Vertigo and peripheral vestibular disorders

1

VERTIGO

B.BaratiOtorhinolaryngologist

Otologist, Neuro-otologistAssociate professor

Shahid Beheshti Medical University

Differential

• 40% Peripheral vestibular dysfunction• 10% Central brainstem vestibular

lesion • 25% Presyncope or disequilibrium• 15% Psychiatric disorder• 10% Unknown cause

Peripheral Vestibular System

Peripheral vs Central Vertigo

• Onset• Severity• Positional• Intrmitant• Otologic findings• Neurologic findings• Nystagmus

Nystagmus

Fa s t p h a s eToward dominant earC O W SH o r i z o n t a l , To r s i o n a lF i x a t i o n s u p p r e s s i o n

Peripheral vs Central Vertigo

Vestibular dysfunction...Peripheral causes

canalithiasis (BPPV) -- 50% vestibular neuronitis (labyrinthitis) --

25% Meniere’s disease -- 10% trauma drugs (aminoglycosides)

Central causes vascular (vertebrobasilar insufficiency)

-- 50% demyelinating (multiple sclerosis) drugs (anticonvulsants, alcohol,

hypnotics)

Benign paroxysmal positional vertigo

Dix-Hallpike

Dix-Hallpike

Other Tx

• Medical • Surgical

Meniere’s Disease