1. Vertigo Dr. Victor James Abdullah

2. Proprioceptors

3. Vestibular Organ

4. Vestibular Hair Cells

5. Semicircular Canals

7. AICA

9. Causes of Vertigo • Trauma • Infection • Vascular • Metabolic • Dysequilibrium of ageing • Psychogenic/Hyperventilation • Tumour • Meniere’s • BPPV

10. Trauma

11. Proprioceptors

12. Traumatic

14. Trauma • Iatrogenic • Head Injury • -Temporal bone # • Whiplash • Perilymph Fistula

15. Infection

16. Proprioceptors

17. Infection • Viral • -Vestibular neuritis • -Viral labyrinthitis • -Herpes Zoster Oticus • Bacterial • -CSOM • -Syphilis

18. Vascular

19. Proprioceptors

21. Vascular • CVA • Migraine • -Vertebrobasilar Migraine • VBI • Vasculitis • Subclavian Steal Syndrome

22. Subclavian Steal Syndrome

23. Wallenburg Syndrome

25. Drugs

26. Drugs • Aminoglycosides • Alcohol • Mercury poisoning • Loop diuretics

28. Metabolic

29. Proprioceptors

30. Metabolic • Anaemia B12 • DM • Hypothyroidism • Hypercholestrolaemia

31. Dysequilibrium of Ageing

32. Dysequilibrium of Ageing • No de novo Meniere’s if >65yrs • multi-sensory deficits • vestibular sedatives not useful • vestibular rehabilitation program • a walking stick

33. PsychogenicHyperventilation

34. Tumours

35. Tumours • Vestibular Schwannoma

37. Meniere’s DiseaseBPPV

38. Meniere’s SyndromeMeniere’s Disease

39. Prosper Meniere

40. Meniere’s disease Pathogenesis: over-accumulation of fluid within the inner ear Meniere’s disease Normal

41. BPPV

42. Pathophysiology

43. Diagnosis confirmed by Dix Hallpike maneuver

45. Benign Paroxysmal Positional Vertigo(BPPV) • Drugs: USELESS • Treatment of choice: Epley maneuver

46. 30 Seconds each step

48. History • Nature • Duration • Associated symptoms • Trauma Drugs Medical History

49. Examination • Gait • ENT Nystagmus+Corneal reflex • Past Pointing • Heel Toe • Romberg’s • Unterberger • Hallpike’s if relevant + Epley’s

50. Peripheral Nystagmus • Unidirectional • Fatiguable • Abolished by optic fixation • Compensated for in time