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بسم الله الرحمن الرحيم. PROBLEMS OF SPATIAL DISORIENTATION. BY PROF. DR. MOHAMED SAAD. BASIC CONSIDERATIONS. APPROPRIATE ORIENTATION AND POSITION OF THE BODY IN SPACE DEPENDS UPON AFFERENT IMULSES FROM. * The retinae. * The labyrinthes. * The proprioceptors of neck joints & muscles.
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PROBLEMS OF SPATIALDISORIENTATION BY PROF. DR. MOHAMED SAAD
APPROPRIATE ORIENTATION AND POSITION OF THE BODY IN SPACE DEPENDS UPON AFFERENT IMULSES FROM * The retinae. * The labyrinthes. * The proprioceptors of neck joints & muscles. * The proprioceptors of lower limbs & trunk.
AFFERENT IMULSES DERIVED FROM THESE SENSE ORGANS ARE INTEGRATED BY :- The cerebellum. The vestibular nuclei. The medial longitudinal bundle. The red nuclei. Higher centers (temporal & parietal lobes).
DISORDERED ORIENTATION IN SPACE RESULT FROM DISORDERED FUNCTION OF :- • Sensory end organs. • Afferent paths. • Central connections.
* DIZZINESS (Broad term).* VERTIGO(Sense of rotation).* GIDDINESS(Light headedness).* DYSEQUILIBRIUM(Unsteadiness).
VERTIGO IS OFTEN ACCOMPANIED BY :- • Vegitative effects. • Disturbance of posture. • Nystagmus.
CAUSES OF VERTIGO • Peripheral causes. B) Central causes. C) Other causes.
PERIPHERAL CAUSES • Vestibular. • Non vestibular.
VESTIBULAR CAUSES • Labyrinthine or oral vertigo • Eighth nerve lesions - Affected cochlear apparatus - Sever vertigo - Temporaty
LABYRINTHINE OR AURAL VERTIGO • MIDDLE EAR DISTURBANCES: • Inflammation • Eustachian tube obstruction • INNER EAR DISTURBANCES: - Circulatory - Drugs & toxins - Inflammation - Meniere,s syndrome - Perilymphatic fistulas - Benign positional vertigo - Post traumatic - Unaccustomed stimuli
EIGHTH NERVE LESIONS • Vestibular neuronitis. • Meningitis. • CPA tumours.
NON-VESTIBULAR CAUSES - Rare. - Associated manifestations. OCULAR CAUSES: * Abnormal visual perception. * Ocular palsies. NECK CAUSES: * Fibrositis. * Diseases of cervical vertebrae.
CENTRAL CAUSES - Non affected peripheral cochlear apparatus. - Less sever but persistent vertigo. - Signs of involvement of neighboring structures. * BRAIN STEM LESIONS. * CEREBELLAR LESIONS. * CORTICAL DISTURBANCES.
BRAIN STEM LESIONS • Vascular lesions. • Neoplastic lesions. • Encephalitis. • M.S.
CEREBELLAR LESIONS • Cerebellar infarctin. • Intra-cerebellar hge.
CORTICL DISTURBANCES * Lesions e.g. vascular neoplastic * Epilepsy. * Migraine.
OTHER CAUSES OF DIZZINESS • Cardiovascular disturbances. • Vasovagal phenomena. • Other medical causes. • Psychiatric disorders.
CARDIOVASCULAR DISTURBANCES • Orthostatic hypotension. • Cardiac arrhythmias. • Carotid sinus hypersensitivity.
VASOVAGAL PHENOMINA • Common vasovagal syncope. • Reflex vasovagal syncope.
OTHER MEDICAL CAUSES • Anemia. • Hypoglycemia. • Etc.
PSYCHIATRIC DISORDERS • Hyperventilation syndrome. • Anxiety neurosis. • Hysterical neurosis. • Affective disorders.
TAKING THE HISTORY - Onset course & duration of symptoms. - Factors that precipitate, aggravate, or relieve symptoms. • Is consciousness lost ? • Are cochlear & vestibular symptoms associated ? • Has there been recent head trauma ? • Is there numbness in hands & feet, visual impairment, or history of diabetes or anemia ? • Are there cardiac symptoms ? • Are there psychiatric symptoms ?
CLINICAL EXAMINATION Examination of the ears: External auditory meatus. - Ear drum Hearing. - Etc. Neurological examination: - Nystagmus. - Cranial nerves. - Co-ordination. - Motor system. - Sensory system. - Other systems.
INVESTIGATIONS * Complete blood picture. * Blood glucose. * ECG. * Audiometry. * EEG. * BAEP. * X-ray cervical spine. * X-ray skull. * CT scan. * MRI.
TREATMENT • Treatment of the cause. • Symptomatic treatment: - Antihistamines (Dimenhydrinate). - Anticholinergic drugs (Scopolamine). - Dopaminergic drugs (Piribedil). - H3 receptors antagonists (Betahistine). - Phenothiazines (Chlorpromazine). - Mild tanquilizers (Diazepam)
