Vertigo Dr. Anwar
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Transcript of Vertigo Dr. Anwar
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Vertigo
Vertigo
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Steps1.History Taking
2.Clear definition(Vertiginous or Nonvertiginousdizziness)
3.Peripheral or Central Vertigo4.Psychogenic Vertigo
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Differential diagnosis1.Dizziness
2.Presyncope3.Disequilibrium:Unsteadygait
4.Light-headedness
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Symptoms Unconscious Pallor Sweating
Nausea/Vomiting Auditory Symptoms :Hearing loss, Tinnitus, aural
(ear) fullness Diplacusis Paracusis Neurologic Symptoms: numbness, weakness,
difficulty with swallowing or speech
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Definitiona subjective sensation ofmovement
May feel either that himinvolving in space or thatobjects in the environmentare moving around him.
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History Taking Description of the sensation (including
associated symptoms) Onset (acute, gradual) Duration (date sensation was first noted,
length of time it lasts) Intensity (how troubling is it?)
Exacerbations (activities, positions,circumstances that worsen situation)
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Remissions (activities, positionscircumstances that make sensation better)
Medications (prescription, herbal, over thecounter)
Other medical problems (diabetes,hypertension, heart disease, etc)
Psychosocial (any stressors?)
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Physical Examinations
Mental conditions
Vital Signs: Bp,HR
Otoscopy Ascultation of the neck for bruits
Rinne Test
Webers Test
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Rinne Test
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Neurologic exams
Nystagmus Rombergs
Gait
Dix-Hallpike Maneuver
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Dix-Hallpike Maneuver
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Peripheral Vertigovs
Central VertigoFeatures Peripheral
VertigoCentralVertigo
Conscious Conscious Unconscious
Nystagmus Horizontal/rotary Vertical
Related to positionchanging
Yes No
Symptoms Auditory symptoms
(auralfullness,tinnitus,hearing loss)
Neurologic
symptoms(disequilibrium,gait)
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Comparison of Common Diseases
Features BPPV Meniere(Labyrinthitis)
Psychogenic CentralVertigo
Type of Vertigo Positional Spontaneous Variable Variable
Duration ofVertigo
1-2min 30min-2hrs Several years Several days-months
Symptoms Auditory symptoms (aural
fullness,tinnitus ,hearingloss)
Palpitations,hyperventilati
on
Neurologic symptoms
(Disequilibrium,unconscious)
Nystagmus Horizontal/rotary Horizontal/rotary Horizontal Vertical
Dix-hallpikemaneuver
+ -/+ - -
Neurologic exam(Rombergs sign)
- - - +
Treatment Repositioning Maneuver 1.Salt-restricted diets2.Diuretics
3.Vestibular suppressants(Meclizine)
4.Surgical;Gentamycininfusion into the middleear
Anti-anxiety or Anti depression drugs
Furtherexaminations(MRI,CT)
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Peripheral Vertigo
Benign paroxysmal positional vertigo: mostcommon in adults
Acute Labyrinthitis Chronic Labyrinthitis (Menieres
Syndrome) Toxic Labyrinthitis Vestibular Neuronitis
Acoustic Nerve Lesions Labyrinthine Ischemia
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Central vertigo Brainstem Lesions
Intravascular: Vertebrobasilar
insufficiency Tumors
Intracranial infection
Demyelinating diseases: MultipleSclerosis, Syringobulbia()
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Conclusions1.History Taking2.Physical Examinations
3.Psychogenic Vertigo must be consider4.Labs for necessary
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Weber
s Test
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