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VERTIGO

What is vertigo?
Vertigo is the illusion of spinning of yourself or your surroundings.(pt will see surrounding is rotating around him)
IS IT SAME AS DIZZINESS?
NO dizziness is false vertigo

Dizziness is a term that is used to explain different sensations, such as lightheadedness and spinning heaviness in head. TRUE VERTIGO is accompanied by an involuntary, rapid, rhythmic eye movement (nystagmus). Hence pt will always say surrounding is rotating n imbalance during the episode.

CAUSES OF DIZZINESS.
Decrease in circulating blood and oxygen to the brain
Irregular heart rate or rhythm (dysrhythmia) can result in a sudden reduction in the amount of blood pumped to the brain and can cause dizziness.
cerebral transient ischemic attack, or TIA Temporary deficiency of blood in the brain secondary to narrowing of the arteries in the brain also can result in dizziness.
orthostatic or postural hypotension Sudden change in position from sitting or lying to standing can cause a drop in blood pressure and dizziness.
Drug indused vasodilators, decongestants, antidepressants, antihypertensives, antihistamines, or diuretics.
Anemiadue to blood loss; and from decreased blood volume or fluid loss from trauma or sweating (dehydration).
Sncope When lightheaded dizziness leads to syncope or loss of consciousness, problems with blood circulation (heart, blood vessels, and problems that affect their function) must be checked.
Systemic diseases diabetes mellitus, multiple sclerosis, and Parkinson's disease.

Causes of true vertigo
Vestibular neuronitis : here pt will have rotational vertigo with imbalance n vomiting for few days . it’s due to infection of balance nerve.
Labyrinthitis : here the whole inner ear is infected hence pt will have rotational vertigo , imbalance , vomiting along with decrease hearing which may be permanent .
Menie’rs disease. The fluid pressure in the inner ear increase due to blockage of endolymphatic duct thus pt feels vertigo till the pressure get back to normal .thus these pt will have true vertigo lasting for few hrs n will be episodic. They will be with feeling of fullness or block ear n tinnitus (whistling sound) in ear which disappear when the episode end.
BPPV : BEINIGN PAROXIXMAL POSITIONAL VERTIGO :. This is commonest cause of vertigo. There are three balance pipes vertical , horizontal n posterior canal. They gives our head position information to brain. Thus if there is any irritativeparticles in these canals they give false stimulatory signals to brain and we feel we are rotating. This is particularly in some position depending on which pipe is involved .Like commonest is posterior pipe where pt gets vertigo on looking up n in bed witheout pillow. In lateral canal bpppv the vertigo is only in bed while turning to sideways. Anterior is very rare here the vertigo is only on looking up or bending down. The vertigo will last for few seconds only if pt stays In that position .these are also episodic vertigo lasting for few seconds for few days. Hence the name paroxysmal positional vertigo. Mainly seen in old age group or after haed injury in younger age group.

HOW DO YOU DIAGNOSE VERTIGO
from the history it self 90% diagnosis is made
History: The individual will be questioned in detail as to when dizziness occurs, the nature of the dizziness, how long the spells last, other concurrent symptoms, and a history of other disease processes. The individual may complain of lightheadedness, spinning (vertigo), fainting (syncope), unsteadiness, a tilting sensation, motion intolerance, and the sense that surrounding noises are growing fainter and fainter. Sometimes other symptoms such as nausea, vomiting, visual blurring, tinnitus, sweating, generalized discomfort, headache, weakness, and disorientation are reported to accompany dizziness.

Examination.:
We examine the peripheral system that is labyrinth by 1] Romberg test: pt need to stand straight with eyes closed.

2]uttenberger test: pt need to march at one spot with close eye Any imbalance in these test signify labyrinthine problem may present as our balance depends on three inputs to brain 1. Eyes ,2.joint sensor ,3. Labyrinth so if we close eye we depend on joint n labyrinth for balance if its disease we may fail to balance ourself.



3] nystagmus: these are spontaeneous eye movements in response to the stimulation from labyrinth. Depends on the nerve involved sup or inf vestibular n .andrt or lt ear the direction of eye movements differ. Hence if they are presents give no of information about the pathology .

To help me you can record these movements in your mobile camera as well when the pt is actually feeling rotational vertigo . just ask the pt to look in camera . be steady for one min , then move u r camera to rt wait for 1 min n then move u r camera to lt n wait for one min.

4] Dix halpikestest : THIS IS SPECIFIC TEST FOR BPPV (BENIGN PAROXIMAL POSITIONAL VERTIGO). Here I will take your head down in particular direction in particular angel so as to stimulate each balance pipe. Here I can see the direction in your eye and can say which pipe is involved. Depending on that I can try and take these particles out of canal and thus releave your symptoms permanently.see video

CAN THE VERTIGO BE CUERED

YES IF DIAGNOSIS IS MADE THE VERTIGO CAN BE COMPLETELY N PERMANENTALY CUERED. IN BPPV ONCE THE PT HEAD IS ROTATED IN PERTICULAR MANNER 90% OF PT WILL NOT HAVE VERTIGO IN FUTURE..AND ALSO THEY WILL NOT REQUIRE ANY MEDICINE AT ALL.
lets see some of the video of real pt treated by manuvers

POSTERIOR CANAL BPPV


LATERAL CANAL BPPV BPPV.





          Dr. Prashant Manohar kewle © 2014
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