Dix-Hallpike Maneuver

1. Dix-Hallpike Maneuver

3. Steps 1.History Taking 2.Clear definition (Vertiginous or Nonvertiginous dizziness) 3.Peripheral or Central Vertigo 4.Psychogenic Vertigo

4. Differential diagnosis 1.Dizziness 2.Presyncope 3.Disequilibrium:Unsteady gait 4.Light-headedness dizziness the term most commonly used by outpatients to describe vertigo; Presyncope usually assoicated with CVD, described as a feeling of impending faint or loss of consciousness but no true syncope (Bp-orthostatic, HR, EKG); Disequilibrium: usually seen in elderly patients, hallmark of this disorder is an unsteady gait (pt with cataracts, neuromuscular CVA, Parkinson�s dx). Light-headedness associated with underlying psychiatric disorders, hyperventilation syndrome. dizziness the term most commonly used by outpatients to describe vertigo; Presyncope usually assoicated with CVD, described as a feeling of impending faint or loss of consciousness but no true syncope (Bp-orthostatic, HR, EKG); Disequilibrium: usually seen in elderly patients, hallmark of this disorder is an unsteady gait (pt with cataracts, neuromuscular CVA, Parkinson�s dx). Light-headedness associated with underlying psychiatric disorders, hyperventilation syndrome.

5. Symptoms Unconscious Pallor Sweating Nausea/Vomiting Auditory Symptoms :Hearing loss, Tinnitus, aural (ear) fullness Diplacusis Paracusis Neurologic Symptoms: numbness, weakness, difficulty with swallowing or speech

6. Definition a subjective sensation of movement May feel either that him involving in space or that objects in the environment are moving around him.

7. History Taking Description of the sensation (including associated symptoms) Onset (acute, gradual) Duration (date sensation was first noted, length of time it lasts) Intensity (how troubling is it?) Exacerbations (activities, positions, circumstances that worsen situation)

8. Remissions (activities, positions circumstances that make sensation better) Medications (prescription, herbal, over the counter) Other medical problems (diabetes, hypertension, heart disease, etc) Psychosocial (any stressors?)

9. Physical Examinations Mental conditions Vital Signs: Bp,HR Otoscopy Ascultation of the neck for bruits Rinne Test Weber�s Test

10. Rinne Test

11. Neurologic exams Nystagmus Romberg�s Gait Dix-Hallpike Maneuver

12. Peripheral Vertigo vs Central Vertigo

13. Comparison of Common Diseases

14. Peripheral Vertigo Benign paroxysmal positional vertigo: most common in adults Acute Labyrinthitis Chronic Labyrinthitis (Meniere�s Syndrome) Toxic Labyrinthitis Vestibular Neuronitis Acoustic Nerve Lesions Labyrinthine Ischemia Sudden onset, self-limit, N/V, may caused by otitis media, otoscopy may discover perforation of the suppurative ear dx aggravated by changing positions, horizontal nystagmus, normal neurologic exams; Meniere�s disease associated with tinnitus, hearing loss,n/v; drugs such as Gentamycin, aspirin, ethacrynic acid.Sudden onset, self-limit, N/V, may caused by otitis media, otoscopy may discover perforation of the suppurative ear dx aggravated by changing positions, horizontal nystagmus, normal neurologic exams; Meniere�s disease associated with tinnitus, hearing loss,n/v; drugs such as Gentamycin, aspirin, ethacrynic acid.

16. Central vertigo Brainstem Lesions Intravascular: Vertebrobasilar insufficiency Tumors Intracranial infection Demyelinating diseases: Multiple Sclerosis, Syringobulbia(?????)

17. Conclusions 1.History Taking 2.Physical Examinations 3.Psychogenic Vertigo must be consider 4.Labs for necessary

19. Weber�s Test