VERTIGO Ppt Powerpoint Presentation slides Mohammad Behnia Medical Slideshow Vertigo - benign paroxysmal positional vertigo

VERTIGO

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lilly on Nov 15, 2009 Says :

Dear Mohd, your presentation has basic information and was very helpful for my presentation in my department.

mohammadbehnia on Sep 03, 2009 Says :

I am happy that my ppt on vertigo has been helpfull for you. It is free to download by anyone. If you encounter problems in dowloading it, Please mail me at mohammadbehnia@hotmail.com. thanks

ramesh on Sep 02, 2009 Says :

needs download

jane on Jul 27, 2009 Says :

nice ppt. the macula and cupula diagrams are quite helpful. great work.

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Notes

Show Notes

Slide 1 :

Vertigo Tunde Magyar MD, PhD

Slide 2 :

What could be reffered to as „dizziness” by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea Loss of memory Loss of confidence Epileptic convulsion

Slide 3 :

Development of vertigo Afferent Visual Proprioceptive Vestibular CNS Efferent Oculomotor Sceletal muscles Vegetative Dizziness

Slide 4 :

What should be considered dizziness by medical personnel? Vertigo A sense of feeling the environment moving when it does not. Persists in all positions. Aggravated by head movement. Dysequilibrium A feeling of unsteadiness or insecurity without rotation. Standing and walking are difficult. Light headedness Swimming, floating, giddy or swaying sensation in the head or in the room.

Slide 5 :

Questions to be asked (taking the history) Anamnesis What the patient means by vertigo Time of onset Temporal pattern Associated sings and symptoms (tinnitus, hearing loss, headache, double vision, numbness, difficulty of swallowing) Precipitating, aggravating and relieving factors If episodic: sequence of events, activity at onset, aura, severity, amnesia etc.

Slide 6 :

Examination of the patient with vertigo 2. Physical examination Spontaneous nystagmus Positional nystagmus Optokinetic nystagmus Posture and balance control Romberg’s test Blind walking, Untenberger Bárány’s test Stimulations of labyrinth Caloric test (cold, warm water) Rotational test

Slide 7 :

In case of vertigo

Slide 8 :

Differentiating peripheral and central vestibular lesion Peripheral „harmonic” vestibular syndrome Falls in Romberg position and deviates during walking with closed eyes to the side of the slow component of nystagmus Direction of nystagmus does not change with direction of gaze (I. II. III. degree!) Nystagmus can be horizontal, or rotational, but never vertical Nystagmus occurs after a brief latent period Severe rotating, whirling vertigo Symptoms aggravate after moving of the head position Severe vegetative sings (vomiting, sweating) Fear of death in severe cases Caloric response decreased on side of lesion

Slide 9 :

2. Central „dysharmonic”vestibular syndrome (rarely harmonic!!) Falls in Romberg position and deviates during walking with closed eyes to the side of the fast component of nystagmus Direction of nystagmus might change with direction of gaze If nystagmus is vertical or dissociated, it cannot be peripheral Vertigo is usually not whirling Vegetativ signs are less severe if any Associated neurological signs: diplopia, dysarthria, dysphagia, numbness, paresis, ataxia. Differentiating peripheral and central vestibular lesion

Slide 10 :

Examination of the patient with vertigo 3. Laboratory examinations and imaging Electronystagmography Video-oculography Audiometry BAEP CT MRI

Slide 11 :

Common causes of vertigo Peripheral Physiological (motion sickness) Benign paroxysmal positional vertigo Vestibular neuronitis Labyrinthitis Meniére disease Perilymph fistula Central Brainstem TIA/infarct Posterior fossa tumors Multiple sclerosis Syringobulbia Arnold - Chiari deformity Temporal lobe epilepsy Basilar migraine Other Cardiac, GI, psycogen, toxins, medications, anemia, hypotension

Slide 12 :

Duration of vertigo

Slide 13 :

Peripheral types of vertigo Benign paroxysmal positional vertigo Most often Lasts less than 30 seconds Occurs only with a change in head position Nystagmus is transient, fatigable and its direction is constant Reason: otoconia Positional vertigo is not always benign and not always vestibular in origin!

Slide 14 :

Left Right HC HC AC AC PC PC + -

Slide 15 :

BPPV diagnosis: Dix-Hallpike manoeuvre

Slide 16 :

BPPV: therapy Medications not necessary Position training Semont Brandt-Daroff

Slide 17 :

2. Vestibular neuronitis Sudden severe vertigo „harmonic” vestibular syndrome No cochlear symptoms (tinnitus, hearing loss) Reduced caloric reaction on affected side Recurrent attacks Lasts for several days

Slide 18 :

2. Vestibular neuronitis Reason: viral infection, vascular or unknown origin Therapy: 1-3. days. bedrest, vestibular suppressants (diazepam, clonazepam) antiemetics, vitamin B antiviral agents (?), corticosteriods(?) From 3. day: position training 3. Labyrinthitis As vestibular neuronitis, but there are also cochlear symptoms.

Slide 19 :

4. Menière disease Recurrent attacks in clusters Tinnitus Progressive hearing loss, unilateral first Vertigo for at least 5 to 30 min Vegetative signs Sense of pressure in the ear Distorsion of sounds Sensitivity to noises

Slide 20 :

4. Menière disease Pathogenesis: endolymphatic hydrops Therapy: salt free diet, nicotin, alcohol-withdrawal, acetazolamide, betahistine

Slide 21 :

5. Perilymphatic fistula Fistula of the round window Hearing loss with or without vertigo Sudden changes of pressure in the middle ear (weight lifting, diving, nose blowing)

Slide 22 :

Drug toxicity Aminoglycoside antibiotics Anticonvulsants Salycilates Alcohol Sedatives Antihistamines Antidepressants

Slide 23 :

Other causes of vertigo Cervical spondylosis Sensory deprivation (neuropathy, visual impairment) Anemia Hypoglycaemia Orthostatic hypotension Hyperventilation

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