Transcript Dizziness, Disequilibrium and Vertigo

Dizziness, Disequilibrium and Vertigo
 There
are three symptoms that are often refered to
as dizziness by patients: dizziness, disequilibrium
and vertigo.
Dizziness
 Is
a nonspecific term that describes a sensation of
alterred spatial orietaiton
 Any sensation of discomfort of head.
 Head lightness or wooziness
Cause of Dizziness
 Circulation
 Metabolic
 Endocrine
 Degeneration
 Psychologic
Vertigo
 Defined
as any abnormal sensation of motion
between patient and surrounding.
 Feeling of linear motion of falling.
 Classification
 : peripheral or central type.
Disequilibrium
 Unsteadiness
or imbalance
 Patient may feel normal when they are stationary,
but notice difficulty when they walk.
 Often ,they have no symptoms of dizziness.
 Disequilibrium suggests a central lesion, but it may
be peripheral. Patients with bilateral peripheral
vestibular loss may note unsteady gait.
Vestibular system
 Play
a dual role, response to gravity and linear
acceleration through the utricle and saccule
 And to angular acceleration through the
semicircular canals.
 If insufficient or conflicting information between
the left and right ears is delivered to the CNS,
vertigo results.
Periphera Vertigo
 Typical
features of peripheral vertigo includea
short or episodic time course, a precipitating factor
and the presence of automomic symptoms,
including sweating, pallor, nausea or vomiting.
 There may be associated with tinnitus, hearing loss,
or facial nerve weakness.
Central vertigo
 In
patients with central vertigo, the autonomic
symtoms are less severe and associated hearing
loss is unusnal.
 Associated with neurological symtoms are
different and may include: diplopia, hemianopsia,
weakness, numbness, dysarthria, ataxia and loss of
consciousness. Oscillopsia may be severe.
Diagnosis
 The
history and neurological examination are
essential .
 Point to the history include weather the symptom
is that of dizziness, vertigo and disequilibrium
 Weather the symptoms have an inciting factor,
duration, frequency, past history, and severity.
Diagnosis
 Complete
neurological examination is necessary.
 CAE
 ENG
 MRI
of brain.
 MRI should be perform on all patientsof a central
process and who had symtoms for 2 weeks or mor
 CD and TCD for possible stroke
Treatment
 According
to the cause.
 For case of peripheral vertigo, vestibular
supressant may be used to relieved symptoms but
should be discontinue use as soon as possilbe ,as
long term use ma delay compensation.
Treatment
 Anticholinergic
drug : scopolamine or
glycopyrrolate
 Antihistamine: meclizine
 Benzodiazepine
Common casue of peripheral vertigo
 BPPV
 Bacterial
or viral infection
 Vestibular neuritis
 Meniere disease
 Tumor
 Trauma
 Drug: alcohol, aminoglycoside
Common cause of central vertigo
 Menigitis
 Vascular
disease: VBI, brainstem or cerebellar
hemorrhage or infarct.
 Migraine
 Tumors
 Trauma
 Multiple sclerosis
BPPV
 Recurrent
vertigo, with change head position
 No hearing loss
 No tinnitus
 Self limited within a few months
Vestibular Neuritis
 Vertigo
associated with suddenly onset, severely
with N/V and nystagmus
 Often previously viral infection
Meniere Disease
 Vertigo,
hearing loss ,tinnitus and aural fullness
 Endolymphatic hydrop
CP angle tumor
 Asymmetrical
sensorineural hearing loss, unilateral
tinnitus or vertigo.
Drug toxicity
 Many
drug, esp. alcohol may cause dizziness
 Cessation of use a drug, usually casues clearing of
the symptoms in a few days.
Cardiac arrythmia
 Low
cardiac output—
  low brain perfusion  dizziness
Prebycusis and presbyastasis
 Age
related hearing loss
esp. high tone
 Age related loss of balance
pyschophysiologic
 Acute
anxiety
 Acute panic
 Hyperventilation