Dizziness And Vertigo
Dizziness and Vertigo
Dizziness or imbalance is a common condition that causes a lot of handicap in both active as well as elderly. Most of experience one form or the other of dizziness at some point in our life and in some cases the symptom can be quite disabling. The causes of vertigo or dizziness can be related to the ear, central nervous system, musculoskeletal system and hematological system.
Balance is maintained by three main systems visual systems, vestibular apparatus which is housed in the ear and the proprioceptive organs. The information provided by these systems is processed by the central nervous system and then the position of the body is defined.
Common causes of dizziness
Peripheral vestibular disorders
- Beningn paroxysmal positional vertigo
- Perilymph fistula
- Labyrinthitis
- Meniere’s disease
- Vestibular neuritis
- Bilateral vestibulopathy
Central disorders
- Cervical vertigo
- Stroke
- Migraine
- Traumatic head injury
- Transient ischemic attacks
- Multiple sclerosis
Psychiatric disorders
- Panic disorders
- Hyperventilation syndrome
- Agoraphobia
Other
- Low blood pressure
- Pre-syncope
- Vertebral artery trauma
- Alternobaric vertigo
- Renal disease
- EB virus
- Brainstem hemorrhage
- Medications
- Arrhythmias
- Diabetes mellitus
- Thyroid dysfunction
- HIV
- Syphilitic labryinthitis
- Freidreich’s ataxia
Managing a patient with vertigo requires a thorough evaluation. History taking from the patient or the caregiver is the most important aspect of vertigo evaluation as it provides the most important clue towards achieving the diagnosis. Details such as the onset, frequency of symptoms, duration of the attack, associated symptoms such as decreased hearing, tinnitus, aural fullness, nausea and vomiting can help to pinpoint towards the possible cause of vertigo. If a provisional diagnosis cannot be deduced from the symptomatology and details from the history, then the diagnosis remains elusive even after detailed investigations thereby the importance a detailed clinical history cannot overlooked.
The emotional aspect associated has to be taken into account while treating the patients of vertigo.
Common symptoms associated with vertigo
- Decreased hearing
- Tinnitus or ringing sensation in the ear
- Facial weakness
- Visual disturbances
- Fullness in the ear
- Discharge from the ear
- Headaches
- Blackouts or sudden attacks of losing consciousness
Common symptoms associated with vertigo
- History
- Clinical examinations-Rhomberg’s test, stepping gait test, head shake, alternating eye cover test etc.
- Audiological examination- Pure tone audiometery, impedance audiometery
- VNG
- Head up tilt tests
- Craniocorpography
- VEMP
- Radiological investigations- MRI brain, HRCT temporal bone
- ECHO cardiography
- Color Doppler carotid artery
Management of vertigo
Management is largely dependent on the diagnosis of the disease. The patient may require only positional maneuver to alleviate the symptoms or may require long term rehabilitation to restore the balance of an individual.
A. Drugs
- Anti- cholinergics- scopolamine
- Benzodiazepines- diazepam , clonazepam
- H1 agonist and H3 antagonist- Betahistine
- Anti- histaminics- diamenhydrinate, meclizine
- Calcium channel blockers- cinnarizine
- Phenothiazine group- Prochlorperazine
B. Positional Maneuver’s
- Epley,s maneuver
- Barbeque roll
- Cassani maneuver
- Semont,s maneuver
- Gufoni maneuver
