vertigo in neurological disorder - f sitorus

7/27/2019 Vertigo in Neurological Disorder - F Sitorus

1/38

1

VERTIGO IN NEUROLOGICAL DISORDERS

FREDDY SITORUS

Neuro-otology & Neuro-ophtalmology Subdivision

Department of Neurology FMUI/ RSCM


2/38

2

DEFINITION OF VERTIGO

An illusion where someone feels his body is moving to the

environment or the environment is moving to him


3/38

3

BALANCE

VESTIBULAR

SYSTEM

VISUAL

SYSTEM

PROPRIOSEPTIVE

SYSTEM


4/38

Balance Function and DysfunctionInteraction of Vestibular, Visual and Proprioceptive systems

Balance

dyfunction

dizziness

Central Nervous system

Muscle and joint

sensory receptors

Postural

control viamuscles

Goebel JA. Otolaryngol Clin North Am 2000;33:48393.

Shepard NT, Solomon D. Otolaryngol Clin North Am 2000;33:45569

Controls

eyemovement

s

Eye Skin pressure

receptorsInner ear

(vestibular

system)


5/38

5

PHYSIOANATOMY OF THE BALANCE SYSTEM

PERCEPTION CEREBRAL CORTEX

INTEGRATION BRAIN STEM

NERVES (Cranial nerve VIII, CN II

Spinovestibulospinal nerves)

RECESSION RECEPTOR


6/38

Types of DIZZINESS

Type Sensation System

Vertigo

Vestibular Vertigo Spinning Vestibular

- Central

- Peripheral

Nonvestibular Vertigo Light headed Visual

Proprioceptive

Presyncope Fainting Cardiovascular

Dysequilibrium - Falling Cerebellar

- Unstable Spinal


7/38

7


8/38

Vestibulocerebellar and vestibulospinal pathways and

connections between vestibular and ocular motor nuclei


9/38

9


10/38

10


11/38

11

VERTIGO


12/38

Internal Ear

1. bony labyrinth

a. 3 semicircular canals

(1) frontal

(2) horizontal

(3) sagittal

b. vestibule

c. cochlea

________________

perilymph


13/38

13

CLINICAL DIFFERENCES BETWEEN VESTIBULAR AND

NON VESTIBULAR VERTIGO

SYMPTOMS VESTIBULAR

VERTIGO

NON VESTIBULAR

VERTIGO

Character Spinning sensation Dizziness,

unsteadiness

Attacks Episodic ContinuousNausea/ vomits (+)

Hearing impairment (+)/(-)

Provoking

movement

Head movement

Provoking situation (-) Crowded, traffic jam


14/38

14

CLINICAL DIFFERENCES BETWEEN CENTRAL AND

PERIPHERAL VESTIBULAR VERTIGO

SYMPTOMS PERIPHERAL CENTRAL

Onset Insidious Slower

Degree Severe Mild

Influence of headmovement (++) (+/-)

Autonomic focal

signs (nausea,

vomits, sweating)

(++) (-)

Cerebral focal signs (-) (+)


15/38

15

LOCALIZATION OF NEUROLOGICAL DISORDERS :

1. CN. VIII (VESTIBULAR NERVE)..............PERIPHERAL

2. VESTIBULAR NUCLEUSBRAIN STEM

3. CEREBELLUM

4. BRAIN

CENTRAL


16/38

16

CAUSES OF VERTIGO IN NEUROLOGY

1. CN. VIII (Vestibular nerve)

ie.: infection, tumor, trauma

2. Vestibular nucleusbrain stem

ie.: TIA/vertebrobasilar stroke, tumor, infection, trauma,

multiple sclerosis, basilar migraine

3. Brain

ie.: epilepsy, stroke

4. Cerebellum

ie.: stroke, tumor

5. Non vestibular vertigo: refractive disorder, neuropathy, myelopathy


17/38

17

CONCLUSION :

Vertigodetermine the type, location, & etiology

Vertigo needs careful history taking & physical examination

Therapy: causative, symptomatic, vestibular exercise


18/38

18

OPTIC NERVE DISORDER IN

INTRACEREBRAL DISEASE

FREDDY SITORUS


19/38

The Visual Process


20/38

20


21/38

21


22/38

CONVERGENCE

When areas of the occipital cortex detect adiscrepancy in the retinal projection from each eyeand amount of blur, a signal is sent to initiateconvergence.

To bring a near object into focus actually involvesconvergence, accomodation (lens curvature

increases) and pupillary constriction. Together, these3 movements are called the near triad.


23/38

23


24/38

24

CONVERGENCY &

ACCOMMODATION


25/38

Accomodation 1. biconvex lens

2. point of intersection 3. near object = more convex

4. far object = less convex

5. role of ciliary muscle


26/38

26

PUPILLARY REFLEX

PATHWAY


27/38

27

Examination :

1.Visual acuity

2.Color3.Visual field

4.Occular movement occulomotor muscles

5.Funduscopy


28/38

28

VISUAL ACUITY: SNELLEN CHART COLOR VISION: ISHIHARA


29/38

29

VISUAL FIELD: CONFRONTATION TEST


30/38

30

VISUAL FIELD: CAMPIMETRY

VISUAL FIELD: PERIMETRY

(TANGENT BJERRUM)

VISUAL FIELD: AMSLER GRID


31/38

VISUAL FIELD DEFECT

31


32/38

32

OCCULOMOTOR

TESTING


33/38

33

FUNDUSCOPY


34/38

34

FUNDUSCOPY

Hypertensive fundus

Hypertensive retinopathy

Diabetic retinopathyprimary

Papil atrophy

secondary

etc


35/38

35

HYPERTENSIVE FUNDUS HYPERTENSIVE RETINOPATHY

PAPIL ATROPHYDIABETIC RETINOPATHY

(PROLIFERATIVE)


36/38

36

Etiology

Acute : Acute infection, trauma, vascular

Chronic : - Chronic infection

primary

- Malignancy

secondary

- Degenerative

- Autoimmune

- Congenital

Therapy : - Depends on etiology

emergency


37/38

37


38/38

38

THANK YOU

vertigo in neurological disorder - f sitorus

Documents