Hello steemian do you had vertigo before or know someone have vertigo now? 21% of people visiting clinic have dizziness in their complain, In this blog I will break up differential diagnosis of vertigo and give you unique feature to each one also I will try to explain warning sign that should make patient seek medical advice immediately.
image
Vertigo vs dizziness
People use dizziness as a common general word for variety of things like
Vertigo : feeling of spinning or external object moving while you are stand still (not moving)
Unsteadiness : sense of imbalance and staggering especially when walk ,
Syncope : temporary or transient loss of conscious , presyncope is sense of fainting or about to faint.
it is normal to feel dizzy looking at this image
an example so you can test how vertigo feels
If you have one of those the first thing to ask about special situation (high attitude, pregnancy, intense emotion,,, etc) to exclude emotion sickness, second to rule out the most common cause of dizziness anemia and hypotension, especially if you dizziness is mild to moderate and associated mainly with change in position or sudden standing from setting position.
Vertigo , unsteadiness , lightheaded and syncope What can't we just say dizziness ?
It may look the same for you but each one of those indicate usually totally different pathology, for example syncopal attack make doctor think about hypotension first then cardiac cause like arrhythmia. Vertigo make doctor think about inner ear disease and neurological disorder. anyway we will focus in Vertigo in this blog.
Most common cause of Vertigo
1 - Benign paroxysmal positional vertigo (BPPV)
2 - Vestibular neuritis
3 - Vertebrobasilr ischemia
4 - Viral lybyrinthitis
5 - Miniere's dieses
6 - Acostic neuroma
Benign paroxysmal positional vertigo (BPPV)
most common among the list, it is disorder of inner ear due to collection of calcium crystals dislodge from it usual place and cause symptom with change in position
Usually gradual onset, triggered by change in head position, each episodes lasts for about 15 seconds but not affect hearing.
Can be diagnose and cured with special clinical test and maneuver.
Dix-Hallpike clinical test to diagnose BPPV
Epley maneuver, to treat BPPV
Vestibular neuritis
It is a disorder of peripheral vestibular system, it is not an infection the correct word to describe pathology here is neuropathy. Usually follow recent upper respiratory tract ( nose, mouth, throat or pharynx, larynx) viral infection, presented with recurrent vertigo attack usually not associated with change in position and lasts for hours or days, no hearing loss.
image
Vertebrobasilr ischemia
Also called beauty parlour syndrome, it is due to decrease blood flow (ischemia) to posterior circulation of the brain Usually presented in elderly patient with dizziness on extension of the neck
Viral lybyrinthitis
Infection or inflammation of inner ear, associated with recent viral infection, presented with sudden onset of Nausea, Vomiting and Vertigo, hearing maybe affected.
Miniere's disease
It is inflammatory disorder of inner ear not fully understood but usually affect one ear at least in the beginning , presented with triad (3 symptom) 1 – dizziness 2- tinnitus (ringing sound) 3- sense of ear fullness . associated with hearing loss.
Acostic neuroma
It is benign tumor of vestibulocochlear nerve usually associated with disease called neurofibromatosis type 2but can occur spontaneously. The trick that it present like Miniere's disease with Vertigo, Tinnitus and associated with hearing loss. The unique feature that could give you a clue is sign in clinical examination there is absent corneal reflex
patient usually close their eyes involuntary when touched by object without seeing it corneal reflex) those who affected have defect in this response because it need intact trigeminal & facial nerve .
image
When it is alarming and I should seek medical advice immediately ?
If vertigo is sudden, sever, associated with tinnitus or hearing loss, if there is any convulsion, weakness or abnormal sensation.
Thank you for reading this blog, i hope it helped
