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DR BANDAR AL-QAHTANI, MD KSMC,RIYADH. Approach to dizzyness (vertigo). “Dizziness”. Faintness Loss of balance Light-headedness Psychologic disorders Vestibular diseases Vertigo is the spinning/rotatory movement Othostatic hypotension should be differentiated from vertigo . - PowerPoint PPT Presentation
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Approach to dizzyness (vertigo)
DR BANDAR AL-QAHTANI, MDKSMC,RIYADH
“Dizziness” Faintness Loss of balance Light-headedness Psychologic disorders Vestibular diseases Vertigo is the spinning/rotatory movement Othostatic hypotension should be
differentiated from vertigo
Vestibular Labyrinth 3 semicircular canals
rotational movement cupula
2 otolithic organs - utricle & saccule linear acceleration macula
Balance Vestibular system Visual system Proprioceptive system – spinothalamic
Dizziness categorized as vestibular or nonvestibular
Vestibular lesion can be located in peripheral or central vestibular
Nonvestibular either systemic diseases /medications related or anxiety
Peripheral vestibular disorders can be : most common :BPV,VIRAL LABRYNTHITIS
common :trauma to labrynth,menieres disease
uncommon :autoimune,bacterial inf.,ototoxic drugs
Central vestibular disorders : most common :migrain common :TIA,CVAs,vasculitis,MS,AN
Diagnosis usually started by history & PE 80-90% of diagnosis HX of present illness,family hx ,allergy hx,drug ..etc Duration of dizziness is having a crucial importance ??? CNS should be recognized and treated as early as
possible CNS s/s ??? Peripheral vestibular causes :
-ear symptoms -discharge,pain,sx,HL,trauma.tinnitus
Seconds BPV
minutes VBI,MIGRAIN
hours Menieres dis
days Vestibular neuritis,labirynth infarct
P.E Crainial nerves Cerebellar function Nystagmus -sign for vertigo-1st ,2nd,3rd
degrees/severity Hearing Neck for tenderness/stiffness and bruit
Nonvestibular causes Systemic diseases DM,HTN,psychiatric diseases Medications for these diseases in particular can
cause dizziness S/S fainting ,fatigue,irregular heart beating ANXIETY is another cause for nonvestibular Floating sensation after hyperventilation-washing
CO2 causing vasoconstriction
Vertebrobasilar Insufficiency
Vertigo, diplopia, dysarthria, ataxia, sensory and motor disturbance
30% of TIA’s
Migraine S/S
personal or family hx, motion intolerance
Vasoconstriction followed by vasodilatation
Classical and non-classical type
Vestibular Neuritis Sudden onset vertigo Normal hearing Viral causes Response to Methylprednisolone
(Ariyasu)
Meniere’s Disease Unknown etiology Hydrops on histologic studies Triad ,hearing loss,tinnitus,vertigo
Meniere’s Disease Salt restriction Diuretics
Thiazides - Na absorption in distal tubule Side effects - hypokalemia, hypotension,
hyperuricemia, hyperlipoproteinemia
BPPV Cupulolithiasis
calcific deposits on cupula rendering SCC gravity dependent
Canalolithiasis calcific debris in SCC pulling of cupula by plunger-like effect
ANY QUESTIONS