniere’s disease Sudden hearing loss Vestibular neuritis Labyrinthitis
BPPV Benign paroxysmal positional vertigo The most common vestibular disorder Age range 11-84 yr. Mean age at onset 54 yr Cupulolithiasis Canalithiasis
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
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
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.
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
Central cause of vertigo 1.Vertebrobasilar insufficiency Elderly Atherosclerosis Vertigo Nausea,vomiting Ataxia Visual illusion ,visual field defect, diplopia, headache
Central cause of vertigo 1.1Brainstem TIA 1.2Wallenberg’s syndrome ( Lateral medullary infartion ) 1.3Acute posterior cerebellar infarction 1.4Acute inferior cerebellar infarction
Central cause of vertigo 2.Cerebellar hemorrhage Vertigo Nausea, vomiting Headache Stiffness of neck, incoordination 50% loss of consciousness in 24 hr.
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.
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
Central cause of vertigo 3.Vestibular migraine Treatment Acute attack : analgesic , antiemetic Prophylaxis for migraine attack : beta-blocker, calcium antagonist
Central cause of vertigo 4. Multiple sclerosis Vertigo without hearing loss Optic neuritis, transverse myelitis, others brainstem signs
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 )