1. Vertigo Lawrence Pike James Street Family Practice To insert your company logo on this slide From the Insert Menu Select Picture Locate your logo file Click OK To resize the logo Click anywhere inside the logo. The boxes that appear outside the logo are known as resize handles. Use these to resize the object. If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize.

2. Definition An illusion or hallucination of movement which is usually rotation, either of oneself or the environment

3. Major Causes in General Practice 3 Major Causes: Vestibular Neuronitis Benign Positional Vertigo Menieres

4. Vestibular Neuronitis

5. Vestibular Neuronitis - Features Commonly occurs on first awakening Nausea is marked and almost universal 57% evidence or recent viral infection Fine horizontal or rotatory nystagmus

6. Vestibular Neuronitis - Course Attacks become sequentially shorter and if not then consider another diagnosis Vertigo symptoms usually resolve over a few days as vestibular compensation occurs

7. Vestibular Neuronitis - Management Symptomatic treatment for first few days only Vestibular drugs delay compensation

8. Vestibular Neuronitis - Prognosis Excellent 5% progress to Benign Positional Vertigo

9. Benign Positional Vertigo

10. Benign Positional Vertigo - Features Recurrent Brought on by changes in head position Episodes last seconds, never >5 mins Onset late middle age usually Females : Males = 2 : 1 Typically turning over in bed, bending over and straightening, extending neck

11. Benign Positional Vertigo - Management Vestibular sedatives should be avoided where the vertigo becomes chronic as they supress vestibular feedback crucial for compensation and symptomatic recovery

12. Benign Positional Vertigo - Brandt-Daroff Exercises Simple repositioning exercises and are appropriate for less severe BPV Complete relief within 3 to 14 days

13. Benign Positional Vertigo - Brandt-Daroff Exercises Sit patient on couch with eyes closed Tilt whole upper body laterally towards lesion until lateral aspect of occiput lies on the bed. Maintain until vertigo subsides Sit patient upright for 30 seconds Repeat on then other side and rest head for 30 seconds Repeat every 3 hours during day

14. Menieres

15. Menieres - Features Hearing Loss Tinnitus Vertigo Sensation of fullness or pressure in ear Fluctuates and episodic, lasts hours Unilateral 20-50 yearsFamilial predisposition

16. Menieres - Course Progressive Early on predominant Vertigo with Deafness but normal hearing between Later on hearing loss stops fluctuating and becomes progressively worse

17. Menieres - Management Referral to ENT Specialist has been recommended for every case of vertigo and hearing loss to exclude acoustic neuroma Betahistine with or without diuretic is favoured current treatment

18. Vertigo Final Notes Vertigo with Diplopia is likely to be a vascular event Vestibular sedatives are not recommended on a prolonged basis for any type of vertigo