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