Notes on Lecture: Symptomatology and Directly Prescribed Medication in Vertigo Treatment

Overview

• Discussion on various terminologies related to vertigo and dizziness.
• How to treat vertigo and related conditions.
• Importance of patient history and examination in diagnosis.
• Practical tests and approaches for assessing vestibular function.
• Medication and non-medication treatments.
• Differential diagnosis of common vestibular disorders.

Dizziness and Vertigo

• Dizziness: An umbrella term used by patients to describe sensations like vertigo, lightheadedness, and imbalance.
• Vertigo: A specific type of dizziness that includes the sensation of spinning or movement of surroundings.
• Oscillopsia: Movement of visual surroundings, often due to vestibular and visual mismatch.

Causes of Dizziness

1. Equilibrium Imbalance: Affects both vestibular aparatuses equally.
2. Peripheral Vestibular Disorders: Disorders affecting labyrinth or vestibular nerves.
3. Central Vestibular Pathways: Affecting brain vestibular pathways.
4. Cardiovascular Issues: Can increase risk and cause loss of consciousness.

Patient Examination

• History Taking: Crucial for understanding the cause, includes details on the duration, type, triggers, and associated symptoms of dizziness/vertigo episodes.
• Physical Examination: Focuses on eye movements, vestibulo-ocular reflexes, head impulse tests, and dynamic visual acuity tests to differentiate between peripheral and central causes.

Tests

• Head Impulse Test: Assesses vestibulo-ocular reflex by rapid head movements to observe corrective saccades, indicating a vestibular deficit.
• Dynamic Visual Acuity Test: Measures visual acuity during head movements to identify vestibular dysfunctions.
• Caloric Testing and Electronystagmography (ENG): Measure vestibular functions.

Vestibular Disorders

1. Vestibular Neuritis: Acute prolonged vertigo with imbalance. Treatment focuses on symptom management and encouraging normal activity as soon as possible.
2. Benign Paroxysmal Positional Vertigo (BPPV): Diagnosed by positional changes causing vertigo. Often involves posterior canal, treated with repositioning maneuvers like the Epley maneuver.
3. Meniere's Disease: Characterized by episodic vertigo, hearing loss, and tinnitus. Treated with lifestyle changes (e.g., low sodium diet), medications, and sometimes intratympanic injections or surgery.
4. Vestibular Schwannoma (Acoustic Neuroma): A slow-growing tumor causing unilateral hearing loss and imbalance. Requires monitoring and sometimes surgical intervention.
5. Central Vestibular Disorders: Often neurodegenerative or due to neurological conditions. Requires a neurologist's evaluation.

Treatment Approaches

• Medications: Generally reserved for short-term symptom management; can prolong recovery if misused.
• Rehabilitation Exercises: Improve vestibular adaptation and reduce symptoms; includes balance training and habituation exercises.
• Surgical Interventions: For specific cases like Meniere's disease or vestibular schwannoma.

Conclusion

• Importance of accurate diagnosis through a detailed history and thorough examination.
• Differentiation between peripheral and central causes is critical for effective treatment.
• Rehabilitation and proper management strategies play a vital role in patient recovery.