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VERTIGO

the feeling that you or your environment is
moving or spinning. When you feel as if you
yourself are moving, it's called subjective vertigo,
and the perception that your surroundings are
moving is called objective vertigo.

CAUSES

Benign paroxysmal positional vertigo (BPPV) is the most common
form of vertigo and is characterized by the sensation of motion
initiated by sudden head movements or moving the head in a
certain direction. This type of vertigo is rarely serious and can be
treated.

Vertigo may also be caused by inflammation within the inner ear
(labyrinthitis), which is characterized by the sudden onset of
vertigo and may be associated with hearing loss. The most
common cause of labyrinthitis is a viral or bacterial infection.

Meniere's disease is composed of a triad of symptoms:
episodes of vertigo, ringing in the ears, and hearing loss.
People have the abrupt onset of severe vertigo, fluctuating
hearing loss, as well as periods in which they are symptom-
free.

Acoustic neuroma is a type of tumor that can cause vertigo.
Symptoms include vertigo with one-sided ringing in the ear
and hearing loss.

The onset is usually abrupt. Walking is also extremely impaired. headache. and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose. difficulty walking. and inability to look toward the side of the bleed. . Vertigo can be caused by decreased blood flow to the base of the brain. The result is that the person's eyes gaze away from the side with the problem. multiple sclerosis. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo.

Migraine. The vertigo is usually followed by a headache.Head trauma and neck injury may also result in vertigo. which usually goes away on its own. . a severe form of headache. There is often a prior history of similar episodes but no lasting problems. may also cause vertigo.

there is a sensation of disorientation or motion. the patient may also have any or all of these symptoms: Nausea or vomiting Sweating Abnormal eye movements The patient may have hearing loss and a ringing sensation in the ears . SYMPTOMS Vertigo implies that there is a sensation of motion either of the person or the environment. In addition. If true vertigo exists.

It is important to tell the doctor about any recent head trauma or whiplash injury as well as any new medications the patient is taking. and difficulty walking. decreased level of consciousness. weakness. and symptoms can be constant or episodic.The duration of symptoms can be from minutes to hours. . difficulty speaking. The patient might have visual disturbances. The onset may be due to a movement or change in position.

or difficulty arousing Difficulty walking or controlling the arms and legs . not acting appropriately.Certain signs and symptoms of vertigo may require evaluation in a hospital's emergency department: Double vision Headache Weakness Difficulty speaking Abnormal eye movements Altered level of consciousness.

which may indicate that true vertigo exists. symptoms and whether they are constant or come and go. EXAM & TESTS Medical history and Physical exam. Do the symptoms occur when moving or changing positions? Is the patient currently taking any new medications? Has there been any recent head trauma or whiplash injury? . sweating. and abnormal eye movements. sensation of motion. Report any nausea. 1. vomiting. The history is comprised of four basic areas. 2.

3. hearing symptoms? Specifically. or difficulty speaking? CT scan. abnormal eye movements. patient have weakness. blood sugar levels electrocardiogram (ECG) . 4. visual disturbances. altered level of consciousness. report any ringing in the ears or hearing loss. difficulty walking.

. in addition to symptomatic treatment. For Meniere's disease. Medical Treatment Specific types of vertigo may require additional treatment and referral: Bacterial infection of the middle ear requires antibiotics. people might be placed on a low salt diet and may require medication used to increase urine output.

for benign paroxysmal positional vertigo. several physical maneuvers can be used to treat the condition . and throat (ENT) specialist for surgery.A hole in the inner ear causing recurrent infection may require referral to an ear. nose.

.Medications Commonly prescribed medications for vertigo include the following: meclizine hydrochloride (Antivert) diphenhydramine (Benadryl) scopolamine transdermal patch (Transderm- Scop) promethazine hydrochloride (Phenergan) diazepam (Valium) These medications should be taken only as directed and under the supervision of a doctor.

