Please enable JavaScript.

Coggle requires JavaScript to display documents.

vertigo - Coggle Diagram

- - - - saccule and utricle
        
        :
        
        central nervous system
        
        fore brain
        (perceived orientation)
        
        oculomotor system
        (eye movement)
        
        spinal cord and cerebellum
        (postural control)
        
        visual, propioception, tactile input
- - - - Method
        
        Closes an eye by a paper for a moment.
        
        Removes the paper.
        
        The patient looks fixedly at the examiner's nose.
      - Interpretation
        
        Positive (vertical nystagmus): central vertigo
    - - Method
        
        The patient looks fixedly at the examiner's nose.
        
        Turns the patient's head to left or right side slowly.
        
        Turns back to the central position quickly.
      - Interpretation
        
        No nystagmus: central vertigo or normal
        
        Nystagmus: peripheral vertigo
- - - - Symptoms
        
        recurrent, sudden onset of vertigo
        
        tinitus
        
        fluctuating hearing loss
        
        aural fullness
      - Treatment
        
        rest
        
        antivertigenous drug, vestibular sedation
        
        betahistine
        
        diuretic, saltrestrict
    - - Viral
        
        Herpes zoster
      - Bacteria
        
        otitis media cholesteatoma
      - Syphilis
    - - M/C Schawannoma
      - 80% of cerebellopotine angle tumor
      - Symptoms
        
        hearing loss
        
        tinitus
        
        loss of balance
        
        mass effect
        
        CN V, VII, X, XI
        
        4th ventricle -> hydrocephalus
  - - - Define
        
        Infflammation of Vestibular nerve from virus
        
        common in 30-60 yr
      - Symptoms
        
        sudden, severe vertigo
        
        spontaneous nystagmus
        
        nausea, vomiting
        
        normal hearing
        
        อาการจะดีขึ้นช้าๆ ในเวลา 1-6 wk
      - coloric test: canal paresis or non-reresponsive
      - Treatment
        
        rest
        
        antivertigenous drug, vestibular sedation e.g.Drammine 50-100 mg
        
        เมื่อดึขึ้นควรทำ vestibular exercise เพื่อเร่ง cerebellar compensation
    - - Cause
        
        otolith จาก Macula หลุดไป deposit ที่ Cupula ของ posterior semicircular canal
      - Diagnosis
        
        อาการเวียนหัวระยะเวลาสั้นเป็นแค่นาที
        
        อาการเวียนหัวสัมพันธ์กับการเปลี่ยนท่า
        
        Dix Hallpike testpositive torsional upbeating nystagmus
        เมื่อผู้ป่วยตะแคงด้านที่มีเป็น BPPV
        
        Dix Hallpike test
      - Treatment
        
        Epley Maneuver
        
        Brandt-Daroff exercise
- - - - Vertigo
      - dizziness
      - Photophobia
      - Nausea
      - Tinnitus
      - Nystagmus
      - Visual aura
      - Phonophobia
      - Headache
    - - Most episode associated with migranous manifestation
      - Atleast 5 episodes of vestibular symptom of atleast moderate intensity
      - Each lasting between 5 minutes to 72 hours
    - - Benzodiazepine
      - Tricyclic antidepressant
      - Flunarizine
      - Beta-blocker
  - - - Neck pain
      - Neck movement limitation
      - Ataxia
    - - No reliable test
    - - Imbalace of somatosensory inputs from C1-C2 root
    - - Physical management of cervical pain syndrome
      - Medical management of cervical pain syndrome
  - - - Minutes to hours and resolves in 24 hours
    - - Numbness
      - Blindness
      - Weakness
    - - Hyperlipidemia
      - DM
      - Hypertension
      - Smoking
    - - Antiplatelet, anticoagulant
      - Consults the neurologist
- - - - near-faint
        
        orthostatic hypotension
        
        vasodepressor syncope
        
        hypoglycemia
        
        hyperventilation
        
        cadiac arrhythmias
      - physiological dizziness
        
        motion sickness
        
        mal debarquement
      - vertigo
        
        recurrent episodes
        
        head-position related
        
        yes
        
        duration
        
        fatigues
        (positioning)
        
        1 more item...
        
        non-fatigable
        (positional)
        
        4 more items...
        
        no
        
        meniere's syndrome
        
        verrebrobasilar ischemia
        
        multiple sclerosis
        
        autoimmune inner ear disease
        
        syphilis
        
        migraine
        
        single episode
        
        systemic illness
        
        transient ischemic attack
        
        syphilis
        
        otitis media
        
        vestibular neuritis
      - psychophysiological dizzness
        
        panic disoders
        
        phobic dizziness
        
        anxiety
      - dysequilibrium without vertigo
        
        endocrine disoders (hypothyroid)
        
        ototoxicity (bilateral vestibular hypofunction)
        
        extraptramidal disoders
        
        presbystasis
        
        apraxia syndromes
        
        sensory ataxia
        
        cerebella atrophy
        
        myelopathy or peripheral neuropathy
      - medical related
      - post traumatics
        
        perilymphatic fistula
        
        brainstem contusion
        
        benign paroxysmal positional vertiga
        
        postconcussion syndrome
- - - - acute peripheral vestibulopathy
      - acute brainstem lesion
    - - physical exercise
      - surgical treatment
  - - - Dimenhydramine, Phenothiazines, Benzodiazepams
      - Ca-channel blockert
      - Metoclopramide
      - ควรรีบหยุดยาเมื่อผู้ป่วยหายคลื่นไส้ โดยเฉพาะยาที่เป็น cerebral suppression
    - - Diazepam or Dramamine (ช่วงที่มีอาการมาก)
      - ร่วมกับ Proclomazine, Ca-antagonist, Antihistamine (ไม่ควรให้ยาเป็นระยะยาว)
    - - Ca antagonist, Histamine analog
      - Meclizine, Cyclizine, Dimenhydramine, Scopolamine
      - รายที่เป็นเรื้อรัง ควรพยายามหยุดยาทุกชนิด และทำกายภาพบำบัด
    - - Clonazepam, Baclofen, Carbamazepine