Download Vertigo

Vertigo
Dr. Abdulrahman Alsanosi
Associate professor
Otolaryngology consultant
Otologist , Neurotologist &Skull Base Surgeon
Head of Otology / Neurotology Unit
Director of cochlear implant program
King Abdulaziz University Hospital
From:
Antonieta Adiova <[email protected]>
Subject:
monday - at 1-2pm
Date:
February 14, 2012 2:49:51 PM GMT+03:00
To:
Abdulrahman Alsanosi <[email protected]>, [email protected]
Cc:
Babylyn Erolin Palmero <[email protected]>, [email protected], Dr. Saleh
Aldhahri [email protected]
dear dr. sanosi,
just to informed you pls that your lecture will be at 1 pm until 2 pm ...this coming monday
pls....for they have Ophtha activities.
thank you and Lyn will be with u coz im leaving tomorrow..
best regards
and NOT in the morning
INTRODUCTION
• Dizziness is a common symptom that accounted for
more than 5.6 million clinic visits in the United States
• 15% to 30% of patients, most often women and the
elderly, will experience dizziness severe enough to seek
medical attention at some time in their live
What are the components of
balance system ?
 Inner ear (3 semicicular canals and
otolith organ )
 Cerebellum
 Vision (VOR)
 Proprioceptive
How does balance
system work ?
Physiology
Function of vestibular system:

Transform of the forces associate with head
acceleration and gravity into a biological signals that
the brain can use to develop subjective awareness of
head position in space (orientation)

produce motor reflexes that will maintain posture and
ocular stability
It is not surprisingly that vestibular
lesion cause:
 Imbalance
 posture and gait imbalance
 visual distortion (oscillopsia ).
What is vertigo?
VERTIGO
 The word "vertigo" comes from the
Latin "vertere", to turn + the suffix
"-igo", a condition = a condition of
turning about).
 It is an allusion of being moving or
the world is moving too.
What are the questions to ask in
history ?
 Onset
 Frequency
 Duration
 Associated auditory symptoms
 Aggrevating and relieving factors
 Ear disease or ear surgery
 Trauma
 Migraine
 Ototoxic drug intake
Differential diagnosis
A) peripheral vestibular loss
B) central vestibular loss
What are the causes of
peripheral vestibular loss ?
peripheral vestibular loss
 Vestibular neuritis
 Benign paroxysmal positional vertigo ( BPPV)
 Meneires disease (Endolymphatic hydrop )
Vestibular neuritis
 Viral infection of vestibular organ
 Affect all ages but rare in childern
 Affected patient presents acutely with
nystagmous ,vertigo and nausea &vomiting
spontaneous
 Patient requires only symptomatic treatment
 It takes 3 weeks to recover from vestibular neuritis
Vestibualr neuritis
 BPPV( benign paroxysmal
positional vertigo )
BPPV
 The most common cause of vertigo in
patient > 40 years
 Repeated attacks of vertigo usually of
short duration less than a minute .
 Provoked by certain positions (rolling
in beds, looking up ,and head rotations)
 Not associated
impairment
with
any
hearing
BPPV
Diagnosis
 History
 Dix-Halpike maneuver
Endolymphatic hydrop
(Meneire’s disease)
Pathophysiology :
 Unknown etiology
 ↑ ↓production of fluid within
inner compartment
 vertigo (minutes to hours )
 Low frequency fluctuating SNHL
 Tinnitus and fullness in the ear.
 In 10 - 20% of cases the disease
later involves the opposite ear
Meneire’s disease
 Diagnosis
-History
-PTA
Meneire’s disease
 Management
-low-salt diet
-Medical therapy
- Meniett device's
-Chemical perfusion
-Surgery
SUMMARY
Diagnosis
Duration of
attack
hearing
Course of
diseases
Treatment
Vestibular N
Days
normal
Self limited
Symptomatic
BPPV
Seconds
normal
Recurrent
Exercise
Meneire’s
diseaseM
Minutes to hours
Affected
Recurrent
Medical
&surgical
40
34
30
20
10
0
17
12
1
1 5
16
MEN
14
5
10
WOMEN
8
1
< 20 21-30
31-40 41-50
51-60 61-70
0
0
MEN
>70
What are the causes of
central ?
 CVA (Cerebero vascular accident)
 Brain tumor ( acoustic neuroma )
 Multiple sclerosis
CVA
 Elderly patient with chronic
disease like (DM ,HTN) with
sudden
attack
of
vertigo
+neurological symptoms
Acoustic tumor
 Benign tumor
 Arise from vestibular devision of
VIII
Clinical presenatation:
 Unilateral tinnitus
 Hearing loss
 Dizziness
Acoustic neuroma
Diagnosis :
 History
 PTA
( Unilateral SNHL )
 Radiology
diagnosis
History is the most important
key to diagnosis for a
dizzy patient .
Investiagtions
 PTA
 Vestibular testing
 CT SCAN
 MRI
A dizzy patient may fit into one
of the following scenarios
Scenario # 1
The patient who is having a first
ever attack of acute spontaneous
vertigo.
 Acute vestibular neuritis
 cerebellar infarction.
How to differentiate ?
-
Clinically
(
General
appearance
/nystagmus/head impulse test)
- Radiology
of
patient
Scenario #2
The patient who has repeated attacks of
vertigo, but is seen while well
A- Recurrent spontaneous vertigo
 Menière’s disease
 Migraine induced vertigo
 perilymph fistula
B- Recurrent Positioning Vertigo
 BPPV
Scenario #3
The patient who is off
balance
 Bilateral vestibulopathy
 posterior fossa tumour
Take away message
Thank you