Professional Documents
Culture Documents
2004/12/6 EBM
Introduction
Vertigo and dizziness are very common symptoms
in the general population
Prevalence rate: 5~10%
Particularly common in the individuals over 40
years of age
The first reason for a medical visit in patients
over 65 years
2004/12/6 EBM
2004/12/6 EBM
Stage 1: irritation
Stage 2: sudden loss of paralysis of the system
Stage 3: central compensation
Stage 4: recovery
2004/12/6 EBM
Stage 1: irritation
Spontaneous nystagmus beats towards the affected side
Normal caloric reaction ( cold waterbeat to opposite
site; warm water beat to ipsilateral site; nystagmus last
for 3 mins)
2004/12/6 EBM
Stage 1: irritation
Stage 2: sudden loss of paralysis of the system
Stage 1: irritation
Stage 2: sudden loss of paralysis of the system
Stage 4: recovery
2004/12/6 EBM
Stage 1: irritation
Stage 2: sudden loss of paralysis of the system
Stage 3: central compensation
Stage 4: recovery
Nystagmus towards the affected side
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Early phase
Stage1&2
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Aims of therapy
Decreasing the neurovegetative S/S
Decreasing antigravitary failure of the affected
side
Decreasing oscillopsia due to nystagmus
Decreasing internuclear inhibition that decreases
progression of functional compensation
Activating sensory substitution phenomena
Re-activating coordination
Decreasing spatial disorientation ( vertigo)
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Pharmacotherapy
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Physical therapy
Vestibular electrical stimulation ( VES)
Exercise
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Exercise in bed
Twice a day, 20-30 mins per session
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Exercise in sitting(1)
Performed during VES and wearing visual prisms
(saccade)
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Exercise in sitting(2)
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post. Semicircular
canal lithiasis
80~90%effective
Semont maneuver
Right ear lat canal PPV
1. Head turn
towards left
side(SS)
1&4
2. Lying on R side,
head is rotated
upward 105,
3mins
3. Lying on L side,
head is rotated
downward 195,
3 mins
4. Slowly sit-up
http://www.neurology.org/cgi/content/full/63/1/150/DC1
(video 1)
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Epley maneuver
Left ear post. Canal PPV
Head rotate
to left 45
http://www.neurology.org/cgi/content/full/63/1/150/DC1
(video 2)
2004/12/6 EBM
Modified Epley
Left ear BPPV
30 sec
30 sec
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Lempert maneuver
Right ear PPV
30~60 sec
2004/12/6 EBM
2004/12/6 EBM