Dizziness, Disequilibrium and Vertigo  There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.

Dizziness  Is a nonspecific term that describes a sensation of alterred spatial orietaiton  Any sensation of discomfort of head.  Head lightness or wooziness

Cause of Dizziness  Circulation  Metabolic  Endocrine  Degeneration  Psychologic

Vertigo  Defined as any abnormal sensation of motion between patient and surrounding.  Feeling of linear motion of falling.  Classification  : peripheral or central type.

Disequilibrium  Unsteadiness or imbalance  Patient may feel normal when they are stationary, but notice difficulty when they walk.  Often,they have no symptoms of dizziness.  Disequilibrium suggests a central lesion, but it may be peripheral. Patients with bilateral peripheral vestibular loss may note unsteady gait.

Vestibular system  Play a dual role, response to gravity and linear acceleration through the utricle and saccule  And to angular acceleration through the semicircular canals.  If insufficient or conflicting information between the left and right ears is delivered to the CNS, vertigo results.

Periphera Vertigo  Typical features of peripheral vertigo includea short or episodic time course, a precipitating factor and the presence of automomic symptoms, including sweating, pallor, nausea or vomiting.  There may be associated with tinnitus, hearing loss, or facial nerve weakness.

Central vertigo  In patients with central vertigo, the autonomic symtoms are less severe and associated hearing loss is unusnal.  Associated with neurological symtoms are different and may include: diplopia, hemianopsia, weakness, numbness, dysarthria, ataxia and loss of consciousness. Oscillopsia may be severe.

Diagnosis  The history and neurological examination are essential.  Point to the history include weather the symptom is that of dizziness, vertigo and disequilibrium  Weather the symptoms have an inciting factor, duration, frequency, past history, and severity.

Diagnosis  Complete neurological examination is necessary.  CAE  ENG  MRI of brain.  MRI should be perform on all patientsof a central process and who had symtoms for 2 weeks or mor  CD and TCD for possible stroke

Treatment  According to the cause.  For case of peripheral vertigo, vestibular supressant may be used to relieved symptoms but should be discontinue use as soon as possilbe,as long term use ma delay compensation.

Treatment  Anticholinergic drug : scopolamine or glycopyrrolate  Antihistamine: meclizine  Benzodiazepine

Common casue of peripheral vertigo  BPPV  Bacterial or viral infection  Vestibular neuritis  Meniere disease  Tumor  Trauma  Drug: alcohol, aminoglycoside

Common cause of central vertigo  Menigitis  Vascular disease: VBI, brainstem or cerebellar hemorrhage or infarct.  Migraine  Tumors  Trauma  Multiple sclerosis

BPPV  Recurrent vertigo, with change head position  No hearing loss  No tinnitus  Self limited within a few months

Vestibular Neuritis  Vertigo associated with suddenly onset, severely with N/V and nystagmus  Often previously viral infection

Meniere Disease  Vertigo, hearing loss,tinnitus and aural fullness  Endolymphatic hydrop

CP angle tumor  Asymmetrical sensorineural hearing loss, unilateral tinnitus or vertigo.

Drug toxicity  Many drug, esp. alcohol may cause dizziness  Cessation of use a drug, usually casues clearing of the symptoms in a few days.

Cardiac arrythmia  Low cardiac output—   low brain perfusion-   dizziness

Prebycusis and presbyastasis  Age related hearing loss esp. high tone  Age related loss of balance

pyschophysiologic  Acute anxiety  Acute panic  Hyperventilation