Approach to dizzyness (vertigo)

DR BANDAR AL-QAHTANI, MD

KSMC,RIYADH

“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

Balance

Vestibular system Visual system Proprioceptive system – spinothalamic

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

Central vestibular disorders :

most common :migrain

common :TIA,CVAs,vasculitis,MS,AN

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

Seconds BPV

minutes VBI,MIGRAIN

hours Menieres dis

days Vestibular neuritis,labirynth infarct

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

ANY QUESTIONS