Dizziness Disequilibrium and Vertigo v There are three

Dizziness, Disequilibrium and Vertigo v There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.

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

Cause of Dizziness v Circulation v Metabolic v Endocrine v Degeneration v Psychologic

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

Disequilibrium v Unsteadiness or imbalance v Patient may feel normal when they are stationary, but notice difficulty when they walk. v Often , they have no symptoms of dizziness. v Disequilibrium suggests a central lesion, but it may be peripheral. Patients with bilateral peripheral vestibular loss may note unsteady gait.

Vestibular system v Play a dual role, response to gravity and linear acceleration through the utricle and saccule v And to angular acceleration through the semicircular canals. v If insufficient or conflicting information between the left and right ears is delivered to the CNS, vertigo results.

Periphera Vertigo v 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. v There may be associated with tinnitus, hearing loss, or facial nerve weakness.

Central vertigo v In patients with central vertigo, the autonomic symtoms are less severe and associated hearing loss is unusnal. v Associated with neurological symtoms are different and may include: diplopia, hemianopsia, weakness, numbness, dysarthria, ataxia and loss of consciousness. Oscillopsia may be severe.

Diagnosis v The history and neurological examination are essential. v Point to the history include weather the symptom is that of dizziness, vertigo and disequilibrium v Weather the symptoms have an inciting factor, duration, frequency, past history, and severity.

Diagnosis v Complete neurological examination is necessary. v CAE v ENG v MRI of brain. v MRI should be perform on all patientsof a central process and who had symtoms for 2 weeks or mor v CD and TCD for possible stroke

Treatment v According to the cause. v 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 v Anticholinergic drug : scopolamine or glycopyrrolate v Antihistamine: meclizine v Benzodiazepine

Common casue of peripheral vertigo v BPPV v Bacterial or viral infection v Vestibular neuritis v Meniere disease v Tumor v Trauma v Drug: alcohol, aminoglycoside

Common cause of central vertigo v Menigitis v Vascular disease: VBI, brainstem or cerebellar hemorrhage or infarct. v Migraine v Tumors v Trauma v Multiple sclerosis

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

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

Meniere Disease v Vertigo, hearing loss , tinnitus and aural fullness v Endolymphatic hydrop

CP angle tumor v Asymmetrical sensorineural hearing loss, unilateral tinnitus or vertigo.

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

Cardiac arrythmia v Low cardiac output— v low brain perfusionv dizziness

Prebycusis and presbyastasis v Age related hearing loss esp. high tone v Age related loss of balance

pyschophysiologic v Acute anxiety v Acute panic v Hyperventilation