| ID | 107 |
|---|---|
| Name | VERTIGO (Dizziness) |
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| Introduction | The terms vertigo and dizziness are generally used to denote the subjective sensation of rotatory movement either of the individual or of the environment and simply an inability to orient the body in relation to surrounding objects |
| History | |
| Etiology | Etiology: 1. Meniere’s disease 2. Drugs (gentamicin, anticonvalsant intoxication) 3. Toxin’s- ethyl alcohol 4. Vestibular neuronitis 5. Multiple sclerosis 6. Migraine 7. Acute cerebral lesion 8. Cerebellopotine angle lesion 9. Partial seizures (temporal lobe focus) 10. Brain stem ischaemia/infarction 11. Benign positional vertigo. |
| Clinical Features | Clinical features: The commonest cause of vertigo is disturbance of labyrinthine function and the commonest form arising in the labyrinth is meniere’s disease. It is characterised by attacks of vertigo, nausea, vomiting, flactuating deafness and tirfhitus; nystagmus is observed during attacks. Vestibular neuronitis is probably infective. The onset is sudden, may be associated with vomiting and nystagmus. There is no auditory complaints. Symptoms: 1. Lesions of the vestibular part of the eighth cranial nerve specially involving the* vestibular nuclei and their connections may cause vertigo. 2. Vertigo can occur in migraine arid localised lesions either vascular or neoplastic in the posterior part of the temporal lobe. 3. Vertigo may be provoked by movement of the head which may follow head injury or ear infection, known as positional vertigo. 4. Vertigo and giddiness is common in patients with anxiety neurosis. |
| Preventions | |
| Treatment | Treatment: 1. Patient with hyperactive labyrinth-Meclizine 25mg 3-4 times daily. Or, Diazepam 5mg 3 times daily. 2. Vestibular neuronitis-Prednisolone in the usual dose. 3. Vertigo in association with migraine-Treatment as migraine. 4. For nausea and vomiting- Chlorpromazine 25mg i.m 6 hourly. 5. Balancing exercise may be helpful. 6. Remove etiology whenever possible. Treatment of vertigo associated with meniear’s disease: During acute attack- 1. Bed rest 2. Vestibular sedations by- Cinnarizine 15-30mg 8-hourly. Or, Prochlorperazine 5-10mg 8-hourly. 3. In more severe attack- Inj. Prochlorperazine 12.5mg i.m stat. Or, Inj. Cyclizine 50mg i.m/i.v may be given 4. Diuretic- Inj. Frusemide 40mg (20mg/amp) i.v may be given to reduce the endolymphatic pressure. Prophylaxis: Vasodilator such as- betahistine 8mg 8-hourly sometimes may be effective to prevent recurrent episodes |
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