VERTIGO MADE EASY

0:00 [Music] hi friends welcome to my channel dr. Srinivas medical concepts this is obviously to us neurologist from under finish today we are going to talk about a very interesting topic worth a and I believe it's going to be useful to ENT surgeons neurologists Europeans journal physicians general surgeons and psychiatry residents what they gue itself is a big specialty so I will be running upon only the important concepts and points what is what they do what

0:48 they go is an illusion of self and environment it's basically a sense of spilling we need to be very clear about these symptoms which the patient tells they may give nonspecific complex like dizziness lightheadedness imbalance which should be sure that it is whatever a sense of spinning how do you confirm that it's a case of what are you a compact of vertigo how do we approach very important point once a person comes with vertigo we need to know whether it is simple what they go or peripheral vertigo firstly what they go this way steep like a badness

1:36 the vestibular no simple vertigo is the brainstem and similar structures again if you take peripheral vertigo where the nerves are involved it could be unilateral or it could be bilateral unilateral usually produces working because of asymmetric input coming from the Lovins to the brain because of this asymmetric input bring gets confused and will have the sense of spinning and vertigo any unitary cause like give me PD benign paroxysmal positional vertigo if it is bilateral the vegetable effectors are damaged and

2:21 therefore the input though it is decreased it is symmetric and therefore a biological damage usually will not produce a signal vertigo they can an ocelot SIA a difficulty in coordination between vision and the head especially the darkness they can have imbalance so this is about the peripheral vertigo where you have the unilateral involvement and the bilateral environment same Calverton this is dangerous because the central causes of vertigo is because of brain stem structures and cerebellum example value Berg syndrome this could be life-threatening so the first and most important point is you need to differentiate with it this

3:07 Center when they go oh I know it's dangerous but how do we differentiate whether it's a central cause of Ortega or peripheral cause of vertigo there are many points there about five important point but the most important point is nystagmus so now I'll be talking more about nystagmus by looking at the nystagmus we can differentiate whether it's a peripheral cause of vertigo on a second cause of vertigo if it's a peripheral cause of birth I go if the vegetable has a purpose the labyrinth is damaged only happen as I told in the last class neuro of the mountain nuances the wisdom one now this

3:53 to block a purpose gets connected to the third no nucleus on the same side with a sixth no nucleus on the opposite side through MLM and therefore when the vegetable is stimulated the eyes you need towards the opposite side and therefore when the vegetable a purpose gets affected the eyes will move towards the same side and the nystagmus will be towards your opposite sign so if it's a purple cause of vertigo then the Uni naturally gaze the first face away from the asian fine suppose if it is a simple cause of vertigo what happens it will be a body directional we guess evoke changes and there would be downbeat nystagmus also right the second important point is the

4:42 direction if it's a federal cause of vertigo it mixed vertical torsional nystagmus with the upper end of the eye looking towards the affected side of the ear which is on the lower side so the mixed vertical fashion nystagmus is a sin because of nystagmus it would be purely vertical or purely caution the permanently cause of vertigo producing and sadness is a mixed vertical totally cannot be purely vertical or torsion because the three semicircular canals will contribute to the direction right and third important point about nystagmus to differentiate between very coarse and gentle cousin said in the

5:28 very cause that nystagmus gets inhibited by visual fixation the visual fixation inhibits the nystagmus and therefore if person loses friends and classes which inhibits visual fixation the nystagmus is well seen so in purple cause of nystagmus if you want to see good friends and glasses it will be lensing whereas if it's a central cause of nystagmus the nystagmus is not suppressed by visual fixation and the fourth important point is they then if first test what does is any questions this is because of vor you need to understand a concept vegetable ocular reflex when the

6:16 head moves to one side the eyes means for the opposite side in an in an opposite direction but of equal amplitude so this is vestibular ocular reflex but in persons where the vegetable is affected the vivo are gets impaired and therefore when the one side like this the eye is also we move along with the head so they have to make a cut to center to focus on an object example if the patient is asked to focus on this camera turn the head to one side and still focus generally in a normal person whose vegetable is functioning well I can turn the head on one side but still my eyes focusing on

7:01 the camera but in persons may be anybody cause off they go where the vegetable affect us gets affected when the head turns to one side the eyes also turns towards the same direction and they have to make a catch-up second to look at the camera so once you see this catch-up second in the heading past rest it is suggestive of periphery cause of Marengo head impulse test is negative in a central cause of the Sens so these are all the four important points of nystagmus by which we differentiate whether it's a present cause of when they go for a central cause of what they go first in a peripheral cause a birthday go it is unidirectional with fast-pace event from

