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7/27/2019 Vertigo in Neurological Disorder - F Sitorus
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VERTIGO IN NEUROLOGICAL DISORDERS
FREDDY SITORUS
Neuro-otology & Neuro-ophtalmology Subdivision
Department of Neurology FMUI/ RSCM
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DEFINITION OF VERTIGO
An illusion where someone feels his body is moving to the
environment or the environment is moving to him
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BALANCE
VESTIBULAR
SYSTEM
VISUAL
SYSTEM
PROPRIOSEPTIVE
SYSTEM
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Balance Function and DysfunctionInteraction of Vestibular, Visual and Proprioceptive systems
Balance
dyfunction
dizziness
Central Nervous system
Muscle and joint
sensory receptors
Postural
control viamuscles
Goebel JA. Otolaryngol Clin North Am 2000;33:48393.
Shepard NT, Solomon D. Otolaryngol Clin North Am 2000;33:45569
Controls
eyemovement
s
Eye Skin pressure
receptorsInner ear
(vestibular
system)
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PHYSIOANATOMY OF THE BALANCE SYSTEM
PERCEPTION CEREBRAL CORTEX
INTEGRATION BRAIN STEM
NERVES (Cranial nerve VIII, CN II
Spinovestibulospinal nerves)
RECESSION RECEPTOR
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Types of DIZZINESS
Type Sensation System
Vertigo
Vestibular Vertigo Spinning Vestibular
- Central
- Peripheral
Nonvestibular Vertigo Light headed Visual
Proprioceptive
Presyncope Fainting Cardiovascular
Dysequilibrium - Falling Cerebellar
- Unstable Spinal
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Vestibulocerebellar and vestibulospinal pathways and
connections between vestibular and ocular motor nuclei
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VERTIGO
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Internal Ear
1. bony labyrinth
a. 3 semicircular canals
(1) frontal
(2) horizontal
(3) sagittal
b. vestibule
c. cochlea
________________
perilymph
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CLINICAL DIFFERENCES BETWEEN VESTIBULAR AND
NON VESTIBULAR VERTIGO
SYMPTOMS VESTIBULAR
VERTIGO
NON VESTIBULAR
VERTIGO
Character Spinning sensation Dizziness,
unsteadiness
Attacks Episodic ContinuousNausea/ vomits (+)
Hearing impairment (+)/(-)
Provoking
movement
Head movement
Provoking situation (-) Crowded, traffic jam
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CLINICAL DIFFERENCES BETWEEN CENTRAL AND
PERIPHERAL VESTIBULAR VERTIGO
SYMPTOMS PERIPHERAL CENTRAL
Onset Insidious Slower
Degree Severe Mild
Influence of headmovement (++) (+/-)
Autonomic focal
signs (nausea,
vomits, sweating)
(++) (-)
Cerebral focal signs (-) (+)
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LOCALIZATION OF NEUROLOGICAL DISORDERS :
1. CN. VIII (VESTIBULAR NERVE)..............PERIPHERAL
2. VESTIBULAR NUCLEUSBRAIN STEM
3. CEREBELLUM
4. BRAIN
CENTRAL
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CAUSES OF VERTIGO IN NEUROLOGY
1. CN. VIII (Vestibular nerve)
ie.: infection, tumor, trauma
2. Vestibular nucleusbrain stem
ie.: TIA/vertebrobasilar stroke, tumor, infection, trauma,
multiple sclerosis, basilar migraine
3. Brain
ie.: epilepsy, stroke
4. Cerebellum
ie.: stroke, tumor
5. Non vestibular vertigo: refractive disorder, neuropathy, myelopathy
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CONCLUSION :
Vertigodetermine the type, location, & etiology
Vertigo needs careful history taking & physical examination
Therapy: causative, symptomatic, vestibular exercise
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OPTIC NERVE DISORDER IN
INTRACEREBRAL DISEASE
FREDDY SITORUS
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The Visual Process
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CONVERGENCE
When areas of the occipital cortex detect adiscrepancy in the retinal projection from each eyeand amount of blur, a signal is sent to initiateconvergence.
To bring a near object into focus actually involvesconvergence, accomodation (lens curvature
increases) and pupillary constriction. Together, these3 movements are called the near triad.
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CONVERGENCY &
ACCOMMODATION
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Accomodation 1. biconvex lens
2. point of intersection 3. near object = more convex
4. far object = less convex
5. role of ciliary muscle
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PUPILLARY REFLEX
PATHWAY
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Examination :
1.Visual acuity
2.Color3.Visual field
4.Occular movement occulomotor muscles
5.Funduscopy
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VISUAL ACUITY: SNELLEN CHART COLOR VISION: ISHIHARA
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VISUAL FIELD: CONFRONTATION TEST
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VISUAL FIELD: CAMPIMETRY
VISUAL FIELD: PERIMETRY
(TANGENT BJERRUM)
VISUAL FIELD: AMSLER GRID
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VISUAL FIELD DEFECT
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OCCULOMOTOR
TESTING
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FUNDUSCOPY
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FUNDUSCOPY
Hypertensive fundus
Hypertensive retinopathy
Diabetic retinopathyprimary
Papil atrophy
secondary
etc
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HYPERTENSIVE FUNDUS HYPERTENSIVE RETINOPATHY
PAPIL ATROPHYDIABETIC RETINOPATHY
(PROLIFERATIVE)
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Etiology
Acute : Acute infection, trauma, vascular
Chronic : - Chronic infection
primary
- Malignancy
secondary
- Degenerative
- Autoimmune
- Congenital
Therapy : - Depends on etiology
emergency
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THANK YOU
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