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

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

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

4. Balance Vestibular system Visual system
Proprioceptive system – spinothalamic

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

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

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

8. -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

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

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

11. 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

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

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

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

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

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

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

18. ANY QUESTIONS