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Dizziness and Vertigo By Dizziness and Vertigo By

Dizziness and Vertigo By - PowerPoint Presentation

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Dizziness and Vertigo By - PPT Presentation

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

dizziness vertigo system vestibular vertigo dizziness vestibular system http common maneuver head prescription hearing www epley artery symptoms vertebral

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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