7:47 the Haitian where there is a central cause of this type in the center cause of what I call the disturbance is bi-directional the changes direction with gaze and there could be dominant the second important point is that the best present cause of vertigo producing nystagmus is never pure ghee vertical or never pure gate torsion it's a mixed but we can toss them whereas in a central cause of what they go the distance either through the central or often the nystagmus can be inhibited by we should fixation and therefore can be better seen with friends and brothers in a peripheral cause of what angle whereas the nystagmus does not get suppressed by English or fixation because important so because of the

8:33 impact vivo our head impulse test is positive there's a custom circuit in a very cause of vertigo where as the hint impulses is absent or negative in a central costs of running these are the four important points regarding distance but there are still other point by which we can differentiate them because of what they go from simply possible to you they are the other associated clinical features in a pen because of birthday go so there could be a unilateral hearing loss generally that way you kneel at the heavy cost in a peripheral cause of what are you but in a central cause of birth ago the hearing loss is not there on a unilateral sign because once it comes to the brainstem it goes by that value so a central cause

9:20 of what they code does not produce a unilateral hearing loss whereas the vegetable cause produces a unilateral hearing loss and then you can have associated clinical findings in the central cause of vertigo like de propia because three four six nodes can get affected in the brainstem they can have diplopia they can have disappear because nine ten knows then 12 nodes can get up your kid you can have this off yeah because cerebrum can say well no gets affected they'll have ataxia so these associate clinical findings mainly are unilateral hearing loss is in favor of also vertical whereas other findings and appropriate at the South Korea and ataxia and favor of semi cause of vertigo using army hearing loss is not present in a central cause of vertigo because once it comes to the brainstem

10:05 the vegetable afternoon goes bilaterally and therefore it does not produce a unilateral hearing loss right another important point is the disc effect manual the Biggs help my manual if we do it we can see the nystagmus especially if it is a benign paroxysmal positional vertigo the nystagmus is busy but what is this Dix halfback manual and how do we do it and what is the basic pathogenesis the basic pathogenesis of the BPD benign paroxysmal positional was that the auto Konya the calcium carbonate crystals which are present in the macula comes to the semicircular canal so as it travels through the

10:52 semicircular canal it induces vertigo and sense of nausea and vomiting along with nystagmus so we can provoke it we can provoke it by doing a man is known as Big South Manor where the patient is helped turn the head is turned 45 degrees ask him to lie down and extend about 20 degrees and then look for instance if the nystagmus appears that it's a perfect record of nystagmus especially bv p vb9 pair of super super takes another important way by which we can find out is the dynamic visual acuity the basic mechanism of

11:39 dynamic visual acuity and helplessness are the same the basic pathogenesis it is because of impact vestibular ocular reflex because of the impairment of the Vista globnar in Flex when you turn it horizontally then we catch up second because it does not move in the opposite direction that is Hetty first test whereas in dynamic visual acuity the visual acuity gets decreased when there is movement dynamic human so in a moment a vertically up and down the ice do not move was the opposite side they move along with the head and therefore make sense one line below the actual light to be seen and therefore the top line of yours blood they can see one line below it well so then they diminish visual acuity so on the post positional

12:25 changes of the head so this is known as dynamic visual acuity so dynamic visual acuity is present in very cause of vertigo whereas it is absent in the sample causes of vertigo then we can do investigations to find out whether it's a peripheral cause or a central cause in a perfect we do argument an argument with a unilateral sensing your own hearing loss there could be lower frequency hearing loss in manias disease so when we do audio might be that could be uniDAC isn't in your oral hearing loss or low frequency hearing loss as amania disease where are we something cause of what they go we know imaging MRI brain by doing MRI brain we can find out where there is an English in the cerebellum or vanilla oblong at the example Valon Berg

13:12 syndrome another sequence which we have to stress in finding out the subtle cause of verticals do MRI brain of internal audit we cannot IAC to rule out to anima so by all of these methods especially nystagmus the four point which I don't the chemical findings the big sulphide manual the dynamic visual acuity and investigations we can different shape with its central cause of vertigo every customer to this is the most important aspect when we approach a case of vertigo once we have differentiated then the rest of things is easy as I said that because of vertigo you need not worry it's not dangerous it's benign but SEM because of vertigo is dangerous and therefore we

13:58 you have to be alert and that's the most important one important approach of different shape whether it's a central concept of that will conservative now let's see the differential diagnosis of what they go the differential makers are working or includes best to grab your own itís even mustard on your own itis it is because of infection usually a viral infection harpy's zoster what we call it as Ramsay Hunt syndrome so when you have the vestibule on itis what is the treatment we give glucocorticoids for about three days we give antibiotics we use vegetable a soft presence I mean talk about in later on but here I would like to mention about ways to graph suppressants vegetables our presence we usually give up three days maximum for fighters because when you prolong but

