- can be crossed, with some symptom right and others on left - ataxia - dysarthria - dysphagia - Hearing loss - drop attack - Sign of cerebellum disfunction (Adams Jr. et al., 2002)
Common Causes of Vertigo 1. Otologic Disorders • BPPV • Meniere Disease • Vestibuler Neuronitis / labyrinithis 2. Neurologic Disorders • Migraine-associated dizziness • Vertebrobasiler Insufficiency • Panic Disorders
DIAGNOSTIC CRITERIA for BPPV Vertigo associated with a characteristic mixed torsional and vertical nistagmus provoked by the Dix-Hallpixe test A latency (typically of 1 to 2 second) between the completion of the Dix- Hallpixe test and the onset of vertigo and nystagmus Paroxysmal of the provoked vertigo and nystagmus ( an increase and then a decline over a period of 10-20 seconds) Fatigability: A reduction in vertigo and nystagmus if the Dix-Hallpike test is repeated
Head Acceleration Head angular Velocity Endolymph Displacement Cupular Angle Cilia Bending Receptor Cell Potential Synaptic Action Generator Potential Primay Afferent Action Potentials CNS Posture VOR Perception Ket: CNS: Central Nervous System VOR: Vestibulo Ocular Reflex
• Symptoms: Acute, spontaneous vertigo accompanied by ringing and pressure in a particular ear, with temporary decrease in hearing. Symptoms clear between attacks, but in the late stages (months to years of attacks) the hearing loss becomes permanent. Also, the other ear may become involved later. • Mechanism: Swelling of the inner compartment (endolymphatic) of the inner ear. • Cause : Unknown • Treatment: Diet: avoid salt and caffeine. Medication: diuretics, Corticosteroid. Meniere’s Disease (Endolymphatic hydrops)
Symptoms: Acute onset, often following a flu-like illness, of severe spinning vertigo. No hearing loss or tinnitus. Recovery occurs gradually over a period of days to weeks. Mechanism: Usually an inflammation of a vestibular nerve, Diagnosis: Spontaneous nystagmus, no loss of hearing (usually), no other signs of neurological disease. Differential: Often confused with the first attack of Meniere’s Disease or BPPV. Treatment: Anti-nausea medications (Meclizine, Valium, etc.) for control of symptoms in the acute phase only. After that, they may interfere with compensation and recovery. A short course of corticosteroid and anti-viral medication often promotes recovery. Vestibular Neuronitis ("Acute labyrinthitis")
THEORY of VERTIGO 1. Sensory Conflict 2. Neural mismatch 3. Dysequilibrium otonomic nerve 4. Neurohumoral
Respond To Stress
BAEP The Advantage • This test is used to check hearing in cooperate or uncooperative patients, such as babies, young children, and people in coma. • It is also helpful in determining whether certain hearing problems are physical or psychological .
Who is the Candidate ?
- Fall '19