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

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

SecondsBPV minutesVBI,MIGRAIN hoursMenieres dis daysVestibular neuritis,labirynth infarct

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

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

ANY QUESTIONS