vertigo

AHMED ALARFAJ
 DEFINITION &
TERMINOLOGIES
 DEFINITION &
TERMINOLOGIES

VERTIGO (illusion of rotational, linear

or tilting movement such as spinning,
whirling or turning of the patient or
the surrounding . DISEQUILBRIUM
sensation of instability of the body
positions, walking or standing described
as off balanced or imbalanced.
 DEFINITION &
TERMINOLOGIES

OSCILLOPSIA (inability to focus on

objects with motion, such as reading
a sign while walking).
 DEFINITION &
TERMINOLOGIES

LIGHTHEADEDNESS (sense of
impending faint, presyncope).
PHYSIOLOGIC DIZZINESS
(motion sickness, height vertigo),
EVALUATION OF THE DIZZY
PATIENT

History
Dizziness is a term used to describe
any of a variety of sensation that
produce spatial disorientation.
Onset and Duration of Symptoms:
EVALUATION OF THE DIZZY
PATIENT

History

Character of Dizziness:
Contributing Factors:
Associated Symptoms:
 PHYSICAL EXAMINATION

H&N and General Physical

Exam:
Otoscopy:
Vestibular Testing:
Neurological Exam:
 General Characteristics of
Peripheral and Central Causes of
Vertigo

Characteristic Peripheral Central

Intensity severe mild

Fatigability fatigues, does not

Associated adaptation fatigue
 General Characteristics of
Peripheral and Central Causes of
Vertigo
Characteristic Peripheral Central

Symptoms nausea, weakness,

hearing loss, numbness
sweating falls more
likely

Eye closed symptom, symptoms

worse with better with
eyes closed eyes closed
 General Characteristics of
Peripheral and Central Causes of
Vertigo
Characteristic Peripheral Central

Nystagmus horizontal, may vertical

be unilateral bilateral
rotary
Ocular suppresses no effect
Fixation nystagmus (may or enhances
not suppress nystagmus
during acute
phase )
 CAUSES OF VERTIGO
PERIPHERAL VERTIGO:
Benign Paroxysmal Positional
Vertigo
Meniere Disease
Vestibular Neuronitis
Perilymphatic Fistulas
 CAUSES OF VERTIGO

PERIPHERAL VERTIGO
Cerebellospontine Angle Tumuors
Otitis Media
Traumatic Vestibular Dysfunction
 CENTRAL AND SYSTEMIC
CAUSES OF VERTIGO

Multiple Sclerosis
Other Neurological Disorder (stroke,
seizures, middle cerebellar lesions,
parkinsonism, psudobulbar palsy)
Metabolic Disorders (hypo/hyper-
thyroidism, diabetes)
 VESTIBULAR TESTING

HALLPIKE TEST
ELECTRONYSTAGMOGRAPHY
POSTUGRAPHY
CALORIC
VESTIBULAR DISORDERS

Menieres Disease (Endolymphatic

Hydrops)
 DIAGNOSIS

Based on clinical history, physical

examination and audiological
findings (initial low-frequency
SNHL) with exclusion of other
causes of hearing loss and vertigo is
adequate for diagnosis and initiating
empirical therapy.
 MANAGEMENT CONCEPT

Safety:
Acute Vestibular Suppression:
Vestibular Rehabilitation:
Surgical Management:
 MEDICAL MANAGEMENT
OF MENIERE DISEASE

Dietary Restrictions
Diuretics
Vestibular Suppressants
Corticosteroids
Stress Reduction
BENIGN PAROXYSMAL
POSITIONAL VERTIGO
(BPPV, Cupulolithiasis)
 BENIGN PAROXYSMAL
POSITIONAL VERTIGO (BPPV,
Cupulolithiasis)

Most common cause of peripheral

vertigo
Causes & pathophysiology:
Typically self limiting may have
recurrent episodes
SSx:
 MANAGEMENT

Education, reassurance and

observation
Particle Repositioning Maneuver
(Epleys Maneuver):
Home vestibular positional exercises
Antivertiginous medications
SURGICAL MANAGEMENT
OF VERTIGO
 SURGICAL MANAGEMENT
OF VERTIGO

Singular Neurectomy
Endolymphatic Sac Surgery:
Vestibular Nerve Section:
Transtympanic Or Intratympanic
Aminoglycoside Injections:
Labyrinthectomy