dizziness, disequilibrium and vertigo there are three symptoms that are often refered to as...
Post on 19-Dec-2015
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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
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
Drug toxicity
Many drug, esp. alcohol may cause dizziness Cessation of use a drug, usually casues clearing of
the symptoms in a few days.