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Vertigo

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  1. Vertigo Dr. Abdulrahman AlsanosiAssociate professor King Saud University Otolaryngology consultant Otologist , Neurotologist &Skull Base Surgeon King Abdulaziz University Hospital / KFMC

  2. What are the components of balance system ?

  3. Inner ear (3 semicicular canals and otolith organ ) • Cerebellum • Vision (VOR) • Proprioceptive

  4. How does balance system work ?

  5. 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

  6. It is not surprisingly that vestibular lesion cause: • Imbalance • posture and gait imbalance • visual distortion (oscillopsia ).

  7. oscillopsia

  8. What is vertigo?

  9. 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.

  10. What is nystagmus ?

  11. 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

  12. Differential diagnosisA) peripheral vestibular loss B) central vestibular loss

  13. What are the causes of peripheral vestibular loss ?

  14. peripheral vestibular loss • Vestibular neuritis • Benign paroxysmal positional vertigo ( BPPV) • Meneires disease (Endolymphatic hydrop )

  15. Vestibular neuritis • Viral infection of vestibular organ • Affect all ages but rare in childern • Affected patient presents acutely with spontaneous nystagmous ,vertigo and nausea &vomiting • Patient requires only symptomatic treatment • It takes 3 weeks to recover from vestibular neuritis

  16. Vestibualr neuritis

  17. BPPV( benign paroxysmal positional vertigo )

  18. 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 with any hearing impairment

  19. BPPV Diagnosis • History • Dix-Halpike maneuver

  20. Treatment Epley maneuver

  21. Video

  22. Endolymphatic hydrop (Meneire’s disease) Pathophysiology : • Unknown etiology • ↑ ↓production of fluid within inner compartment

  23. 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

  24. Meneire’s disease • Diagnosis -History -PTA

  25. Meneire’s disease • Management -low-salt diet -Medical therapy - Meniett device's -Chemical perfusion -Surgery

  26. SUMMARY

  27. What are the causes of central ?

  28. CVA (Cerebero vascular accident) • Brain tumor ( acoustic neuroma ) • Multiple sclerosis

  29. CVA • Elderly patient with chronic disease like (DM ,HTN) with sudden attack of vertigo +neurological symptoms

  30. Acoustic tumor • Benign tumor • Arise from vestibular devision of VIII Clinical presenatation: • Unilateral tinnitus • Hearing loss • Dizziness

  31. Acoustic neuroma Diagnosis : • History • PTA ( Unilateral SNHL ) • Radiology

  32. diagnosis History is the most important key to diagnosis for a dizzy patient .

  33. Investiagtions • PTA • CLORIC TEST • ENG • CT SCAN • MRI

  34. Take away message

  35. Thank you