vertigo making it simple dr anita bhandari n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Migraine doctor and specialist in Jaipur PowerPoint Presentation
Download Presentation
Migraine doctor and specialist in Jaipur

Loading in 2 Seconds...

play fullscreen
1 / 77

Migraine doctor and specialist in Jaipur - PowerPoint PPT Presentation


  • 49 Views
  • Uploaded on

BPPV is the most common cause of vertigo. Read more about vertigo symptoms, get to know what is vertigo and it's treatment and how to cure it with migraine doctor.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Migraine doctor and specialist in Jaipur


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
    Presentation Transcript
    1. VERTIGO – MAKING IT SIMPLE DR.ANITA BHANDARI CONSULTANT NEUROTOLOGIST VERTIGO AND EAR CLINIC, JAIPUR 

    2. ETIOLOGY

    3. MATTER OF CONCERN More amenable to treatment -more sinister consequences

    4.  Seconds – late ototoxicity  Minutes – BPPV, TIA  Hours – Meniere’s disease , Migraine related vertigo  Days – Vestibular neuritis  Months – years - Hysterical

    5. EQUILIBRIUM  Spatial orientation  Ocular stabilization  Postural control

    6. NEUROTOLOGICAL EVALUATION  A battery of tests  Many systems to be evaluated to assess structural and functional integrity

    7. For An ENT Specialist,  We look at the ears first.  In vertigo --> eyes are most important

    8. SVV  Otoliths act as gravito-inertial force detectors  SVV is a psychophysical measure of the angle between perceptual vertical and true/gravitational vertical  Also used to measure vestibular rehabilitation  Compensated utricular hypofunction may be detected on dynamic SVV testing. The defect will be unmasked on eccentric rotation because any otolith function asymmetry will be enhanced.

    9. SUBJECTIVE VISUAL VERTICAL AND HORIZONTAL  Pt is asked to adjust the orientation of a luminous bar until they perceive it as vertical  SVV – saccule and its central pathways  SVH – utricle and its central pathways  Pinar et al reported changes in SVV and SVH in >25% pts of chronic dizziness concluding that evaluation of the otolith system is mandatory

    10. SVV FINDING CONDITION Normal range Upto 2° deviation Ipsiversive tilt – >2o peripheral vestibular disorder pontomedullary lesion thalamic lesion Controversive Pontomesencephalic lesion parietoinsular vest. lesion Migraine Abnormal, little literature

    11. CRANIOCORPOGRAPHY  Developed by Claussen [1968]  Assessment of vestibulospinal system  Photographic recording of head and body movement during gait testing  Evaluation includes Romberg, Tandem walking and Unterburger’s test

    12. CCG : PROCEDURE  Done in dark room  Pt is blindfolded  Pt wears a helmet with LED lights  Path of the pt is recorded using an SLR camera  Result depends on vestibular system only as visuals cues cut off – pt is blindfolded and by stepping in one place, the soles intermittently lose contact with the floor thus reducing somatosensory input

    13. NORMAL PARAMETER OF CCG [CLAUSSEN] PARAMETER NORMAL RANGE- LOWER BORDER NORMAL RANGE- UPPER BORDER Longitudinal displacement 30.03 cm 113.35 cm Lateral sway 5.17 cm 16.15 cm Angular deviation 55.13° (right) 48.37° (left) Body spin 82.21° (right) 82.89° (left)

    14. INTERPRETATIONS OF CCG PATHOLOGY CCG FINDINGS Peripheral vestibular lesions Ipsilateral deviation Brainstem lesion, bilateral peripheral vestibulopathy Enlarged lateral sway, no angular deviation CPA tumors, PICA synd. Contralateral deviation, enlarged sway

    15. INCREASED SWAY

    16. ANGULAR DEVIATION TO LEFT

    17. ANGULAR DEVIATION TO LEFT

    18. HEAD IMPULSE TESTING  Introduced by Halmagyi and Curthoy  Simple, fast, reliable  Tests scc function – can evaluate all 3 pairs  Measures high freq. vestibular response in 3 dimensions

    19. HEAD IMPULSE TEST  VHIT – using Video Frenzel glasses  Test for gaze stabilization during rapid translation of head  Assesses the peripheral utricular system and superior vestibular N  A corrective saccade after VHIT indicates hypofunction of same side

    20. HIT : PROCEDURE  Subject seated upright with eyes focused on an fixed object  Unpredictable , low amplitude [10 – 20°] head rotation with high acceleration  Angular VOR generates compensatory eye movements equal in amplitude and opposite in direction to stabilize gaze

    21. HEAD IMPULSE

    22. HEAD SHAKING TEST  Nystagmus indicates an imbalance in vestibular tone between the 2 sides  Not seen in bilateral vestibular dysfunction

    23. HEAD SHAKING TEST

    24. HEAD SHAKING – DOWN BEATING NYSTAGMUS

    25. DYNAMIC VISUAL ACUITY TEST Functional test of VOR  Comparison of visual acuity with head still to VA with head moving  Reduction by 2 lines indicates dysfunction of VOR as seen in bilateral peripheral vestibulopathy  Improvement with rehab will improve DVA  Early sign of vestibular toxicity 

    26. BPPV AND PARTICLE REPOSITIONING MANEUVERS 

    27. The ampulla contains the cupula – a gelatinous mass with the same density as the endolymph.Cupula forms an impermeable barrier across the lumen of the ampulla. Hence the particles in scc may only exit via the end with no ampulla.

    28. POSTERIOR CANAL BPPV POSTERIOR CANAL BPPV  Most common– posterior canal is most gravity dependent in upright and supine position  Once debris enter the post. canal ,the cupula at the shorter most dependent arm trap the debris.  Debris can exit only through the longer arm through the crus commune [non-ampullary]

    29. DIX-HALLPIKE MANEUVRE

    30. POSTERIOR BPPV

    31. EPLEY EPLEY’ ’S MANEUVER S MANEUVER

    32. EPLEY’S MANEUVRE

    33. SEMONT SEMONT’ ’S MANEUVER S MANEUVER  Liberatory maneuver for pBPPV and cupulolithiasis  Used to overcome otoconia jam after Epley’s maneuver

    34. SEMONT SEMONT’ ’S MANEUVRE S MANEUVRE

    35. SEMONT’S MANEUVRE

    36. BRANDT – DAROFF EXERCISES BRANDT – DAROFF EXERCISES  Used as a home program  Indications o Posterior canal cupulolithiasis o Persistant posterior canal canalithiasis  Mechanism o Dislodge debris attached to cupula o Habituation through central compensation

    37. BRANDT-DAROFF EXERCISES

    38. BRANDT – DAROFF EXERCISES BRANDT – DAROFF EXERCISES  Things to remember o The exercises may dislodge more otoconia from the utricle causing an increase in symptoms. o May cause multiple canal involvement. o Important to hold for 30 seconds in each position.

    39. HORIZONTAL SCC BPPV HORIZONTAL SCC BPPV  Pagnini-McClure maneuvre  Geotropic nystagmus – debris are away from ampulla , side showing stronger nystagmus is the side involved  Apogeotropic nystagmus – indicates cupulolithiasis

    40. McCLURE PAGNINI MANEUVER McCLURE PAGNINI MANEUVER SUPINE ROLL TEST SUPINE ROLL TEST