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Approach to dizzyness (vertigo)

DR BANDAR AL-QAHTANI, MD KSMC,RIYADH. Approach to dizzyness (vertigo). “Dizziness”. Faintness Loss of balance Light-headedness Psychologic disorders Vestibular diseases Vertigo is the spinning/rotatory movement Othostatic hypotension should be differentiated from vertigo .

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Approach to dizzyness (vertigo)

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  1. DR BANDAR AL-QAHTANI, MD KSMC,RIYADH Approach to dizzyness (vertigo)

  2. “Dizziness” • Faintness • Loss of balance • Light-headedness • Psychologic disorders • Vestibular diseases • Vertigo is the spinning/rotatory movement • Othostatic hypotension should be differentiated from vertigo

  3. Vestibular Labyrinth • 3 semicircular canals • rotational movement • cupula • 2 otolithic organs - utricle & saccule • linear acceleration • macula

  4. Balance • Vestibular system • Visual system • Proprioceptive system – spinothalamic

  5. Dizziness categorized as vestibular or nonvestibular • Vestibular lesion can be located in peripheral or central vestibular • Nonvestibular either systemic diseases /medications related or anxiety

  6. Peripheral vestibular disorders can be : most common :BPV,VIRAL LABRYNTHITIS common :trauma to labrynth,menieres disease uncommon :autoimune,bacterial inf.,ototoxic drugs

  7. Central vestibular disorders : most common :migrain common :TIA,CVAs,vasculitis,MS,AN

  8. Diagnosis usually started by history & PE • 80-90% of diagnosis • HX of present illness,family hx ,allergy hx,drug ..etc • Duration of dizziness is having a crucial importance ??? • CNS should be recognized and treated as early as possible • CNS s/s ??? • Peripheral vestibular causes : -ear symptoms -discharge,pain,sx,HL,trauma.tinnitus

  9. P.E • Crainial nerves • Cerebellar function • Nystagmus -sign for vertigo-1st ,2nd,3rd degrees/severity • Hearing • Neck for tenderness/stiffness and bruit

  10. Nonvestibular causes • Systemic diseases • DM,HTN,psychiatric diseases • Medications for these diseases in particular can cause dizziness • S/S fainting ,fatigue,irregular heart beating • ANXIETY is another cause for nonvestibular • Floating sensation after hyperventilation-washing CO2 causing vasoconstriction

  11. Vertebrobasilar Insufficiency • Vertigo, diplopia, dysarthria, ataxia, sensory and motor disturbance • 30% of TIA’s

  12. Migraine • S/S • personal or family hx, motion intolerance • Vasoconstriction followed by vasodilatation • Classical and non-classical type

  13. Vestibular Neuritis • Sudden onset vertigo • Normal hearing • Viral causes • Response to Methylprednisolone (Ariyasu)

  14. Meniere’s Disease • Unknown etiology • Hydrops on histologic studies • Triad ,hearing loss,tinnitus,vertigo

  15. Meniere’s Disease • Salt restriction • Diuretics • Thiazides - Na absorption in distal tubule • Side effects - hypokalemia, hypotension, hyperuricemia, hyperlipoproteinemia

  16. BPPV • Cupulolithiasis • calcific deposits on cupula rendering SCC gravity dependent • Canalolithiasis • calcific debris in SCC • pulling of cupula by plunger-like effect

  17. ANY QUESTIONS

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