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term
Different meanings to different people
Could
-
mean
Vertigo
Weak
Anemia
- Syncope
- Giddiness
- Depression
- Presyncope
- Anxiety
- Unsteady
of movement
Peripheral or Central
Syncope
Transient
impending loss of
consciousness
Psychiatric
Dizziness
dizziness
not related to vestibular dysfunction
Disequilibrium
Feeling
of unsteadiness, imbalance or
sensation of floating while walking
Vestibular Labyrinth
Pathophysiology
Complex
semicircular canals
rotational
movement
cupula
otolithic organs
utricle
& saccule
linear acceleration
Macula
Vertigo
activity
Abnormal
Direction
Physiologic
motion
Vertigo
sickness
A mismatch between visual, proprioceptive and
vestibular inputs
Not a diseased cochleovestibular system or CNS
Vertigo-Differential Diagnoses
Etiologies
of Vertigo
BPPV
Labyrintitis
Acute suppurative
Serous
Toxic
Chronic
Vestibular neuronitis
Vestibular ganglionitis
Mnires
Acoustic neuroma
Perilymphatic fistula
Cerumen impaction
Vertigo-History
Is
it true vertigo?
Autonomic
symptoms?
Pattern of onset and
duration
Auditory
disturbances?
Neurologic
disturbances?
Was there syncope?
Unusual
eye
movements?
Any past head or
neck trauma?
Past medical history?
Previous symptoms?
Prescribed and OTC
medications?
Drug and alcohol
intake?
Vertigo-Physical Exam
Cerumen/FB in EAC
Auscultate for carotid bruits
Otitis media
Orthostatic vital signs
Pneumatic otoscopy
Tympanosclerosis or TM BP and pulse in both arms
perforation
Dix-Hallpike maneuver
Nystagmus
Gross hearing
Fundoscopic exam
Weber-Rinne test
Pupillary abnormalities
External auditory canal vesicles
Extraocular muscles
Muscle strength
Cranial nerves
Gait and Cerebellar function
Internuclear ophthalmoplegia
Dix-Hallpike Maneuver
Vertigo-Characteristics
Peripheral
Onset
Sudden
Severity of Vertigo
Intense
Pattern
Paroxysmal
Exac. by movement Yes
Autonomic
Frequent
Laterality
Unilateral
Nystagmus
Horizontorotary
Fatigable/Fixation
Yes
Auditory symptoms Yes
TM
May be abnormal
CNS symptoms
Absent
Central
Usually slow
Usually mild
Constant
Variable
Variable
Uni or bilat
Any
No
No
Normal
Present
Vertigo-Ancillary Tests
CT-if
Peripheral Vertigo-Differential
Labyrinthine
Disorders
Most
Extremely
common
Otoconia displacement
No hearing loss or tinnitus
Short-lived episodes brought on by rapid
changes in head position
Usually a single position that elicits vertigo
Horizontorotary nystagmus with crescendodecrescendo pattern after slight latency period
Less pronounced with repeated stimuli
Typically can be reproduced at bedside with
positioning maneuvers
Otoconia in BPPV
Labyrinthitis
Associated
suppurative
Toxic
Chronic
Labyrinthitis
Serous
Adjacent
infection
Mild to severe vertigo with nausea and vomiting
May have some degree of permanent impairment
Acute
suppurative labyrinthitis
Acute
Labyrinthitis
Toxic
Due
Labyrinthitis
Chronic
Localized
Most
Etiology
is due to destruction by a
cholesteatoma
Vestibular Neuronitis
Suspected
viral etiology
Sudden
Mild
May
Highest
Vestibular Ganglionitis
Usually
Affects
May
Ramsay
Hunt Syndrome
-Deafness
-Facial Nerve Palsy
-Vertigo
-EAC Vesicles
Mnire Disease
First
described in 1861
Triad of vertigo, tinnitus and hearing loss
Due to cochlea-hydrops
Unknown
etiology
Possibly autoimmune
Abrupt,
Mnire Disease
Often
Acoustic Neuroma
Peripheral
Central Vertigo-Differential
Central
Vertigo
Vertebrobasilar
Insufficiency
Atheromatous
plaque
Subclavian Steal Syndrome
Drop Attack
Wallenberg Syndrome
Cerebellar
Hemorrhage
Multiple Sclerosis
Head Trauma
Neck
Injury
Temporal lobe seizure
Vertebral basilar
migraine
Metabolic
abnormalities
Hypoglycemia
Hypothyroidism
Vertebrobasilar Insufficiency
Important
Related
to decreased perfusion of
vestibular nuclei in brain stem
Vertigo
Unusual
Vertebrobasilar Insufficiency
Most
-Dysarthria
-Hemiparesis
Tinnitus
-Ataxia
-Diplopia
-Facial numbness
-Headache
Vertical
nystagmus is characteristic of a
(superior colliculus) brain stem lesion
Up
Drop attack
Abruptly
Believed
to be caused by transient
quadraparesis due to ischemia at the
pyramidal decussation
but treatable
Arm
Blood
Classic
Wallenberg Syndrome
Occlusion
of PICA
Relatively
Associated
Symptoms:
-nausea
-vomiting
-nystagmus
-ataxia
-Horner syndrome
-palate, pharynx and laryngeal paresis
-loss of pain and temperature on ipsilateral
face and contralateral body
Cerebellar Hemorrhage
Neurosurgical
emergency
Suspected
May
Motor-sensory
Gait
Multiple Sclerosis
Vertigo
Metabolic Abnormalities
Hypoglycemia
Suspected
Hypothyroidism
Clinical
Management
Based
Management
Severe
-Diphenhydramine
-Droperidol
Epley Maneuver
Epley Maneuver
University
of Baltimore
107
patients
Diagnosed with BPPV
Right ear affected 54%
Posterior semicircular canal in 105 patients
Treated with 1.23 treatments
Successful in 93.4%
Laryngoscope. 1999 Jun;109(6):900-3
Summary
Ensure
Not
Questions
c.
f.