1 / 33

VERTIGO

WHY MY WORLD IS SPINNING

amilah1
Download Presentation

VERTIGO

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Vertigo- hOW TO APPROACH DR NOR AMILAH MOHD RAMLI 18 AUGUST 2024

  2. Outlines • Objectives • Introduction • Physiology of Balance (Outline) • Definition (Vertigo Vs Giddiness) • Common causes ( Central vs Peripheral) • Management (Investigations and Treatment)

  3. Objectives • To understand various causes of vertigo or giddiness • Quality improvement towards patients care

  4. Introduction • 20-30% of population encountered giddiness at some point at least least once in entire life • The overall incidence reaches 40% in patients older than 40 years • Risk of fall is 25% in subjects older than 65 years.

  5. Balance:Input Vestibular system Vision Integrating/ data storage system Proprioception/ Superficial sensation

  6. Balance: Output Cortical awareness of head/body/motion Control of oculomotor activity Integrating/ data storage system Control of posture Control of motor skills

  7. Dizziness? Giddiness? • impairment in spatial perception and stability -Dorland Medical Dictionary (Sensation of imbalance usually occurring when standing or walking) *GeneralMedicalDisorder

  8. Vertigo? • “A hallucination of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as he himself were revolving in space (subjective vertigo).” -Dorland Medical Dictionary *Peripheral Vestibular Disorder

  9. VERTIGO TRUE VERTIGO NON ROTATORY VERTIGO CNSCVS DRUG INDUCED OTHERS (dizziness/blackouts) (dizziness/imbalance ) (non specific) Associated features: Arrhytmias antihypertensive Metabolic Visual changes Anaemia anticonvulsants Psychiatric Numbness/paresis Orthostatic hypotension sedatives/hypnotics Altered sensorium Altered speech dysphagia cerebellar signs OTOLOGICAL CAUSES Associated features: presence of other ear symptoms episodic nausea/vomiting aggravated with movement nystagmus

  10. OTOLOGICAL VERTIGO Vertigo: minutes-hours Vertigo: seconds Vertigo: days to weeks Vertigo: minutes-hours . Hearing loss . no auditory symptoms . no auditory symptoms . no auditory symptoms . Tinnitus . triggered by head position . commonly after URTI . usually spontaneous . ear pressure . crystals in the posterior .viral infection of vestibular . recurrent reafferentation . usually spontaneous semicircular canal nerve of vestibular nerve . endolymph hydrops . rotatory nystagmus . horizontal nystagmus .horizontal nystagmus . horizontal nystagmus MENIERE’S DISEASE BENIGN PAROXYSMAL VESTIBULAR NEURONITIS RECURRENT POSITIONAL VERTIGO (viral labyrinthitis) VESTIBULOPATHY NOTE : i) In cases of asymmetrical sensorineural hearing loss hearing loss consider Acoustic Neuroma ii) True vertigo typically presents as rotatory vertigo , occasionally as swaying of the environment iii) MRI is indicated for any CNS vertigo

  11. Examinations & Investigations

  12. 1)Gait test2) Oculomotor examination- Assess for an ophthalmoplegia and gaze-dependent nystagmus. - Nystagmus of peripheral (ie, labyrinthine) origin typically is unidirectional.- Nystagmus of brainstem or cerebellar (ie, central) origin may be bidirectional and have more than one direction, eg, torsional plus horizontal movement. - Pure vertical nystagmus almost always is a sign of brainstem disease and not a labyrinthine disorder.

  13. 3) Rhomberg test • Patient asked to stand with feet together and eyes closed • Fall or step is positive test • Equal sway with eyes open and closed suggests proprioceptive or cerebellar site • More sway with eyes closed suggests vestibular weakness

  14. 4) Fukuda Stepping Test( Stepping test of Urtunberger) • Originally described by Fukuda using 100 steps on a marked floor. • Patients are asked to step with eyes closed and hands out in front • Rotation by more than 45 degrees is abnormal • Rotation usually occurs to the side of the lesion • Rotation often found in asymptomatic patients

  15. 5)Dix Hallpike • Used to provoke nystagmus and vertigo commonly associated with BPPV • This test involves having the patient lie back suddenly with the head turned to one side. • Head turned 45 degrees to maximally stimulate posterior semicircular canal • Head supported and rapidly placed into head hanging position • The test results are considered abnormal if the patient reports vertigo and exhibits a characteristic torsional (ie, rotary) nystagmus that starts a few seconds after the patient lies back (latency), lasts 40-60 seconds, reverses when the patient sits up, and fatigues with repetition

  16. 6) Head Shake Test • Evaluates unilateral vestibular weakness • Head tilted back 30 degrees • Shake back and forth for 30 seconds as quickly as possible • Unilateral vestibular deficit causes slow phase nystagmus to the side of lesion • 7) Head Thrust Test • Head tilted 30 degrees • Rapid head movements to either side with focus on examiner’s nose • Patients have catch-up saccade when rotated to side of weakness • Sensitivity 75%, Specificity of 85%

  17. 8) Fistula Test • The test involves the application of pressure to the patient's ear canal and observation of eye movements with Frenzel lenses in place • The fistula test is designed to elicit symptoms and signs of an abnormal connection (fistula) between the labyrinth and surrounding spaces. • Fistulas may be acquired, most commonly as a result of cholesteatoma or, less commonly, as a dehiscence of bone overlying the superior semicircular canal. • Iatrogenic causes include chronic ear surgery and stapes surgery.

  18. Cerebellar test: • Speech pattern- ataxic dysarthria • Nystagmus • Finger nose test • Dysdiadokokinesia • Heel shin test Orthostatic hypotension • Most often in patients on BP meds with “light headedness” on sitting to standing • Defined as drop of SBP 20mm Hg or DPB 10mm Hg within 3 minutes of standing

  19. Audiogram Meniere’s Disease

  20. Others: • Vision test • Blood works- FBC/ TFT/ Blood sugar level/ Electrolytes/ Etc

  21. Laboratory examination of the vestibular system 1)Electronystagmography ( ENG) / Videonystagmography( VNG) 2) Rotational chair testing 3) Posturography 5) Vestibular evoked myogenic potential(VEMP)

  22. Role of CT Scan (Brain)/ MRI • Limited Role • Useful in highly suspicious cases of intracranial pathology (eg stroke) • incidence of acute intracranial lesions is extremely low in patients with dizziness with a NORMAL neurological examination and no other significant neurological symptoms • Not cost effective to do in ALL cases of giddiness/vertigo

  23. Treatment • Symptomatic treatments, may alleviate patient’s symptoms but for temporary measures • Must be targeted towards the correct diagnosis or aetiologies as discussed earlier • Consider revise the diagnosis, if treatment is not successful • Some patient may have more than 1 diagnoses

  24. Take Home Messages • Carefully try to understand the words giddiness / vertigo used by patients • History will give diagnosis of majority of disorders • Try to differentiate central vs peripheral causes • Central cause--> abrupt, severe • Peripheral cause--> ~insidious, benign • Correct diagnosis, correct treatment

More Related