DIZZINESS Varieties. : Fainting, hypotension : Rotatory, spinning. : Muscular incoordination : Collapse without LOC: ELH : Disturbed awareness

Transcription

1 DIZZINESS Varieties head Syncope Vertigo Dysequilibrium Ataxia Drop attacks Confusion Panic Attacks Non-organic : Fainting, hypotension : Rotatory, spinning : Unsteadiness on moving : Muscular incoordination : Collapse without LOC: ELH : Disturbed awareness : Psychological aberration : Confabulation, malingering

2 Collapse on Parade: Syncope.

3 Collapse due to hypotension: Syncope.

4 Benign positional vertigo. Short-lived true vertigo upon specific positional changes: arising, rolling over, looking up. Results from otoconia displaced into the endolymph, irritating the sensory epithelium of the semicircular canal cupula.

5 ELH: Failure of the saccus drainage results in four outcomes: fullness in the ear, tinnitus, a (usually low frequency) sensori-nerual deafness and rotatory vertigo. The exact cause of failure remains undecided.

6 Vertigo: the classic low frequency sensorineural loss that accompanies the severe vertigo of of endolymphatic hydrops.

7 Healing auricular herpes zoster vesicles. Severe vertigo, profound sensorineural deafness, and facial palsy constitute Ramsay-Hunt syndrome (herpes zoster oticus). Subsequent dysequilibrium. Viral labyrinthitis.

8 Bilateral superior semicircular canal dehiscence. This can be a cause of recurrent vertiginous problems.

9 Audiology of the previous frame case, showing atypical supra-threshold sensorineural levels.

10 Right acoustic schwannoma. Lingering unsteadiness (mild dysequilibrium), associated with unilateral sensorineural deafness and tinnitus result from compression of the VIII.

11 Chronic dysequilibrium: uncompensated unsteadiness on movement or posture change (after removal of an VIII th tumour). Poor CNS adaptation to the loss of vestibular function, worse in the elderly.

12 An early axial CT scan illustrating a cerebellar abscess complicating cholesteatomatous COM, with resultant ataxia and confusion.

13 Ataxia: brainstem compression from an advancing large schwannoma.

14 Cerebellar and brainstem glioma. Gross ataxia.

15 MS. Typical periventricular enhancement on CT. Variable ataxia, depending on site and severity.

16 Further view of the prior case showing the typical enhancing lesions.

17 Drop attacks: sudden collapse without loss of consciousness. End stage of ELH. Not syncopal, no LOC.

18 Confusional state: late in the evening.

19 Gross cerebral atrophy, age related. Confusion due to dementia, or ataxia due to deterioration of the cerebellum and brainstem.

20 Past left occipito-parietal infarct. Concurrent unsteadiness due to advancing small vessel disease causing mild ataxia, a prominent cause of dizziness in the elderly.

21 Panic attacks. Lesser psychological states, e.g. neuroses or anxiety, frequently complicate the symptomatology of unsteadiness conditions and may complicate assessment.

22 Romberg test: eyes shut, feet together. Inability to maintain this stance. CNS pathology.

23 ENG: Basic caloric testing, using hot and cold irrigation tanks (above the couch) to excite vestibular responses.

24 Electronystagmography. The electrodes detect corneal movement, secondary to either innate responses or those secondary to caloric or postural stimuli.

25 Caloric testing. Each ear is tested by irrigation with hot (44 0 ) or cold (30 0 ) water for 30 seconds, the responses being recorded via the electrodes.

26 ENG tracing showing a profound right vestibular palsy post labyrinthectomy, viral labyrinthitis, VIII neurectomy etc.) Dysequilibrium likely.

27 Hyperactive ENG responses, typical of cerebellar pathology. Ataxia likely.

28 Benign positional vertigo results from canalolithiasis calcite crystals dislodged from the vestibular structures. Most respond to Epley manoeuvres, as above.