PROBLEMS OF SPATIALDISORIENTATIONBYPROF. DR. MOHAMED SAAD

BASIC CONSIDERATIONS

APPROPRIATE ORIENTATION AND POSITION OF THE BODY IN SPACE DEPENDS UPON AFFERENT IMULSES FROM* The retinae.* The labyrinthes.* The proprioceptors of neck joints & muscles.* The proprioceptors of lower limbs & trunk.

AFFERENT IMULSES DERIVED FROM THESE SENSE ORGANS ARE INTEGRATED BY :-The cerebellum.The vestibular nuclei.The medial longitudinal bundle.The red nuclei.Higher centers (temporal & parietal lobes).

DISORDERED ORIENTATION IN SPACE RESULT FROM DISORDERED FUNCTION OF :-Sensory end organs.

Afferent paths.

Central connections.

DEFINITIONS

* DIZZINESS (Broad term).

* VERTIGO (Sense of rotation).

* GIDDINESS (Light headedness).

* DYSEQUILIBRIUM (Unsteadiness).

VERTIGO IS OFTEN ACCOMPANIED BY :-Vegitative effects.

Disturbance of posture.

Nystagmus.

CAUSES OF VERTIGOPeripheral causes.B) Central causes.C) Other causes.

PERIPHERAL CAUSESVestibular.

Non vestibular.

VESTIBULAR CAUSESLabyrinthine or oral vertigoEighth nerve lesions - Affected cochlear apparatus - Sever vertigo- Temporaty

LABYRINTHINE OR AURAL VERTIGOMIDDLE EAR DISTURBANCES:InflammationEustachian tube obstructionINNER EAR DISTURBANCES:- Circulatory - Drugs & toxins- Inflammation - Meniere,s syndrome- Perilymphatic fistulas - Benign positional vertigo- Post traumatic - Unaccustomed stimuli

EIGHTH NERVE LESIONSVestibular neuronitis.Meningitis.CPA tumours.

NON-VESTIBULAR CAUSES - Rare. - Associated manifestations.

OCULAR CAUSES:* Abnormal visual perception.* Ocular palsies. NECK CAUSES:* Fibrositis.* Diseases of cervical vertebrae.

CENTRAL CAUSES - Non affected peripheral cochlear apparatus. - Less sever but persistent vertigo. - Signs of involvement of neighboring structures.

* BRAIN STEM LESIONS. * CEREBELLAR LESIONS. * CORTICAL DISTURBANCES.

BRAIN STEM LESIONSVascular lesions.Neoplastic lesions.Encephalitis.M.S.

CEREBELLAR LESIONSCerebellar infarctin.

Intra-cerebellar hge.

CORTICL DISTURBANCES* Lesions e.g. vascular neoplastic * Epilepsy.

* Migraine.

OTHER CAUSES OF DIZZINESSCardiovascular disturbances.Vasovagal phenomena.Other medical causes.Psychiatric disorders.

CARDIOVASCULAR DISTURBANCESOrthostatic hypotension.Cardiac arrhythmias.Carotid sinus hypersensitivity.

VASOVAGAL PHENOMINACommon vasovagal syncope.

Reflex vasovagal syncope.

OTHER MEDICAL CAUSESAnemia.Hypoglycemia.Etc.

PSYCHIATRIC DISORDERSHyperventilation syndrome.Anxiety neurosis.Hysterical neurosis.Affective disorders.

MANAGEMENT OF DIZZINESS

TAKING THE HISTORY- Onset course & duration of symptoms.- Factors that precipitate, aggravate, or relieve symptoms.Is consciousness lost ?Are cochlear & vestibular symptoms associated ?Has there been recent head trauma ?Is there numbness in hands & feet, visual impairment, or history of diabetes or anemia ?Are there cardiac symptoms ?Are there psychiatric symptoms ?

CLINICAL EXAMINATIONExamination of the ears: External auditory meatus. - Ear drum Hearing. - Etc.Neurological examination:- Nystagmus. - Cranial nerves.- Co-ordination. - Motor system.- Sensory system. - Other systems.

INVESTIGATIONS* Complete blood picture. * Blood glucose.* ECG. * Audiometry.* EEG. * BAEP.* X-ray cervical spine. * X-ray skull.* CT scan. * MRI.

TREATMENTTreatment of the cause.Symptomatic treatment:- Antihistamines (Dimenhydrinate).- Anticholinergic drugs (Scopolamine).- Dopaminergic drugs (Piribedil).- H3 receptors antagonists (Betahistine).- Phenothiazines (Chlorpromazine).- Mild tanquilizers (Diazepam)