8. Peripheral Central
1.Onset sudden insidious
2.Pattern episodic continuous
3.Sensation frequent infrequent
of rotation
4.Severity often intense seldom intense
5.Duration min.,hr. mo. to yr.
9. Peripheral Central
6.Influence of marked slight or none
head movement
7.Syncope never rare
8.Convulsion never rare
9.Tinnitus common rare
10.Deafness common rare
10. Peripheral Central
11.Spontaneous may be may be
nystagmus present present
12.Type of horizontal horizontal,
nystagmus vertical
13.Other CNS rare common
involvement
11. Peripheral Cause of Vertigo
BPPV
Meniere’s disease
Sudden hearing loss
Vestibular neuritis
Labyrinthitis
12. BPPV
Benign paroxysmal positional vertigo
The most common vestibular disorder
Age range 11-84 yr. Mean age at onset 54 yr
Cupulolithiasis
Canalithiasis
13.
14.
15. BPPV
Signs and Symptoms
Vertigo and nystagmus
Latency of onset , usually 2-6 sec.
Short duration , usually less than 30 sec.
Reversibility
Fatigability
Nausea , vomiting
Dix-Hallpike maneuver
30. Labyrinthitis
Virus : mump, measles, Herpes
Bacteria : syphilis , OM ,meningitis
TB more often a complication of Tubercuolus
meningitis than of Tuberculous otitis media.
Syphilis : congenital , acquire
Fluctuating episodes of hearing loss and vertigo
31. Acoustic neuroma
Acoustic schwannoma
Schwann cell tumor of vestibular part of CN VIII มักเกิด
บริเวณ Internal acoustic canal แล้วยื่นเข้าไปบริเวณ CP
angle
Initially,slowly progressive hearing loss and tinnitus .
Postural imbalance or disequilibrium.
32. Acoustic neuroma
Once the lesion compress the brainstem and
vestibulocerebellum ,central compensation becomes
impaired : vertigo , ataxia.
Audiogram : unilateral SNHL
ABR
Caloric test : hypofunction
MRI
Treatment : surgery, radiation
33. Central cause of vertigo
1.Vertebrobasilar insufficiency
Elderly
Atherosclerosis
Vertigo
Nausea,vomiting
Ataxia
Visual illusion ,visual field defect, diplopia, headache
34. Central cause of vertigo
1.1Brainstem TIA
1.2Wallenberg’s syndrome ( Lateral medullary
infartion )
1.3Acute posterior cerebellar infarction
1.4Acute inferior cerebellar infarction
35. Central cause of vertigo
2.Cerebellar hemorrhage
Vertigo
Nausea, vomiting
Headache
Stiffness of neck, incoordination
50% loss of consciousness in 24 hr.
36. Central cause of vertigo
3.Vestibular migraine
Episodes of vertigo
Increased sensitivity to motion during the attack and
increased susceptibility to motion sickness in between
attacks
In 33% of pt episodic vertigo is not associated with
headache.
37. Central cause of vertigo
3.Vestibular migraine
In 33% vertigo is associated with visual symptoms ,
dysarthria , tinnitus, decreased hearing , diplopia,
ataxia, bilateral paraesthesia, bilateral paresis or
decreased level of consciousness
38. Central cause of vertigo
3.Vestibular migraine
Treatment
Acute attack : analgesic , antiemetic
Prophylaxis for migraine attack : beta-blocker,
calcium antagonist
39. Central cause of vertigo
4. Multiple sclerosis
Vertigo without hearing loss
Optic neuritis, transverse myelitis, others brainstem
signs
40. Central cause of vertigo
5.Vestibular epilepsy
Dysequilibrium with rotational or linear vertigo
Accompany by body , head and eye rotation with or
without nystagmus
May associated with mild nausea(vomiting not typical )
