1. بسم الله الرحمن الرحيم

2. PROBLEMS OF SPATIAL DISORIENTATION BY PROF. DR. MOHAMED SAAD

3. BASIC CONSIDERATIONS

6. APPROPRIATE ORIENTATION AND POSITION OF THE BODY IN SPACE DEPENDS UPON AFFERENT IMULSES FROM * The retinae. * The labyrinthes. * The proprioceptors of neck joints & muscles. * The proprioceptors of lower limbs & trunk.

7. AFFERENT IMULSES DERIVED FROM THESE SENSE ORGANS ARE INTEGRATED BY :- The cerebellum. The vestibular nuclei. The medial longitudinal bundle. The red nuclei. Higher centers (temporal & parietal lobes).

8. DISORDERED ORIENTATION IN SPACE RESULT FROM DISORDERED FUNCTION OF :- Sensory end organs. Afferent paths. Central connections.

9. DEFINITIONS

10. * DIZZINESS (Broad term). * VERTIGO (Sense of rotation ). * GIDDINESS (Light headedness). * DYSEQUILIBRIUM (Unsteadiness).

11. VERTIGO IS OFTEN ACCOMPANIED BY :- Vegitative effects. Disturbance of posture. Nystagmus.

12. CAUSES OF VERTIGO A)Peripheral causes. B) Central causes. C) Other causes.

13. PERIPHERAL CAUSES Vestibular. Non vestibular.

14. VESTIBULAR CAUSES Labyrinthine or oral vertigo Eighth nerve lesions - Affected cochlear apparatus - Sever vertigo - Temporaty

15. LABYRINTHINE OR AURAL VERTIGO A)MIDDLE EAR DISTURBANCES: -Inflammation -Eustachian tube obstruction A)INNER EAR DISTURBANCES: - Circulatory - Drugs & toxins - Inflammation - Meniere,s syndrome - Perilymphatic fistulas - Benign positional vertigo - Post traumatic - Unaccustomed stimuli

16. EIGHTH NERVE LESIONS Vestibular neuronitis. Meningitis. CPA tumours.

17. NON-VESTIBULAR CAUSES - Rare. - Associated manifestations. OCULAR CAUSES: * Abnormal visual perception. * Ocular palsies. NECK CAUSES: * Fibrositis. * Diseases of cervical vertebrae.

18. CENTRAL CAUSES - Non affected peripheral cochlear apparatus. - Less sever but persistent vertigo. - Signs of involvement of neighboring structures. * BRAIN STEM LESIONS. * CEREBELLAR LESIONS. * CORTICAL DISTURBANCES.

19. BRAIN STEM LESIONS Vascular lesions. Neoplastic lesions. Encephalitis. M.S.

20. CEREBELLAR LESIONS Cerebellar infarctin. Intra-cerebellar hge.

21. CORTICL DISTURBANCES * Lesions e.g. vascular neoplastic * Epilepsy. * Migraine.

22. OTHER CAUSES OF DIZZINESS Cardiovascular disturbances. Vasovagal phenomena. Other medical causes. Psychiatric disorders.

23. CARDIOVASCULAR DISTURBANCES Orthostatic hypotension. Cardiac arrhythmias. Carotid sinus hypersensitivity.

24. VASOVAGAL PHENOMINA Common vasovagal syncope. Reflex vasovagal syncope.

25. OTHER MEDICAL CAUSES Anemia. Hypoglycemia. Etc.

26. PSYCHIATRIC DISORDERS Hyperventilation syndrome. Anxiety neurosis. Hysterical neurosis. Affective disorders.

27. MANAGEMENT OF DIZZINESS

28. TAKING THE HISTORY - Onset course & duration of symptoms. - Factors that precipitate, aggravate, or relieve symptoms. -Is consciousness lost ? -Are cochlear & vestibular symptoms associated ? -Has there been recent head trauma ? -Is there numbness in hands & feet, visual impairment, or history of diabetes or anemia ? -Are there cardiac symptoms ? -Are there psychiatric symptoms ?

29. CLINICAL EXAMINATION Examination of the ears: - External auditory meatus. - Ear drum - Hearing. - Etc. Neurological examination: - Nystagmus. - Cranial nerves. - Co-ordination. - Motor system. - Sensory system. - Other systems.

30. INVESTIGATIONS * Complete blood picture. * Blood glucose. * ECG. * Audiometry. * EEG. * BAEP. * X-ray cervical spine. * X-ray skull. * CT scan. * MRI.

31. TREATMENT A)Treatment of the cause. B)Symptomatic treatment: - Antihistamines (Dimenhydrinate). - Anticholinergic drugs (Scopolamine). - Dopaminergic drugs (Piribedil). - H3 receptors antagonists (Betahistine). - Phenothiazines (Chlorpromazine). - Mild tanquilizers (Diazepam)