Dizziness, Disequilibrium and Vertigo. There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo. Dizziness. Is a nonspecific term that describes a sensation of alterred spatial orietaiton Any sensation of discomfort of head.
Dizziness, Disequilibrium and Vertigo • There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.
Dizziness • Is a nonspecific term that describes a sensation of alterred spatial orietaiton • Any sensation of discomfort of head. • Head lightness or wooziness
Cause of Dizziness • Circulation • Metabolic • Endocrine • Degeneration • Psychologic
Vertigo • Defined as any abnormal sensation of motion between patient and surrounding. • Feeling of linear motion of falling. • Classification • : peripheral or central type.
Disequilibrium • Unsteadiness or imbalance • Patient may feel normal when they are stationary, but notice difficulty when they walk. • Often ,they have no symptoms of dizziness. • Disequilibrium suggests a central lesion, but it may be peripheral. Patients with bilateral peripheral vestibular loss may note unsteady gait.
Vestibular system • Play a dual role, response to gravity and linear acceleration through the utricle and saccule • And to angular acceleration through the semicircular canals. • If insufficient or conflicting information between the left and right ears is delivered to the CNS, vertigo results.
Periphera Vertigo • Typical features of peripheral vertigo includea short or episodic time course, a precipitating factor and the presence of automomic symptoms, including sweating, pallor, nausea or vomiting. • There may be associated with tinnitus, hearing loss, or facial nerve weakness.
Central vertigo • In patients with central vertigo, the autonomic symtoms are less severe and associated hearing loss is unusnal. • Associated with neurological symtoms are different and may include: diplopia, hemianopsia, weakness, numbness, dysarthria, ataxia and loss of consciousness. Oscillopsia may be severe.
Diagnosis • The history and neurological examination are essential . • Point to the history include weather the symptom is that of dizziness, vertigo and disequilibrium • Weather the symptoms have an inciting factor, duration, frequency, past history, and severity.
Diagnosis • Complete neurological examination is necessary. • CAE • ENG • MRI of brain. • MRI should be perform on all patientsof a central process and who had symtoms for 2 weeks or mor • CD and TCD for possible stroke
Treatment • According to the cause. • For case of peripheral vertigo, vestibular supressant may be used to relieved symptoms but should be discontinue use as soon as possilbe ,as long term use ma delay compensation.
Treatment • Anticholinergic drug : scopolamine or glycopyrrolate • Antihistamine: meclizine • Benzodiazepine
Common casue of peripheral vertigo • BPPV • Bacterial or viral infection • Vestibular neuritis • Meniere disease • Tumor • Trauma • Drug: alcohol, aminoglycoside
Common cause of central vertigo • Menigitis • Vascular disease: VBI, brainstem or cerebellar hemorrhage or infarct. • Migraine • Tumors • Trauma • Multiple sclerosis
BPPV • Recurrent vertigo, with change head position • No hearing loss • No tinnitus • Self limited within a few months
Vestibular Neuritis • Vertigo associated with suddenly onset, severely with N/V and nystagmus • Often previously viral infection
Meniere Disease • Vertigo, hearing loss ,tinnitus and aural fullness • Endolymphatic hydrop
CP angle tumor • Asymmetrical sensorineural hearing loss, unilateral tinnitus or vertigo.
Drug toxicity • Many drug, esp. alcohol may cause dizziness • Cessation of use a drug, usually casues clearing of the symptoms in a few days.
Cardiac arrythmia • Low cardiac output— • low brain perfusion- • dizziness
Prebycusis and presbyastasis • Age related hearing loss esp. high tone • Age related loss of balance
pyschophysiologic • Acute anxiety • Acute panic • Hyperventilation