2026/2/26 1 Vertigo
2026/2/26 2 Vertigo • Disturbance of the sense of equilibrium and movements • Feels surrounding / onself rotating • Defined as ‘subjective sense of imbalance’ or ‘the hallucination of movement’ • Varies mild imbalance of dizziness to severe incapacitating vertigo • c/f – syncope (fainting)
2026/2/26 3 Causes of vertigo • Physiological : Heights Spinning movements Floor texture • Functional • Pathological causes in the ear – labyrinthitis,Meniere’s syndrome – MD, BPPV, vestibular neuronitis,VS, trauma, PL fistula, CSOM vascular,motion sickness, ototoxicity causes outside the ear – CVS – hypertension, hypotension,BBB, AR,MR,arrhythmias CNS – vertebrobasilary syndrome,MS, tumour,abscess,migraine, epilepsy, ICP,head injury metabolic – DM,hypoglycaemia,hypothyroidism anaemia,eye – diplopioa, RE, glaucoma cervical spondylosis
2026/2/26 4 Approach to a case of vertigo • History • History • History • Examination • Investigations • Treatment
2026/2/26 5 History taking in Vertigo • DOPEA (duration,onset,progress, effect,associated symptoms) • Is it a true vertigo ? • First attack, frequency • Precipitating factors • Trauma,infection • PMH,medication,alcohol
2026/2/26 6 Examination of a vertiginous patient • Complete otological/neurological examination • Middle ear normal ? • Hallpike in BPPV • Nystagmus • Cerebellar tests • Romberg,Unterberger test • Gait assessment
2026/2/26 7 Investigations of a vertiginous patient • Audiovestibular investigations : Pure tone audiometry, Evoked Response Audiometry (also k/a ABR, BERA) Caloric test, Electronystagmography (ENG) Posturography • MRI with gadolinium enhancement • Other investigatons according to suspected cause
2026/2/26 8 Treatment of vertigo • Treat the cause if possible • Vestibular rehabilitation – mainstay of treatment Counselling, reassurance, different exercises In BPPV – Epley manouvre, Brandt-Daroff exercises • Symptomatic relief – labyrinthine sedatives prochlorperazine – im, iv or oral cinnarizine betahistine anxiolytic No vasodilators after head injury & MI • Surgery – limited role
2026/2/26 9 Surgical treatment of vertigo • Meniere’ disease – endolymphatic sac decompression, vestibular neurectomy, labyrinthectomy • Middle ear infusion of aminoglycosides via RW • BPPV – singular neurectomy Post SCC obliteration
2026/2/26 10 Benign Paroxysmal Positional Vertigo (BPPV) • The most common cause for peripheral vertigo • Brief but violent attacks of vertigo provoked by certain head positions • No auditory symptoms • Attacks variable, usually 3 weeks. Recurence common • Etiology – canalolithiasis. Closed head injury,degeneration,stapes surgery,no cause • Dx –history +Hallpike manouvre – head 30* turn & 30* down, nystagmus : latency, rotatory towards underlying ear,fatiguable,no change in direction, with vertigo • Treatment : General principle, Epley manouvre, Singular neurectomy or PSSC obliteration