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“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
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
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
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