GIDDINESS ---- DIZZYNESS--------VERTIGO

These are probably some of the most common words uttered in medical practice

Vertigo

Definition Latin origin: vertere, to spin
•ANY MOVEMENT OR SENSE OF MOVEMENT,EITHER IN THE INDIVIDUAL HIMSELF OR IN THE  EXTERNAL OBJECTS,THAT INVOLVES A DEFECT,REAL OR SEEMING IN THE EQUILIBRIUM OF THE BODY.

The illusion that the environment is spinning distinct from “dizziness”
 - light-headed faintness
 - off-balanced feeling
 -feeling of floating

Types :

a. Peripheral Vertigo :
    • structures peripheral to the brainstem (8th nerve, vestibular apparatus)
    • abrupt onset with intense spinning
    • aggravated by movement or changes of posture

Causes :

Benign positional vertigo
Labyrinthitis –Viral

                     Bacterial
Vestibular Neuronitis
Meniere’s disease
Middle ear effusions/CH.SOM/Chelesteatoma
Mastoiditis
Physiologic motion sickness
Perilymphatic fistula
Otosclerosis,
Trauma – Temporal bone Fracture
                Labyrinthine Concussion
Drug induced-
Alcohol , Aminoglycosides , Chloramphenicol , Quinine , Cisplatin , Aspirin ,Phenytoin ,Phenobarbitone ,Furosemide ,Ethacrynic acid, Antihypertensive


b. Central Vertigo :
     • brain stem or cerebellum
     • less intense spinning
     • not affected by movement
 

Causes:

--CNS -Cerbellopontine angle tumors,CVA,Drugs, Ageing
Vascular- Arteriosclerosis,H/T, Anemia,Atrial Fibrillation,Postural Hypotension,Syncope
Multiple sclerosis
Complex partial seizures
Migraine with vertiginous symptoms
Infections ( meningitis, encephalitis,Syphilis)

What Can I Do to Reduce Dizziness?

•Avoid rapid changes in position, especially from lying down to standing up or turning around from one side to the other.
•Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting). •Eliminate or decrease use of products that impair circulation, e.g. nicotine, caffeine, and salt.
•Minimize your exposure to circumstances that precipitate your dizziness, as stress and anxiety or allergans. •Avoid hazardous activities when you are dizzy, such as driving an automobile or operating dangerous equipment, or climbing a step ladder, etc.

Medical management of Vertigo

Antihistamine:
Prochloroperazine/ promethazine
Ca++ Channel blocker:
Cinnarizine
H1agonist with antagonist:
Betahistine

Remember :

Most cases of dizziness and motion sickness are mild and self-treatable disorders. But, severe cases and those that become progressively worse, deserve the attention of a physician with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.
There’s a saying that dizzy patients don’t get better - they simply keep going to different doctors. The average dizzy patient, in fact, sees 4.5 physicians before getting a diagnosis, let alone proper
treatment.