Understanding & Managing Vertigo : Dr Vijay Sardana
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Understanding & Managing Vertigo : Dr Vijay Sardana
- 1. UNDERSTANDING AND MANAGING VERTIGO Vijay Sardana MD,DM Professor & Head, Deptt. Of Neurology, Medical College, Kota
- 3. Vertigo Defination Illusion of spinning sensation of self or Surroundings, usually due to disturbance of vestibular system
- 6. What causes vertigo ? Contradictory information from: Vestibular, Visual & proprioceptive system
- 7. Causes of Dizziness Types of Dizziness Patients Experience Pathologic Causes Vertigo Illusion of movement of patients or Surroundings Disturbance of peripheral or CNS pathways of vestibular system Syncope or Presyncope Impending loss of consciousness Cerebral perfusion of brain falls below a critical level Disequilibrium A sense of imbalance Vestibular, Proprioceptive, Cereballer,Visiual III defined dizziness Emotional disorders Hyperventilation, Anxiety, Depression, Conversion reaction
- 48. Vertigo-Pharmacological Treatment Histaminergic Medication- Betahistine
- 49. Mode of action Betahistine Vascular Effects (in inner ear & brain) Neurological Effect (in brain)
- 50. Betahistine-Vascular Effects H3 autoreceptor Antagonist Inhibits autoregulation of histamine release Improve cochlear micro circulation Improve cerebral/vertibrobasilar blood flow H1 Agonist
- 51. Betahistine-Neurological Effects Regulates firing activity of Vestibular Nuclei Blocks H3 Receptors
- 59. Vertigo-Pharmacologic treatment Calcium Antagonist Adverse effects : Short term-Sedation,Weight gain Long term-Depression,Parkinsonism Cinnaizine(1966) Flunarizine(1985) Mechanism ? Vestibular hair cells endowed with ca channels - H1 antihistamnic properties -Sedative -Antidoaminergic action
- 67. Thanks
Editor's Notes
- e:\\vinayak\\duphar\\final\\vertin training slide kit 4a.ppt (sys pc5 vicky) Adaptation, habituation and compensation are mechanism involved in the VRT process. Adaptation is not the result of one particular system but is the distributed property of many system and CNS. Beside the basic phenomenon at vestibular nuclei, other systems like visual system, spinal cord. Cerebellum, proprioceptive ( musculoskeletal) systems play an important role Habituation is the fundamental mechanism of all adaptive processes. Repeated exposure to vestibular defect (error situation) will induce such changes in CNS that vestibular defect is annihilated for la long time. Repeated exposure to vestibular defective stimulus is the indispensable condition Compensation can take place in two ways vestibular compensation, in which normal labyrinth will send modified responses to adjust for error situation created by defective labyrinth. Non -vestibular compensation in which visual and propioceptive input will substitute for incorrect vestibular input. We will review vestibular compensation in more details in further slides.
- e:\\vinayak\\duphar\\final\\vertin training slide kit 4a.ppt (sys pc5 vicky) For the maninatanenec of stability it is very essential that electrical discharge from the two sides is equal. If one of the labyrinth is severely damaged, there will be very little or no elctrical dischage from that labyrinth. This wiil,lead to gross inequality between th etwo sides, resulting in vertigo an imbaalance. Over a period of time, after repeated exposure to this situation, Vestibular compensation is brought about by CNS mainly, through Cerebellum. CNS has an inherent capacity to bring about corrective changes when there is weakening of function on any part of peripheral nervous system. The asymmetry between the electrical discharge between the two sides is sensed by CNS and in turn it responds by causing requisite changes. It is possible by two ways. A. by increasing electrical discharge from damaged labyrinth. This is not possible. B. by decreasing the electrical discharge from normal intact labyrinth. This is achieved with the help of cerebellum by process called Cerebellar clamp or vestibular shutdown.
- e:\\vinayak\\duphar\\final\\vertin training slide kit 4a.ppt (sys pc5 vicky) Cerebellum through its connections with vestibular nuclei, induces reduction in resting electrical discharge of the vestibular nuclei, called a s vestibular shutdown. The advantage of this process is reduction in symptoms of vertigo, nausea etc. The disadvantge fo this process is reduced vestibular sensitivity. Inhibited vestibular system fails to react to vestibular assault. Hence sudden change of head position will cause vertigo, while at rest there will be no vertigo. Once acute symptoms are controlled, chronic compensation takes place. The inhibitory effect of cerebellum on vestibular nuclei is gradually removed. And requisite anatomical changes are initiated at brainstem region so that healthy labyrinth can now serve the total labyrinthine requirement of patient. This restructuring of central vestibular pathways occur so that vestibular nuyclei on the damaged side gets connected anatomically and functionally to vestibular nuclei on the healthy labyrinth side. This restructuring of the synapses at the level of brain stem is functionally very much like developments of vascular collaterals after a blood vessel has been blocked. When the natomical restrucring takes place as discussed ijn earlier slide, when there is vestibular assault e.g. sudden change in head position, Vestibular nuceli on damaged side gets input from vestibular nuclei on intact side and not from affected vestibule.
- e:\\vinayak\\duphar\\final\\vertin training slide kit 4a.ppt (sys pc5 vicky) In normal situation in healthy person, right vestibular nuclei gets information rogt vestibule and left vestibular nuclei gets input from left vestibule In vertigo episode, right vestibule is damaged, it sends incorrect input to right vestibular nuclei.. Left vestibular nuclei gets input from intact left labyrinth. Then there is a imbalance between the two sides. When the natomical restrucring takes place as discussed ijn earlier slide, when there is vestibular assault e.g. sudden change in head position, Vestibular nuceli on damaged side gets input from vestibular nuclei on intact side and not from affected vestibule. This process of central compensation is initiated and enhanced by activities provoking vertigo and inhibited by inactivity.
- e:\\vinayak\\duphar\\final\\vertin training slide kit 4a.ppt (sys pc5 vicky)