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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