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Vertigo a practical approach
- 1. VERTIGO- A PRACTICAL APPROACH DR.ANITA BHANDARI
- 2. MAINTENANCE OF BALANCE PROPRIOCEPTIVE EYES INNER EAR SYSTEM BRAIN
- 3. According to the National Institute of Health, 42% of the population is said to suffer from balance problems some time in their life.
- 4. Vertigo, imbalance, dizziness, disequilibrium – these are all terms used by the pt. to describe a sensation of altered orientation to the environment. Affects day to day life Who to consult?
- 5. Challenging for the physician Vague history Vague complaints Investigations ? Etiology ?
- 7. • DURATION OF ILLNESS • DURATION OF ATTACKS • TRIGGERS • ASSOCIATED SYMPTOMS
- 10. SECONDS – LATE OTOTOXICITY MINUTES –BPPV, TIA HOURS – MENIERE’S DISEASE , MIGRAINE DAYS – VESTIBULAR NEURITIS MONTHS TO YEARS- HYSTERICAL
- 11. CHANGE IN POSITION – BPPV URI – VESTIBULAR NEURITIS RAISED INTRATHORACIC PRESSURE – PERILYMPH FISTULA
- 12. AUDIOMETRY CRANIOCORPOGRAPHY -HELPS IN ELECTRONYSTAGMOGRAP DIFFERENTIATING HY PERIPHERAL & CENTRAL DISORDERS
- 14. 28 YEAR OLD FEMALE INTENSE SPINNING ON GETTING UP IN MORNING LASTING SEVERAL HRS. CANNOT GET UP FROM BED N/V ++ NO HEARING LOSS
- 15. • TYMP. MEMBRANE – WNL • NYSTAGMUS – LEFT BEATING SPONTANEOUS • CRANIAL NERVES WNL • GAIT –COULD NOT BE TESTED • NO NEUROLOGICAL DEFICIT
- 18. Pathogenesis – viral infection of superior division of vestibular N. History – sudden onset of severe vertigo without hearing loss. Usually preceded by URI. Investigations Audiometry – WNL ENG – canal paresis CCG – rotation to the affected side
- 19. • CONTROL OF SYMPTOMS • INITIALLY STRONG VEST. SEDATIVES – MECLIZINE , PROCLOPERAZINE ,ALPRAZOLAM, • ONDANSTERON – NOT MORE THAN 5 DAYS • IF PT. SEEN WITHIN 2 DAYS OF ONSET – STEROIDS • START VESTIBULAR REHABILITATION ASAP
- 20. 41 YR. OLD MALE RECURRENT EPISODES OF VERTIGO SINCE 4 MONTHS WHICH LAST FOR FEW HRS. N/V+ HEARING LOSS AND RINGING IN RT.EAR DURING THE ATTACK
- 21. TM – N NO NYSTAGMUS STEPPING TEST – 90* ROTATION TO RT AUDIOMETRY – LOW FREQ. HEARING LOSS RE ENG – HYPERACTIVE CALORIC RESPONSE ON RT
- 24. MENIERE’S DISEASE Pathogenesis- endolymphatic hydrops Dilated membranous Normal membranous labyrinth labyrinth in Meniere's disease (Hydrops)
- 25. SYMPTOMS • Fluctuating hearing loss TRIAD • Tinnitus • Vertigo
- 26. DURING ACUTE PHASE, VEST.SEDATIVES MAY BE GIVEN – MECLIZINE ,CINNARIZINE LOW SALT ,HIGH K DIET CARBONIC ANHYDRASE BETAHISTINE
- 27. 23 YR. OLD FEMALE PERSISTANT FEELING OF UNSTEADINESS OFTEN EPISODES OF SPINNING FREQ. HEADACHES WITH SENSORY AMPLIFICATION NO AURAL SYMPTOMS HIGH STRUNG PERSONALITY
- 28. ENT – WNL GAIT, STEPPING TEST – WNL AUDIO – WNL ENG - WNL
- 29. • D/D –PHOBIAS, HYSTERIA • ABORTIVE THERAPY - TRIPTANS • PREVENTIVE THERAPY • BETA BLOCKERS • FLUNERIZINE
- 32. • 60 YR. MALE • INTENSE SPINNING ON GETTING UP FROM BED • N/V ++ • NO AURAL SYMPTOMS
- 33. TM- WNL NO SPONTANEOUS NYSTAGMUS GAIT WNL NO NEUROLOGICAL DEFECIT DIX-HALLPIKE MANEUVRE – NYSTAGMUS ON LT
- 34. BENIGN- self- limiting POSITIONAL PAROXYSMAL VERTIGO – sudden onset
- 37. 55 YR.OLD MALE CHR. UNSTEADINESS SINCE SEVERAL MONTHS INCREASED ON CHANGE OF POSITION DECREASED HEARING BE HYPERTENSIVE,DIABETIC H/O ATT 10 YRS. AGO WITH STREPTOMYCIN
- 38. AUDIOMETRY – MODERATE SNHL BE CCG – WIDE BASED ATAXIC GAIT ENG –BILATERAL CANAL PARESIS NO NYSTAGMUS
- 39. ALONG WITH SYSTEMIC DISORDERS START VESTIBULAR REHABILITATION CONTROL HTN,DM START NOOTROPIC AGENTS AVOID VESTIBULAR SEDATIVES