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. 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. SecondsBPV minutesVBI,MIGRAIN hoursMenieres dis daysVestibular neuritis,labirynth infarct

10. 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

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

18. ANY QUESTIONS