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Common peripheral neuropathy :musical_note: (:three: Vestibular neuritisâĶ
Common peripheral neuropathy
:musical_note:
:one:
Benign Paroxysmal Positional Vertigo (BBPV)
:star: M/C found peripheral vertigo
Epidemiology in Thailand :female_sign: : male = 2:1
PathoPSO
Calcium carbonate crystals (otoconia) that normally in utricle
migrate into Semicircular canals
(
posterior canal is m/c
affected due to its anatomical position)
Mechanical problem in Inner ear that causes spinning sensation when moving head against gravity
Signs & Symptoms
Severe dizziness occurs as attacks triggered by Head movements
Spinning sensation
Loss of balance or Unsteadiness
N/V
Ipsilateral torsional/vertical/horizontal nystagmus
:fireworks:
NO
Hearing Loss and neurological symptom
PE
Dix-Hallpike maneuver
Further Inx
Electronystagmography (ENG)
Audiogram
MRI
Mx
Medication for symptomatic Rx
Physical therapy
Canalith repositioning therapy
Epley maneuver
for Posterior semicanal BPPV
Lempert maneuver
for Lateral canal BPPV
Deep head hanging maneuver for Superior canal BPPV
Vestibular rehabilitation
Surgery
:three:
Vestibular neuritis
Inflammation of vestibular nerve results in Hypofunction of affected sides and causes vertigo
Common cause of
Acute
onset
Nonrecurrent
vertigo
Typically
NO assoc. hearing loss
Epidemiology: affect middle age to elderly (can occur at any age), no gender predom
Causes: mainly caused fr
Viral infection
or Autoimmune ds
PathoPso
theres two things that can happen
Neuritis: Affect balance â Dizziness but No loss in hearing
Labyrinthitis: Results in Dizziness, Vertigo, & Hearing loss
Signs & Symptoms
Hx of URI infection prior
Sudden vertigo
No assoc. Hearing loss
Balance issues
N/V
Dizziness
Trouble concentrating
Investigation
Treatment
Diazepam + Vestibular suppressants
both uses until 1 wk then āļāđāļāļĒāđtaper off
:two:
Meniereâs ds
Caused by Episodic disturbances of Endolymph(āļāđāļģāđāļāļāļāļĨāļĨāļđāļ) formation and resorption
Signs & Symptoms
Vertigo at least 20 min
Hearing loss (Burnt out Meniereâs ds)
Tinnitus
Drop attacks
Dx
No specific Dx test
Criteria
need all 3 for Definite Dx
2 spontaneous episodes of Rotational vertigo lasting at least 20 mins
Audiometric confirmation of Sensorineural Hearing loss
Low freq
or Combined low- and high- freq sensory loss
Normal hearing in the mid frequencies
Hearing
loss flattens out
Tinnitus
and/or a perception of
Aural fullness
Further Inx to R/O Ddx
PE
During attack
Looks for
spontaneous nystagmus
After attack looks for
submerged nystagmus
Head thrust test/Halmagyi test
Stepping test/Unterberger test
Past pointing test
Head shaking test
Gaze-evoked nystagmus
Romberg/Sharpened Romberg test
Tandem gait
Mx
Medications
Motion sickness meds such as Meclizine or Diazepam (Valium)
Anti-nausea medications eg Promethazine
Diuretic (Hydrochlorothiazide) + Limit dietary salt intake
Betahistine for improving inner ear perfusion
Non-invasive therapies & procedures
Rehabilitation to improve ur balance
Hearing aid in ear affected by Meniereâs ds might improve ur hearing
Meniett device for improve fluid exchange
Middle ear injection
Gentamicin (toxic to inner ear so āļāļģāļĨāļēāļĒāļāļąāļ§āļŠāđāļāļŠāļąāļāļāļēāļ)
Steroids such as Dexamethasone may help control vertigo attacks in some people
Surgery
Endolymphatic sac procedure
Vestibular nerve section
Labyrinthectomy
Prevention
Lifestyle & Home remedies
Coping support