Dizziness vertigo vertigo Syncope or presyncope dysequilibrium ER

Dizziness /vertigo

分類 � � 眩暈(vertigo) 昏厥或昏厥前期（Syncope or pre-syncope） 不平衡(dysequilibrium) 心理性頭昏

ER case � � � A 67 year-old man rolled over in bed early in the morning and suddenly developed severe nausea as well as the unpleasant sensation that the room was spinning around him. The spinning resolved within 30 seconds but recurred again in the opposite direction when he rolled back to his original position. This had never happened to him before. The patient denied tinnitus, hearing loss, recent viral illness, or head trauma

� � Vital signs : 37. 2, pulse 70/min , BP 140/85, RR 12/minute, Spa. O 2 98%. PH : mild HTN

Key questions? � � � What differentiates peripheral from central vertigo? What differentiates benign paroxysmal positional vertigo (BPPV) from other peripheral causes of vertigo, such as labyrinthtis and vestibular neuritis? What is the optimum treatment for benign paroxysmal positional vertigo?

Peripheral vertigo � � � 良性姿勢性眩暈症（Benign Paroxysmal Positional Vertigo, BPPV） 前庭神經病變（Vestibular Neuropathy Meniere氏病（Meniere’s Disease）

Epley maneuver v. s Hallpike test

治療 � � � Mild : 可給口服Meclizine或 Promethazine(IM) Severe: 可給diazepam（Valium）PO或IV， prochlorperazine（Novamine）IM。 長期而言，給予低鹽食物或用去鈉之利尿 劑，如thiazide，acetazolamide（Diamox） 可以減少發病次數

BPPV Labyrinthitis Meniere’s CP angle tumour Brain stem Character of Paroxysmal vertigo Gradual onset over hours Episodic or persistent, insidious Often constant Course Frequent attacks then recovery Constant Severe then recovery attacks with remission Progressive Usually improves with time Duration 10 -20 sec. (< 1 min) Hours to days Persistent Can be persistent Positional Yes, turning head to one side Days, dynamic symptoms may persist weeks No, may be exacerbated by movement May or may not Yes Hearing loss No Paroxysmal, spontaneous No, may be exacerbated by movement Yes Usually no