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

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

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

Balance Vestibular system Visual system Proprioceptive system – spinothalamic

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

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

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

-ear symptoms -discharge,pain,sx,HL,trauma.tinnitus 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

Seconds BPV minutes VBI,MIGRAIN hours Menieres dis days Vestibular neuritis,labirynth infarct

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

DM,HTN,psychiatric diseases 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

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

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

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

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

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

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

ANY QUESTIONS