FAINTNESS/LIGHT-

HEADEDNESS
Dizziness
• variety of common sensations that
• described as light-headedness followed
by visual blurring and postural swaying
along with a feeling of warmth,
diaphoresis, and nausea
include vertigo, light-headedness, • symptom of insufficient blood, oxygen,
faintness, and imbalance or, rarely, glucose supply to the brain
• provocative tests to reproduce the • can occur prior to a syncopal event of
symptoms may be helpful: any etiology and with hyperventilation
• Valsalva maneuver or hypoglycemia
• Hyperventilation • rarely occur during an aura before a
• Postural changes leading to seizure
orthostasis • chronic light-headedness is a common
somatic complaint with depression
•

TYPES OF VERTIGO

•
Vertigo
sense of movement of the body or the environment,
1. Physiologic Vertigo
-results from unfamiliar head movement (seasickness)
-mismatch between visual-proprioceptive-vestibular system inputs
most often a feeling of spinning (height vertigo, visual vertigo during motion picture chasescenes)
• due to a disturbance in the vestibular system; 2. Pathologic Vertigo
abnormalities in the visual or somatosensory systems -causedby a peripheral (labyrinthor eighth nerve) or central CNS lesion
• accompanied by nausea, postural unsteadiness, and
3. Peripheral Vertigo
gait ataxia
• may be provoked or worsened by head movement -severe, accompaniedby nausea and emesis
• rapid rotation in a swivel chair is a simple provocative -tinnitus (a feeling of ear fullness, or hearing loss may occur)
test to reproduce vertigo -jerk nystagmus is almost always present
• Benign positional vertigo is identified by the Dix- -the nystagmus does not changedirection with a changein direction of gaze; it is usually
Hallpike maneuver to elicit vertigo and the horizontal with a torsional component and has its fast phase away from the side of the
characteristic nystagmus;
lesion.
• Pt begins in a sitting position with head turned 45°,
holding the back of the head. -inhibited by visual fixation
• The examiner gently lowers the pt to supine position -pt senses spinning motion away from the lesion and tends to havedifficulty walking,
with head extended backward 20° and observes for with falls towardthe side of the lesion, particularly in the darkness or with eyes closed
nystagmus.
• After 30 s the pt is raised to sitting position.
• After 1 min rest the maneuver is repeated on other
side.
 TYPES OF VERTIGO
-no other neurologic abnormalities are present
-cute prolonged vertigo may be caused by infection, trauma, or ischemia
-no specific etiology is found
-Acute Labyrinthitis or Vestibular Neuritis is used to describe the event
-Acute Bilateral Labyrinthine Dysfunction is usually due to drugs (aminoglycoside
antibiotics), alcohol, or a neurodegenerative disorder
-Recurrent Labyrinthine Dysfunction with signs and symptoms of cochlear disease is
usually due to Ménière’s disease (recurrent vertigo accompanied by tinnitus and
deafness)
4. Positional Vertigo
-precipitated by a recumbent head position; Benign Paroxysmal PositionalVertigo (BPPV)
-posterior semicircular canalis particularly common
-pattern of nystagmus is distinctive
-BPPV may follow trauma but is usually idiopathic; it generally abates spontaneously
after weeks or months
-Vestibular Schwannomas of the eighth cranial nerve (acoustic neuroma) usually present
with hearing loss and tinnitus, accompanied by facial weakness and sensory loss due to
involvement of cranial nerves VII and V
TYPES OF VERTIGO
5. Psychogenic Vertigo
-pts with chronic incapacitating vertigowho also have agoraphobia, panic attacks
-normal neurologic examination
-no nystagmus
6. Central Vertigo
-associatedbrainstem or cerebellar signs such as dysarthria, diplopia, dysphagia, hiccups,
cranial nerve abnormalities, weakness, or limb ataxia; depending on the cause
-headache may be present
-the nystagmus can take almost any form (i.e., vertical or multidirectional) but is often
purely horizontalwithout a torsional component and changes direction with different
directions of gaze
-chronic, mild, and is usually not accompanied by tinnitus or hearing loss
-due to vascular,demyelinating, neurodegenerative, or neoplastic disease
-vertigo may be a manifestationof migraine or temporallobe epilepsy

Most useful bedside test of peripheral vestibular function:

● Head Impulse Test

○ vestibuloocular reflex (VOR) is assessed with small
amplitude (∼20 degrees) rapid head rotations
■ 1. Pt fixates on a target, the head is rotated to
the left or right.
■ If the VOR is deficient (e.g., in peripheral
vertigo), the rotation is followed by a catch-up
saccade in the opposite direction (e.g., a
leftward saccade after a rightward rotation).
■ If a central cause for the vertigo is suspected
(e.g., no signs of peripheral vertigo, no hearing
loss, no ear sensations, or the presence of
other neurologic abnormalities indicating
central nervous system [CNS] disease), then
prompt evaluation for central pathology is
required.

