Dizziness, Disequilibrium and Vertigo

1. Dizziness, Disequilibrium and Vertigo • There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.

2. Dizziness • Is a nonspecific term that describes a sensation of alterred spatial orietaiton • Any sensation of discomfort of head. • Head lightness or wooziness

3. Cause of Dizziness • Circulation • Metabolic • Endocrine • Degeneration • Psychologic

4. Vertigo • Defined as any abnormal sensation of motion between patient and surrounding. • Feeling of linear motion of falling. • Classification • : peripheral or central type.

5. Disequilibrium • Unsteadiness or imbalance • Patient may feel normal when they are stationary, but notice difficulty when they walk. • Often ,they have no symptoms of dizziness. • Disequilibrium suggests a central lesion, but it may be peripheral. Patients with bilateral peripheral vestibular loss may note unsteady gait.

6. Vestibular system • Play a dual role, response to gravity and linear acceleration through the utricle and saccule • And to angular acceleration through the semicircular canals. • If insufficient or conflicting information between the left and right ears is delivered to the CNS, vertigo results.

7. Periphera Vertigo • Typical features of peripheral vertigo includea short or episodic time course, a precipitating factor and the presence of automomic symptoms, including sweating, pallor, nausea or vomiting. • There may be associated with tinnitus, hearing loss, or facial nerve weakness.

8. Central vertigo • In patients with central vertigo, the autonomic symtoms are less severe and associated hearing loss is unusnal. • Associated with neurological symtoms are different and may include: diplopia, hemianopsia, weakness, numbness, dysarthria, ataxia and loss of consciousness. Oscillopsia may be severe.

9. Diagnosis • The history and neurological examination are essential . • Point to the history include weather the symptom is that of dizziness, vertigo and disequilibrium • Weather the symptoms have an inciting factor, duration, frequency, past history, and severity.

10. Diagnosis • Complete neurological examination is necessary. • CAE • ENG • MRI of brain. • MRI should be perform on all patientsof a central process and who had symtoms for 2 weeks or mor • CD and TCD for possible stroke

11. Treatment • According to the cause. • For case of peripheral vertigo, vestibular supressant may be used to relieved symptoms but should be discontinue use as soon as possilbe ,as long term use ma delay compensation.

12. Treatment • Anticholinergic drug : scopolamine or glycopyrrolate • Antihistamine: meclizine • Benzodiazepine

13. Common casue of peripheral vertigo • BPPV • Bacterial or viral infection • Vestibular neuritis • Meniere disease • Tumor • Trauma • Drug: alcohol, aminoglycoside

14. Common cause of central vertigo • Menigitis • Vascular disease: VBI, brainstem or cerebellar hemorrhage or infarct. • Migraine • Tumors • Trauma • Multiple sclerosis

15. BPPV • Recurrent vertigo, with change head position • No hearing loss • No tinnitus • Self limited within a few months

16. Vestibular Neuritis • Vertigo associated with suddenly onset, severely with N/V and nystagmus • Often previously viral infection

17. Meniere Disease • Vertigo, hearing loss ,tinnitus and aural fullness • Endolymphatic hydrop

18. CP angle tumor • Asymmetrical sensorineural hearing loss, unilateral tinnitus or vertigo.

19. Drug toxicity • Many drug, esp. alcohol may cause dizziness • Cessation of use a drug, usually casues clearing of the symptoms in a few days.

20. Cardiac arrythmia • Low cardiac output— •  low brain perfusion- •  dizziness

21. Prebycusis and presbyastasis • Age related hearing loss esp. high tone • Age related loss of balance

22. pyschophysiologic • Acute anxiety • Acute panic • Hyperventilation