Those with risk factors for stroke should control their high blood pressure and high cholesterol and stop smoking. Prevention People whose balance is affected by vertigo should take precautions to prevent injuries from falls. Patient's with Meniere's disease should limit salt in their diet. .

while usually self- limited. Most commonly this will make the symptoms completely go away or make the condition tolerable. Vertigo caused by a brain lesion may need emergency evaluation by a neurologist and neurosurgeon. Prognosis depends on the source of the vertigo. The prognosis of vertigo from a brain lesion depends on the amount of damage done to the central nervous system. . in some cases can become completely incapacitating. Vertigo caused by problems in the inner ear. The use of drugs and rehabilitation exercise is mainstay of treatment.

but severe.  Benign: not a very serious or progressive condition  Paroxysmal: sudden and unpredictable in onset  Positional: comes with a change in head position  Vertigo: causing a sense of dizziness. . BPPV  Inner ear problem that results in short lasting. room-spinning vertigo.

. Frequency : 10-64/100000  Sex : 64% women  Age : older population ( 51-57) younger than 35 – head trauma.  History :  sudden  days-weeks  occassionally months -years  episodes.

BPPV .

 There is no new hearing loss or tinnitus.  Any turn of the head bring on dizziness.  nausea and vomiting.  looking up or down (top-shelf vertigo)  rolling over in bed. . Starts suddenly  first noticed in bed. when waking from sleep.  Patients often describe the occurrence of vertigo with  tilting of the head.

 Barany 1921  Dix-Hallpike 1952 – important features of nystagmus  Abnormal sensation of motion elicited by certain critical positions  Provocative position  nystagmus  At least 20% of vertigo  Underestimated .

 Idiopathic  Infection (viral neuronitis)  Head trauma  Degeneration of the peripheral end organ  Surgical damage to the labyrinth .

 Subclassification : scc post/lat/ant/bilat  Pathophysiology :  Canalithiasis  cupulolithiasis .

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 Procedures:  The Dix-Hallpike test. aids in the diagnosis of BPV.  Imaging Studies:  Head CT scan or MRI. Physical :  neurological examination – normal  except – Dix-Hallpike  pathognomonic  Lab Studies:  No pathognomonic laboratory test for BPV exists. along with the patient's history. Laboratory tests may be ordered to rule out other pathology. .

The Dix-Hallpike test .

 Medications  The Canalith Repositioning Procedure (CRP)  Surgery  Antiemetic  Antihistaminic  Anticholinergic .

 The patient is instructed to wear a neck brace for 24 hours and to not bend down or lay flat for 24 hours after the procedure.  Takes approximately 5 minutes.  One week after the CRP. the Dix-Hallpike test is repeated.  If the patient does experience vertigo and nystagmus. . then the CRP is repeated with a vibrator placed on the skull in order to better dislodge the otoconia.Canalith Repositioning Procedure ( CRP )  The treatment of choice for BPPV.  Also known as the Epley maneuver.  The patient is positioned in a series of steps so as to slowly move the otoconia particles from the posterior semicircular canal back into the utricle.

The Epley Maneuver .

 These exercises should be performed  for two weeks. three times per day  for three weeks. twice per day.  In each time.  1 repetition = maneuver done to each side in turn (takes 2 minutes) . usually used when the office treatment fails.Brandt-Daroff Exercises  method of treating BPPV. one performs the maneuver as shown five times.

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 Singular neurectomy  Vestibular Nerve Section  Posterior Canal Plugging Procedure .

.  Can cause hearing loss in 7-17% of patients and fails in 8-12%.Singular neurectomy  Old procedure  Section the nerve that transmits information from the posterior semicircular canal ampulla toward the brain.

 The balance part of the nerve is cut.Vestibular Nerve Section  done when the attacks of vertigo cannot be controlled with medication.  An incision is made behind the ear and balance- hearing nerve is located.  The operation is done with a neurosurgeon and takes two hours. .  The hearing is usually not affected.  The success rate (no vertigo attacks) is over 90%.

exposing the delicate membranous channel in which the crystalline debris is floating.  A mastoidectomy is performed through an incision made behind the ear.  The canal is then sealed and the incision closed.  One-night hospital stay is advised. but firmly packed off with tissue so the debris can no longer move within the canal and strike against the nerve endings.  The balance center is then uncovered and  The posterior semicircular canal is opened.  The patient returns in one week for suture removal. .  less than 20% hearing loss.Posterior Canal Plugging Procedure  Recently developed procedure  Replaced the singular neurectomy.  The canal is then gently.