● The initial test is usually an MRI scan of the
posterior fossa distinguishing between
central and peripheral etiologies can be
accomplished with vestibular function tests,
including videonystagmography
● Simple bedside examinations including the
Head Impulse Test and Dynamic Visual Acuity
(measure acuity at rest and with head rotated
back and forth by the examiner; a drop in
acuity of more than one line on a near card or
Snellen chart indicates vestibular
dysfunction).
TREATMENT
• Acute vertigo consists of vestibular suppressant drugs for
short term relief (Table 53-2). They may hinder central
compensation, prolonging the duration of symptoms, and
therefore should be used sparingly and for a short period of
time.
• Vestibular rehabilitation promotes central adaptation
processes and may habituate motion sensitivity and other
symptoms of psychosomatic dizziness. The general approach is
to use a graded series of exercises that progressively challenge
gaze stabilization and balance.
TREATMENT
• BPPV may respond dramatically to repositioning exercises such
as the Epley Maneuver designed to empty particulate debris
from the posterior semicircular canal.
• For vestibular neuritis, antiviral medications are of no proven
benefit unless herpes zoster oticus is present. Glucocorticoids
improve the likelihood of recovery in vestibular neuritis if given
within 3 days of symptom onset.
• Ménière’s disease may respond to a low-salt diet (1 g/d) or to a
diuretic. Otolaryngology referral is recommended.
• Recurrent episodes of migraine-associated vertigo should be
treated with anti-migraine therapy.

Body
weakness
• reduction of power in one or more muscles
• feeling of being tired, exhausted, and
experiencing a loss of strength
• can be accompanied by obvious or visible
sickness
• often accompanied by other neurologic
abnormalities helps indicate the site of
responsible tension
FAINTNESS/LIGHT-
HEADEDNESS
• described as light-headedness followed
by visual blurring and postural swaying
along with a feeling of warmth,
diaphoresis, and nausea
• symptom of insufficient blood, oxygen,
or, rarely, glucose supply to the brain
• can occur prior to a syncopal event of
any etiology and with hyperventilation
or hypoglycemia
• rarely occur during an aura before a
seizure
• chronic light-headedness is a common
somatic complaint with depression
•

CAUSES
Paralysis indicates weakness that is so severe
that the muscle cannot be contracted at all • Thyroid disease • Certain muscle disease
• Amyotrophic lateral sclerosis
paresis refers to less severe weakness
• Lack of sleep
(ALS)
• Vitamin B-12 • Muscle
The prefix hemi- refers to one half of the body,
para- to both legs, and quadri- to all four
deficiency breakdown(rhabadomyolysis)
limbs. • Flu • Diabetes
• Anemia • Fibromyalgia
The suffix -plegia signifies severe weakness or
• Infections (HIV/AIDS)
paralysis. • Depression or anxiety
 LIFE-THREATENING CAUSES

• Arrhythmias(irregular
heartbeats)
• Congestive heart failure
• Kidney failure
• Stroke
 COMPLICATIONS
Full Body
weakness
● Difficulty performing daily
routine
● Inability to work or go to
school • also known as fatigue
● Loss of mobility • similar feeling when you get
● Progression of symptoms flu.

SYMPTOMS
• Dizziness
• Confusion
• Lightheadedness
• Difficulty speaking

• Chest pain
• Changes in vision • Difficulty breathing
 Muscle Fatigue
● Feeling of strong and
resilient, overtime muscle
feel weak and tired
● A symptom that your
muscles decrease ability to
perform normally
● Can be associated with a
state of exhaustion after
strenuous exercise.

TYPES

RIGIDITY
Tone SPASTICITY

• Velocity independent
• Hypertonic present
• Increase in tone associated with disease throughout the range of
● Resistance of muscle •
of upper neurons
Sudden release after reaching a maximum
motion which affects
flexors and extensors
to passive stretch •
(clasp-knife phenomenon)
Predominantly affects the antigravity
muscles(upper-limb flexors and lower-
limb flexors)
 AGOMAA, EDUARDO JR A. GARCIA, JIRAH S.
REMEDIES
TOLENTINO, CATHERINE
BRIZ-RULL, JOSIAH NOELLA P.
C.
Manual stretching
01 -Using body weight and gravity. Stretch
with sufficient force to overcome hyper
CERILLO, JIMMY L.
VILLENO, APRIL AYANA
JOYCE C.
tonicity and passively lengthen the muscle

VILLENO, JAN ROD

02 Splinting DOLLANO, JIA RAQUEL KAMILLE C.
C.
-Splints and casts devices designed to
apply, distribute or remove forces to or
from body in a controlled manner to
perform one or both basic functions

03 Serial casting
-Technique used in managing spasticity
related contracture.
-The joints are immobilized with a semi-
rigid, well-padded cast. Every one to two
weeks as range of motion is restored.