SYMPTOM ANALYSIS -VERTIGO

Dr. Jyothi Reshma S

VERTIGO

17.1

15

12.3

11.4

10.1

8.3

CAUSES

BPPVPhobic postural vertigoCentral vestibular syndromesVestibular migraineMeniere's diseaseVestibular neuronitis

HISTORY

• Vertigo/dizziness/unsteadiness• Onset • Episodic or persistent• Aggravating and relieving factors• Other associated symptoms• Family history

Examination • Eye examination : Nystagmus – significant – occurs in primary position, aymmetric or more pronounced on one side, gaze evoked, positional, latenct present, rotational, fixation suppressionPursuits and saccades• Ear examination and hearing tests• Brain stem signs (staggering ataxic gait, diplopia, facial palsy,

weakness, sensory loss, numbness of face)• Postural instability and cerebellar signs• Special tests: head thrust test, caloric test, Dix-Hallpike test, supine

lateral head turns; head impulse, nystagmus, test of skew (HINTS)

Central Peripheral Vertigo Constant, less severe Intermittent, severe

Nystagmus +/-, uni or bidirectional +, unidirectional, fatigable

Ear symptoms +/- +

Brain stem signs + -

Eye signs Abnormal pursuit, saccades

Abnormal but spares other eye movements

EXAMINATION vestibular tests• Electrooculography or electronystagmography : corneoretinal

potential• Videooculography : record eye movements in 3 D• Vestibular evoked myogenic potentials : evaluate saccular and

utricular function• Video head impulse testing: eye velocity during head rotation• Posturography: evaluate vestibular visual and somatosensory

systems• Rotatory chair testing: SCC, bilateral vestibular hypofunction,

children

Treatment CLASS DRUG DOSE

Antihistamines Promethazine Meclizine

15-25mg PO/IM BD/TID25-50mg TID

Histamine analog Betahistine 48-96mg

BZD DiazepamLorazepam

2-5mg0.5-2mg PO/IV TID

Antiemetic Prochlorperazine Metoclopramide Dimenhydrinate

5-10mg PO/IM TID10-20mg50-100mg TDS

Calcium antagonists Cinnarizine 25-75mg TDS

Anticholinergic Scopolamine 0.6mg

• Presyncope : prodomal symptom of fainting or near faint

• Graying out/black out• Related to posture: postural hypotension• Not related to posture: cardiac arrhythmia

(cardiac disease, CAD, CHD)• Vasovagal attacks