Dizziness, Disequilibrium and Vertigo

1
Dizziness, Disequilibrium and Vertigo

• There are three symptoms that are often refered
  to as dizziness by patients dizziness,
  disequilibrium and vertigo.

2
Dizziness

• Is a nonspecific term that describes a sensation
  of alterred spatial orietaiton
• Any sensation of discomfort of head.
• Head lightness or wooziness

3
Cause of Dizziness

• Circulation
• Metabolic
• Endocrine
• Degeneration
• Psychologic

4
Vertigo

• Defined as any abnormal sensation of motion
  between patient and surrounding.
• Feeling of linear motion of falling.
• Classification
• peripheral or central type.

5
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.

6
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.

7
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.

8
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.

9
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.

10
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

11
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.

12
Treatment

• Anticholinergic drug scopolamine or
  glycopyrrolate
• Antihistamine meclizine
• Benzodiazepine

13
Common casue of peripheral vertigo

• BPPV
• Bacterial or viral infection
• Vestibular neuritis
• Meniere disease
• Tumor
• Trauma
• Drug alcohol, aminoglycoside

14
Common cause of central vertigo

• Menigitis
• Vascular disease VBI, brainstem or cerebellar
  hemorrhage or infarct.
• Migraine
• Tumors
• Trauma
• Multiple sclerosis

15
BPPV

• Recurrent vertigo, with change head position
• No hearing loss
• No tinnitus
• Self limited within a few months

16
Vestibular Neuritis

• Vertigo associated with suddenly onset, severely
  with N/V and nystagmus
• Often previously viral infection

17
Meniere Disease

• Vertigo, hearing loss ,tinnitus and aural
  fullness
• Endolymphatic hydrop

18
CP angle tumor

• Asymmetrical sensorineural hearing loss,
  unilateral tinnitus or vertigo.

19
Drug toxicity

• Many drug, esp. alcohol may cause dizziness
• Cessation of use a drug, usually casues clearing
  of the symptoms in a few days.

20
Cardiac arrythmia

• Low cardiac output
• ? low brain perfusion-
• ? dizziness

21
Prebycusis and presbyastasis

• Age related hearing loss
• esp. high tone
• Age related loss of balance

22
pyschophysiologic

• Acute anxiety
• Acute panic
• Hyperventilation