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Vertigo

Vertigo. Vertigo / Dizziness. Sir Terence Cawthorne said: “ Labyrinthine disturbance may make one feel like the end of the world has arrived….” Doctor said: “ dealing with dizzy patient make me dizzy”. Definitions. Dizziness (vertigo):

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Vertigo

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  1. Vertigo

  2. Vertigo / Dizziness • Sir Terence Cawthorne said: “ Labyrinthine disturbance may make one feel like the end of the world has arrived….” • Doctor said: “ dealing with dizzy patient make me dizzy”

  3. Definitions • Dizziness (vertigo): spinning or hallucination of movement. • Imbalance : unsteadiness. • Light headedness : orthostatic hypotension ,syncope.

  4. Ear anatomy

  5. BalanceAnatomy & Physiology • Vestibular sense organ: consists of : *three semicircular canals ( posterior ,horizontal, anterior). to detect: angular acceleration. *Utricle & saccule :( have otoconia embedded in a gel overlying the cilia, to detect linear acceleration.

  6. BalanceAnatomy & Physiology • Inner ear ( cochlea & vestibule & vestibular nerve). • Vestibular nuclei (brain stem). • The two other inputs are: *Vision. *Proprioception (skin, joints ,muscle receptors ,mainly neck & ankles). **The brain stem computerise these 3 inputs with the help of cerebellum to maintain balance (head & balance).

  7. BalanceAnatomy & Physiology

  8. Causes of Dizziness • Otogenic (inner ear) : 50% (of dizziness causes). • Central (neurological) :( 5%) • Medical : (5%) • Psychological :( 15%) • Unknown : (25%).

  9. Otogenic(50% of all dizziness) • BPPV :(50% of otogenic ) (begnin paroxysmal position vertigo) . • Meniere:( 18% of otogenic). • Vestibular neurinitis & Labyrinthitis:(14%). • Acoustic neuroma :( 10%). • Perilymph fistula : (rare). • Bilateral vestibular loss :(rare).

  10. Central or Neurological(5% of all dizziness) • Migraine , stroke :( 50% of neurological). • MS :( %5). • Cerebrum degeneration / chiari:(5%). • Head injury. • Meningitis. • Brain abscess.

  11. Medical (5% of all dizziness) • Hypo/ hypertension. • Cardiac arrhythmia. • Drugs.

  12. Psychological(15% of all dizziness) • Anxiety. • Panic. • Phobia. • Malingering.

  13. Unknown(25% of all dizziness) • Multi sensory disequilibrium (elderly). • Post trauma. • Psychogenic.

  14. How to diagnose? • Confirm vertigo (spinning). • Duration of vertigo: • For seconds < minute (BPPV) • For hrs < 24hr (Meniere ,migraine ..). • For days ( Labyrithitis , vestibular neurinitis,tumours). • Otological signs (tinnitus, hearing loss, ear discharge, surgery,..) • General health ,medication .

  15. Examination • Otological exam ( mandatory). • Neurological exam (mandatory- cranial nerves) • Nystagmus. • Vestibulo-ocular refluxes : *Hallpike (posterior canal) *Caloric test (horizontal canal) *Nystagmus *ENG test • Vestibulo-spinal refluxes: *Romberg *Unterburger *Gait

  16. Investigations • Audiogram ,tempanometry, acoustic refluxes. • Caloric test ,ENG (electronystagmography). • MRI (acoustic neuroma). • Blood tests (? medical ).

  17. Treatment • Medical treatment : *to the causes. *vestibular sedatives (prochlorperazine, stemitil..) *vestibular vasodilatations (histamine analogues, betahistine.cinnerezin.).

  18. Treatment • Surgery: *endolymphatic sac shunting (damagehearing). *vestibular neurectomy (save hearing). *Labyrinthectomy ( damage hearing): -surgical. -chemical / injection of gentamycin.

  19. Treatment • Vestibular rehabilitation: *walking stick. *spectacles. *Eply manoeuvre (BPPV). *cocksacy cawthorne exercises.

  20. Eply & Brandt-Daroff Manoeuvres

  21. Re-positioning otolith forBPPV (Eply & Brandt-dorff manoeuvre)

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