Meighan OConnor POPPF Dizziness and Vertigo Dizziness includes lightheadedness motion intolerance imbalance floating or vertigo Vertigo is a type of dizziness defined as the illusion of the environment or oneself spinning ID: 711577
Download Presentation The PPT/PDF document "Dizziness and Vertigo By" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Dizziness and Vertigo
By
Meighan
O’Connor, POPPFSlide2
Dizziness
and Vertigo
Dizziness includes lightheadedness, motion intolerance, imbalance, floating or vertigo.
Vertigo is a type of dizziness defined as the illusion of the environment or oneself spinning.
A
pproximately 40 % of dizzy patients have peripheral vestibular dysfunction; 10 % have a central brainstem vestibular lesion; 15 % have a psychiatric disorder; and 25 % have other problems, such as
presyncope
and disequilibrium.Slide3
CC: “Dizziness”
HPI: 52 y/o female with h/o Ehlers
Danlos
type IV and migraines complains of “dizziness.” She states that earlier today she was walking into her living room and suddenly started stumbling to the right and fell into the floor. While she was lying on the floor she could not focus on objects and the room would not stop spinning. She denies nausea, vomiting, sweating, syncope, numbness, tingling, weakness, other vision or hearing changes, trouble speaking, new or severe h/a, or chest pain. After two minutes the sensation went away and she was left with 2/10 pain on the left side of her neck and head that is still present. She said this has never happened before. Slide4
Meds:
Imitrex
prn
,
PMHx
: Ehlers
Danlos
Type IV diagnosed three
years ago, migraines for past 25 years.
SHx
: Sigmoid colon perforation repair 30
years ago.
SocHx
: Denies using tobacco products or ETOHSlide5
PE
Vitals: BP 134/87 standing, 138/88 supine
Pulse 80; RR 14
HEENT: PERRLA, EOM intact BL; Tympanic membrane grey and reflective BL, Weber and
Rinne
hearing test negative BL; Nasal
turbinates
non-inflamed, pink and moist BL; Throat pink and moist, no ulcers.
Cardio: No carotid bruits or murmurs
auscultated
BL, normal rate
Neuro
: CN II-XII intact BL, sensation was intact BL and DTR were 2/4 BL, heel-toe walking was normal.
MSK:
F
ull ROM of cervical spine BL, C2-C5FRLSL with associated hypertonic
paraspinals
BL
Cranial: CRI at 16 cycles/minuteSlide6
DDX
TIA
CVA
Vertebral Artery Dissection
Brain Tumor
BPPV
Vestibular
Neuronitis
(
mcc
acute vertigo)Slide7
Common Causes of Dizziness:
Dizziness not including vertigo is more likely
due to central nervous system (CNS
) such as MS, cardiovascular such as CVA and
orthostatic hypotension,
or systemic
diseases such as anemia where the symptoms are often gradual
and
ill-defined.
Cardiovascular disease is important to rule out in the elderly, although dizziness at a late age may have multiple etiologies.Slide8
Common Causes of Vertigo
Inner Ear Pathology:
Vestibular
N
euronitis
is the most common cause of acute vertigo and may result from a reactivation of HSV that affects the vestibular ganglion nerves. Vertigo is without auditory or other CNS symptoms and lasts for several days
Benign Paroxysmal Positional Vertigo
is the second most common cause of vertigo. Typically patients experience brief vertigo upon changing head or body position. The mechanism of BPPV can be due to
canalithiasis
(
otoconia
floating in the
endolymph
) or
cupulolithiasis
(
otoconia
adherent to
cupula
).
Ménière
Di
sease
presents with symptoms of episodic vertigo, tinnitus, and hearing loss. Untreated, severe hearing loss and unilateral vestibular paresis are
inevitable. The
common
pathophysiology
is disordered fluid homeostasis in the inner ear.
Other Pathology: TIA or Stroke, MS, post-traumatic as with concussion,
medicatons
, migrainesSlide9
Modified
Epley
ManeuverSlide10
Epley
Maneuver Slide11
CC: “Dizziness”
In order to r/o vertebral artery dissection, an MRA was performed.
The test
showed a diminutive left vertebral artery with a focal area of absent/decreased flow and abnormal signal
hyperintensity
from the C1-2 through the C5-6 levels. These findings likely represent dissection of a short segment of vertebral artery
.
Patient was given
intravenous heparin and then switched to
warfarin
anticoagulationSlide12
TX
Medications:
An antihistamine, such as the prescription medicine
meclizine
,
or non-prescription medicines like
dimenhydrinate
,
or
diphenhydramine
.
Prescription anti-nausea medicines, such as
promethazine
,
metoclopramide
,
or
ondansetron
.
Prescription
sedative medicines, such as diazepam,
lorazepam
, or
clonazepam
Canalith
repositioning
:
Maneuvers such as
Epley
Maneuver is a treatment that may be recommended for people with benign paroxysmal positional vertigo (BPPV). The purpose is to reposition any
otoliths
in the vestibular canals
.
Balance rehabilitation:
Most patients with vertigo prefer to keep their head still. However, staying still and not moving the head can make it harder to cope with vertigo. Rehabilitation can help people with vertigo that is caused by injury to the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
The rehabilitation works by helping your brain adjust its response to changes in the vestibular system. The therapy can also help train your eyes and other senses to "learn" how to compensate. This therapy is most helpful when it is started as soon as possible after you develop vertigo.Slide13
OMT
Dizziness can be caused by a temporal bone
dysfuncion
-specifically the bone becomes internally rotated, compressing the
vestibulochoclear
nerve (CN VIII) which can also cause
tinnitis
.
SCM
hypertonicity
especially when chronic can pull the temporal bone and cause local tissue inflammation, blocking the lymphatic flow. i.e.
meniere's
syndrome.
Otitis
media can give vestibular symptoms that can be treated using the raking the face maneuver.
Many case studies have been reported where treating the cervical soft tissue and joints gave significant or complete relief of dizziness. Somatic dysfunctions of the cervical spine including OA, upper
thoracics
and cranium should be treated.Slide14
References
Dizziness, Vertigo, and Imbalance
Author:
Hesham
M
Samy
, MD, PhD; Chief Editor: Robert A Egan, MD http://emedicine.medscape.com/article/1159385-overview#a30;
Patient information: Dizziness and vertigo;
Author Joseph M Furman, MD, PhD; Section Editor Michael J
Aminoff
, MD,
DSc
; Deputy Editor Janet L
Wilterdink
, MD
http://www.uptodate.com.ezproxylocal.library.nova.edu/contents/patient-information-dizziness-and-vertigo?source=search_result&search=epley+maneuver&selectedTitle=2%7E4
A Case of Dizziness
, http://www.ferne.org/Lectures/dizziness1001.htm#AB
Osteopathic Approach to Vertigo,
Developed for OU-COM CORE
by
: Derek Stone,
DO. 2006. http://www.ohiocore.org/gfx/media/contribute/Session9CranialPPT_000.pdf
Dizziness and Vertigo,
Attorney & Physician Advisory
Board,
American Medical Forensic Specialists, Inc. http://www.bailey-law.com/docs/dizziness-and-vertigo.htm