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dizziness
The document discusses dizziness, its types (vertigo, disequilibrium, pre-syncope, syncope), common causes, diagnostic approach, examination findings, investigations, and treatment. The diagnostic approach involves taking a thorough history and conducting physical examinations like neurological and vestibular tests. Common causes include peripheral vestibular disorders, central nervous system issues, and psychiatric conditions. Treatment is directed at the underlying cause, which may include medication, repositioning procedures, rehabilitation therapy, or lifestyle changes.
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dizziness
- 1. dizziness dizziness HebaAl-thuwaini – Bayan Alsultan Group : 1
- 2. 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?
- 3. Case summary A45 years old female presents with the primary complaint of being “ dizzy ”
- 4. Dizziness • Dizzinessis the feeling of being lightheaded, woozy, or unbalanced.
- 5. Types Of Dizziness Vertigo 54% Disequilibrium Pre-syncope syncope
- 6. Types Of Dizziness • 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 .
- 7. Causes of dizziness Vertigo Disequilibriu m Pre-syncope syncope
- 8. Systems That Maintain Balance vision Vestibular labyrinth proprioceptors
- 9.
- 10. Peripheral Causes of vertigo • Benign paroxysmal positional vertigo (BPPV) : 20% • vestibular neuronitis (labyrinthitis):15% • Meniere’s disease:10% • Drugs (aminoglycosides)
- 12. Benign paroxysmal positionalvertigo (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.
- 14. 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.
- 15. 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
- 17. Central causes ofvertigo • Vascular disease ( vertebrobasilar insufficiency): 50% of central causes • Demyelinating (Multiple sclerosis) • Drugs (anticonvulsants, alcohol, hypnotics)
- 18. 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.
- 19. 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.
- 20. 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
- 21. Causes of Pre-syncope • Caused by psychiatric disorders: ·Major depression 25% ·Generalized anxiety or panic disorder 25% ·Somatization disorder ·Alcohol dependence ·Personality disorder ·Hyperventilation
- 22. Causes of Syncope • Drop in blood pressure (orthostatic hypotension). • Inadequate output of blood from the heart. • Dehydration • Low blood sugar
- 23. The approach toreach the diagnosis
- 24. 1- Taking History • History alone reveals the diagnosis in roughly three out of four patients complaining of dizziness
- 25. What to ask! 1- ask patient what he mean by “ I’m dizzy” ?
- 26. What to ask! 2- Or ask the patient questions to identify the type of dizziness.
- 27. What to ask! 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 ?
- 28. 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 .
- 29. 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.
- 30. Weber’s test Hearingtests: Rinne test
- 31.
- 32.
- 33. Romberg test Gaittest Dix-Hallpike maneuver :Examining Vestibular system
- 34. Fukuda test Finger-nosetest Tandem walking
- 35. Examining eye function •Electronystagmography (ENG) - tests vestibular function by using electrodes to detect nystagmus. •Frenzel goggles
- 36. Investigation • Patientswith sudden ongoing attacks, should have: pulse oximetry Glucose test Pregnancy test
- 37. Further investigations include ECG MRI Audiological evaluation
- 38. • Laboratory teststests such as electrolytes, glucose, blood counts, and thyroid function tests are rarely helpful. • Except for patients with chronic vertigo and bilateral hearing loss.
- 39. 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.
- 40. • 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).
- 42. Complication • Patientswith 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.
- 43. Prevention Dizziness isneither 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.
- 44. Simple self-care tipsthat 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.
- 45.
- 46. Reference www.merckmanuals.com www.ncbi.nlm.nih.gov www.aan.com www.dizziness-and-balance.com
- 47.
Editor's Notes
- #7 There are four types of dizziness: vertigo, dysequilibrium, presyncope, and syncope. The most prevalent type is vertigo which accounts for 54 percent of reports of dizziness in primary care.
- #9 \ The body maintains balance with sensory information from three systems: vision proprioception (touch sensors in the feet, trunk, and spine) vestibular system (inner ear) Sensory input from these three systems is integrated and processed by the brainstem. In response, feedback messages are sent to the eyes to help maintain steady vision and to the muscles to help maintain posture and balance.
- #13 the utricle and saccule — contain crystals that make you sensitive to gravity. For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. this causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.
- #15 The vestibular nerve is one of the two branches of the vestibulocochlear nerve, functioning in tandem with the cochlear nerve. It has the job of transmitting data that has to do with the regulation of the sense of balance to and from the brain.
- #16 The semicircular canals sense movement of the head and help to control balance and posture. The cochlea is concerned with hearing. Messages of balance and sound are sent down nerves (the vestibular nerve and the cochlear nerve) to the brain.
- #19 The vertebrobasilar system is located at the back of the brain and includes several blood vessels, the vertebral and basilar arteries. These vessels supply blood, oxygen and nutrients to vital brain structures. In addition, the vertebrobasilar system supports the occipital lobes, which are responsible for vision, and the cerebellum, which is responsible for balance and coordination.
- #20 drugs (anticonvulsants, alcohol, hypnotics)
- #21 Improve dramatically when patient touches a stationary object.
- #23 Drop in blood pressure (orthostatic hypotension). A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. Inadequate output of blood from the heart. Certain conditions such as any of the various diseases of the heart muscle (cardiomyopathy), an abnormal heart rhythm (arrhythmia) or a decrease in blood volume may cause inadequate blood flow from your heart.
- #26 1- what they mean when they say they are dizzy ?