Medical knowledge | Otorhinolaryngology, ear, nose, throat » Dr. Ágnes Szirmai - Vestibular system disorders

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Year, pagecount:2010, 32 page(s)

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Source: http://www.doksinet Dr. Agnes Szirmai Source: http://www.doksinet Source: http://www.doksinet Source: http://www.doksinet Labyrinth Vestibular nerve Vestibular nuclei Vestibular pathways (vestibulocerebellar, vestibulospinal, vestibuloocular, vestibuloreticular) Source: http://www.doksinet Space orientation Proprioceptive afferentation Brainstem nuclei and pathways Visual field control Visual afferentation Vestibular afferentation Muscle tone control Source: http://www.doksinet ORL Psychiatry Rheumatology Neurology Vertigo Family care Ophthalmology Internal medicine Source: http://www.doksinet ™Case history ™Nystagmus ™Vestibulospinal function (Romberg- test, blind walking test) ™Provoked nystagmus (special tests) Source: http://www.doksinet Previous vertigo-provoking diseases: heart diseases, blood-pressure, renal failures, drugs, ear diseases, neurological diseases, neck vertebra problems Types of vertigo: rotatory vertigo, unsteadiness,

lightheadedness, imbalance Length of vertigo : seconds, minutes, hours, days, constant dizziness Single ⇔recurrent attacks Concomitant symptoms: hearing loss, tinnitus, discharge from ear, nausea, vomits, loss of consciousness, headache Source: http://www.doksinet Differential diagnostic value Length of vertigo Disease Seconds Benign positional paroxysmal vertigo Minutes Labyrinthine fistula Hours Meniére’s disease Days Vestibular neuronitis, herpes zoster, labyrinthitis Constant vertigo Pyramid bone fracture, Vestibular schwannoma Source: http://www.doksinet DIFFERENTIAL DIAGNOSTIC VALUE ™Hearing loss is obligatory: ™Conductive: labyrinthitis ™Sensorineural: ™Cochlear lesion: Meniere’s disease, labyrinthine artery occlusion, ™Retrocochlear lesion: vestibular schwannoma ™No hearing loss: Vestibular neuronitis , benign paroxysmal positional vertigo ™Hearing loss is optional: pyramid bone fracture, herpes zoster Source: http://www.doksinet ™Case

history ™Nystagmus ™Vestibulospinal function (Rombergtest, blind walking test) ™Provoked nystagmus (special tests) Source: http://www.doksinet Non-voluntary, rhythmical eye movement Slow and quick phase. ™ I. degree: looking to nystagmus direction ™ II. degree: looking forward ™ III.degree: looking oppositely to nystagmus direction Source: http://www.doksinet ™Case history ™Nystagmus ™Vestibulospinal function (Rombergtest, blind walking test ) ™Provoked nystagmus (special tests) Source: http://www.doksinet ™Romberg’s test ™Past pointing tests ™Blind walking test Source: http://www.doksinet ™Case history ™Nystagmus ™Vestibulospinal function ™Provoked nystagmus (special tests) Source: http://www.doksinet ™Harmonic syndrome-peripheral lesion Direction of tilting , deviation and past-pointing is opposite to the nystagmus direction ™Disharmonic syndrome- central dysfunction Direction of tilting and deviation is the same, as the main direction of

nystagmus Source: http://www.doksinet Pyramid bone fracture Infections: Vestibular neuronitis Herpes zoster oticus Labyrinthitis Vascular lesion:Sudden loss of hearing and balance Tumours: Vestibular schwannoma Others: Meniére’s disease Benign paroxysmal positional vertigo Traumas: Source: http://www.doksinet ™Longitudinal or transversal fracture ™ Cochlear damage: sensorineural hearing loss ™ Semicircular canal damage:vertigo ™ VIII. nerve damage:hearing loss and vertigo ™ VII. nerve damage: facial palsy ™ Additional symptoms: headache, cerebrospinal fluid leakage Source: http://www.doksinet Sudden loss of peripheral vestibular function, caused by viral infection Symptoms: ™Sudden onset, severe , few-days long rotatory vertigo with loss of balance ™Vomitus, nausea ™Normal hearing ™After the acute phase: constant unsteadiness (complete recovery: 2-3 months) Source: http://www.doksinet ™Herpes eruptions in the auricle ™Sensorineural hearing loss ™Vertigo

™Facial palsy Source: http://www.doksinet Middle ear cholesteatoma propagates to inner ear Source: http://www.doksinet Complication of chronic middle ear infection ™Circumscript labyrinthitis: fistula-symptom ™Serous labyrinthitis: excitation of labyrinth (nystagmus to the affected side, severe combined hearing loss) ™Purulent labyrinthitis: loss of inner ear function ( total deafness, nystagmus to the healthy side) Treatment: surgery- radical mastoidectomy Source: http://www.doksinet ™Sudden deafness ™Severe tinnitus ™Severe vertigo Occlusion of labyrinthine artery Source: http://www.doksinet Slowly growing benign tumour in internal auditory canal or in cerebellopontine angle Symptoms: ™Unilateral hearing loss and tinnitus ™Unsteadiness (slow loss of function) ™Facial numbness ™Facial palsy Source: http://www.doksinet Synonym: acoustic neuroma Treatment: surgery Source: http://www.doksinet Few hours long attacks with: ™rotatory vertigo and nystagmus ™

nausea and vomitus ™ unilateral hearing loss ™ unilateral tinnitus Source: http://www.doksinet Source: http://www.doksinet Source: http://www.doksinet Source: http://www.doksinet ™ statoconia detach A from membrane ™ insufficient lysis in endolymphe ™ sink into canal ™ clod together Benign paroxysmal positional vertigo 30 seconds-long attacks gravity Fatiguable rotatory nystagmus Source: http://www.doksinet Source: http://www.doksinet