dizziness
TRANSCRIPT
Learning objectives
• What is vertigo and dizziness ?
• What are the causes of dizziness?
• What is the approach to reach the diagnosis?
• Mention steps and findings in examination of dizziness case ?
• Mention the investigation for a dizziness case?
• What is the treatment in the above case?
• Vertigo: sensation of movement either of the patient or of the surroundings.
• Disequilibrium: sensation of imbalance.
• Pre-syncope : Sense of impending fainting .
• Syncope: sudden transient loss of consciousness with
concurrent loss of postural tone .
Types Of Dizziness
Peripheral Causes of vertigo
• Benign paroxysmal positional vertigo (BPPV) :
20%
• vestibular neuronitis (labyrinthitis):15%
• Meniere’s disease:10%
• Drugs (aminoglycosides)
Benign paroxysmal positional vertigo (BPPV)
• BPPV is caused by particles in the semicircular canals which alter endolymph flow
• It may be due to minor head injury or because of repetitive head movement
• symptoms sometimes occur at night during movement whihe asleep
• vertigo = Less than one minute
• BPPV is common in women than men.
Vestibular neuritis :
• This is inflammation of the vestibular nerve, possibly due to viral infection.
• This inflammation disrupts the transmission of sensory information from the ear to the brain.
• Vertigo Associated with severe nausea and vomiting
• vertigo = Longer than one day.
Meniere’s disease :
• It caused by increased volume of endolymph in the semicircular canals.
• psychological factors such as stress can act as a trigger mechanism for an attacks.
• Vertigo = less than one day and more than one minute.
• Associated symptoms :
• Tinnitus
• fluctuating hearing loss ( unilateral )
• Nausea & vomiting
Central causes of vertigo
• Vascular disease ( vertebrobasilar insufficiency): 50% of central causes
• Demyelinating (Multiple sclerosis)
• Drugs (anticonvulsants, alcohol, hypnotics)
Vertebrobasilar Insufficiency
• Is a condition where there is an insufficient delivery of blood flow via the vertebral and/or basilar arteries to the brain.
• The vertebrobasilar system supports the occipital lobes, which are responsible for vision, and the cerebellum, which is responsible for balance and coordination.
Multiple Sclerosis (MS):
• Is an immune system disease that affects the central nervous system.
• A lesion or lesions in the brain stem or cerebellum, the area of the brain that controls balance & coordinate visual, spatial and other input to the brain needed to produce and maintain equilibrium, May cause vertigo.
Causes of Disequilibrium
• Common in the elderly people.
• caused by Multisensory disorder due to any combination of:
•peripheral neuropathy
•visual impairment
•musculoskeletal disorder interfering with gait
•vestibular disorder
Causes of Pre-syncope
• Caused by psychiatric disorders:
•Major depression 25%
•Generalized anxiety or panic disorder 25%
•Somatization disorder
•Alcohol dependence
•Personality disorder
•Hyperventilation
Causes of Syncope
• Drop in blood pressure (orthostatic hypotension).
• Inadequate output of blood from the heart.
• Dehydration
• Low blood sugar
• History alone reveals the diagnosis in roughly three out of four patients complaining of dizziness
1- Taking History
3- When did the dizziness occur and the duration of it?( Help to differentiate between the types of vertigo ).
4- Was is it associated with other symptoms? (Tinnitus, hearing loss , nausea and vomiting.)
5- Are there certain body position that cause the dizziness?
6- Did it occur after performing certain activates ?
What to ask!
Medical history
1. Determine if the patient has a condition such as:
• Vascular disease • Multiple sclerosis • Cardic disease• Hypertntion• Or recent viral upper repiratory infection.
2- Ask the patient about the drug history.
3- Determine if the patient had an ear surgery.
• Family history .
Physical examination
• Review of vital signs : BP (supine and standing), HR, presence of fever, irregular pulse.
• Ear examination : Examine the tympanic membrane for vesicles
or cholesteatoma.
•Electronystagmography (ENG) - tests vestibular function by using electrodes to detect nystagmus.
•Frenzel goggles
Examining eye function
• Patients with sudden ongoing attacks, should have:
pulse oximetry Glucose test Pregnancy test
Investigation
• Laboratory tests tests such as electrolytes, glucose, blood counts, and thyroid function tests are rarely helpful.
• Except for patients with chronic vertigo and bilateral hearing loss.
Treatment and Management
• Treatment is directed at the cause, including
stopping, reducing, or switching any
causative drugs.
• If a vestibular disorder is present and thought to
be secondary to active Meniere disease or
vestibular neuronitis or labyrinthitis, the most
effective vestibular nerve suppressants are
(diazepam). Antibiotics are rarely needed.
• Meniere disese diuretics & low salt diet.
• vestibular rehabilitation therapy – for recurrent vertigo secondary to unilateral vestibular weakness
• Vertigo associated with (BPPV) is treated with the Epley maneuver (otolith repositioning).
Complication
• Patients with frailty are at significant risk of falling with consequent fractures;
• their fear of moving and falling often significantly decreases their ability to do daily activities.
Dizziness is neither predictable nor preventable. However, we have some guidelines:
• Avoid reading while traveling if it makes you feel sick.
• Relaxation techniques can help ward tension and anxiety that can cause dizziness.
• Changes to the diet can also cut down on episodes of dizziness.
• People with menier’s disease may avoid episodes of vertigo by cutting salt, alcohol and caffeine out of their diets.
Prevention
Simple self-care tips that can lower you dizziness:
•Dizziness is always a symptom of danger and it is
better to consult the doctor immediately.
•Drink plenty of fluids.
•Have regular meals.
•Get plenty of rest.
•Practice relaxation by yoga or meditation.