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Nurdjaman Nurimaba
Neurological Department, Medical Faculty Padjadjaran University Bandung - Indonesia
Introduction
Acute Spontaneus Vertigo due to acute spontaneus unilateral depression of vestibular function.
Provoked Vertigo due to unilateral excitation of vestibular function. Poor Balance due to chronically inadequate peripheral or central vestibular or cerebellar function.
Sudden unilateral, impairment of vestibular function. One side suddenly stop working. Loss of peripheral input (e.g attacck of Menieres during Labyrinthectomy ). Agravated by head motion and often by lying down. Relieved by sitting up right, keeping the head still or lying with intact side lowermost.
Vertigo continous with eye clossed. Ussually too distressed to note of self rotation. Nystagmus is present. Phenomenon as double vision. Standing and walking are repaired. Might falls to affected siden. Automic disturbance.
Those with recurring attack that last minutes to hours. Those who have had a single severe attack that lasted more than 1 day.
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Sudden, temporary, largely reversible impairment of resting neural activity of one labyrinth, with subsequent recovery to normal. Last minutes to hours. Common vertigo problem seen in office practice. Well at the time of consultation. If clinical examination and laboratory test not helpful, diagnosis hinge on the history
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The temporale profile vertigo, lasting minutes with vertebrobasilar ischaemia and multiple sclerosis or hours with Menieres disease. Simultaneous neurological symptom. The background history migrain headache, vascular headache, head injury.
Recurrent vertigo lasting at least 2 to 3 hours, simplest way to make diagnosis : vestibular evaluation during a vertigo attack
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Mennieres dissease and its variant. Migraine. Vertebrobasilar transient ischaemia brainstem or labyrinthine. Perilymph fistula. Autoimmune inner ear disease. Multiple sclerosis.
Severe attack of vertigo. Only sometime. Already well. Symptom last several days. Has been sudden permanent impairment of the function of 1 labyrinth or central connections. Improvement by compensation.
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Vestibular neuritis. Vertebrobasilar infarction. Menieres disease. Cerebelar or brainstem hemorrhage. Bacterial labyrinthitis. Autoimmune neurolabyrinthitis. Multiple sclerosis.
After 4 to 6 weeks might patient be asymptomatic, might no residual abnormalities detectible clinically.
First task then is to determine vertigo central or peripheral. Truly the patients first attack. Other presenting symptom. Familiarity
Provoked Vertigo
Due to sudden inappropriate excitation. Stimulated cupula of a semicircular canal in patient with benign positional vertigo or by transmitted pressure in patients with a perilymp fistula.
Inappropiate excitation of crista of one semicircular canal. Brainstem and cerebellar lesions can cause a more persistent positional vertigo accompanied by different types of nystagmus.
Common causes :
In patient with several labyrinthine and vestibular nerve disorders. Infrequenly. Reported in association with acoustic neuroma and cholesteotoma, sequelle of vestibular neuritis. Mechanism is uncertain. Probably result from hyperventilation induced changes in turn increase the excitability or partially damaged vestibular nerve.
Poor balance
Two of most common causes are : - cerebellar - vestibullar Chronic vestibular insufficiency : - ototoxic drug. - congenital & hereditary disorders. - autoimmune disease. - bilateral Menieres disease. - temporal bone infection. - bilateral acoustic neuroma. - idiophatic bilateral isolated. - severe unilateral vestibular loss of any cause.
Symptom of CVI
Hereditary or acquired cerebellar degenerations. Cerebellar tumor. Chiari malformation. Multiple sclerosis. Cerebellar infarction. Certain drug.