dizziness, disequilibrium and vertigo

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