14:45 you give on a problem basis beyond five days you are hampering him going in the center compensation process and therefore generally the students editors should not be given beyond three days maximum - so that is the best you grab your own IDs now ways to broth my green vegetable migraine is usually seen in persons having migraine they can have symptoms of headache or may not have symptoms of headache but they'll have associated findings they can have photophobia they can have wound up Seija they can have other findings of migraine symptoms they can have extreme sensitivity to motion especially the pictures so when you

15:32 think it's a case of vegetable migraine I was like magnet you have to give auntie prophylactic migraine is drugs namely sodium perborate or coke remember so you have you know - and restricted migraine then we have manias disease manias disease usually they have low frequency hearing loss they have tinnitus and where they go it is due to excess fluid it is due to excess fluid when you have the indignant in the immediate that treatment consists of diuretics low salt intake surgery equal to ablative surgery or non ablative surgery like some procedures or it could be decompressive surgery this is about mania disease then we have West you

16:17 brush Ranma vegetable schwannoma is tumor it grows when you stool on a chronic basis and therefore the compensation takes face and therefore vegetable form of persons usually do not produce it but table they have associated findings like they can have hearing loss hippie bus just is positive and of course by taking MRI brain and say focusing on the internal or if we cannot we can diagnose it and date it by say fine MA now let me talk about a very important cause of Bert I hope the benign paroxysmal positional vertigo otherwise known as BPPV as the names that is it is benign again

17:03 as the main that just process when it comes and goes it's very very brief less than one minute having 20 to 30 seconds this is a recurrent working it is provoked by head changes especially to gravity so when a person is asked to get up from the supine position to the standing position or the person exchange at it and looks at the ceiling because of the positional changes especially related to gravity they have severe 110 but we need to understand the mechanism why a position changes causes vertigo in BPPV what is the pathophysiological basis the pathophysiological basis as I have already mentioned is because of auto odium the free-floating auto Konya which

17:50 is otherwise known as calcium carbonate crystals there are supposed to be in the utricle but they may get discharged from the utricle and come to the semicircular canal so as the Pilsen King jINSA position the auto poignant travels in the semi cell plug cannot and induces a nystagmus Indian nystagmus and what they go so the basic pathophysiological basis of BPPV is auto cornea coming from the UT club macula to the semicircular canals so this can be provoked by a man you are known as Diggs halfback manual so what will be the treatment treatment will be able to put back the auto cornea from the semi sector chemist back to the new triggers so the pathogenesis the

18:35 pathology is because of the auto connect coming from the Utica to the semicircular canal and it can be induced by Desalle pac-man you the treatment consists of putting back the auto cornea from the semicircular canals to the utricle by a method by known as a policeman you by method known as a policeman you so by doing a policeman here you can put it back from the semicircle cannot how do we diagnose it generally there are three commands seven o'clock announcer post unis any second on the horizonte' send me all sorts it is a birthday mom and aunt is a visa platinum the postal semi-circular cannot the what is the type of the nystagmus the nystagmus is vertical torsional the upper I was looking towards the lower end towards the affected ear so vertical

19:24 torsional the upper eye born looking towards the affected lower here so when tickle torsional nystagmus is highly suggestive of a posterior semicircular cannot environment and this is the most common in this type is more than 95 percent less than 5 percent is because of the horizontal semicircular canal when it produces a horizontal distance or it could be because of the of the antenna semicircular canal also piercing receptor Bremen usually does not produce the status so this is all about the benign paroxysmal positional what they go it is because of the auto Konya coming from the utricle to the semicircular cannot induce by disciplic failure the treatment consists of a please when you buy putting it back on the semicircle cannot do the utricle the angel part is like this help make manual but you turn 90 degrees and again 90

20:11 degrees like this so that then no space is about 35 degrees to the flow and this gets destroyed and a person becomes better right now we talk about the bilateral vegetable hypofunction you need to speed in you do ototoxic drugs like amino glycosides because both are a world that is symmetrical symmetrical decrease in the noodle output because it's symmetrical because it usually does not produce what I hope it produces imbalance and Orthodox here again here the dynamic we shall activities reduce the hit is positive but here it is in both history in both Center dispositive because both listed on our practices

20:57 inward so heading process is positive on both sides and treatment consists of vegetable rehabilitate them positional excess next we come to these central vestibular disorders as I said it it includes a brain stem and the cerebellum we have to be really careful with this type of what they go central cause of what they go picked up by a monic because it is dangerous it could be violent but syndrome or it could be safe Bella embrace one of it is the brain stem and cerebellum are affected so this is going to be very many dangers and we need to be extra careful with this the treatment in the treatment depends upon the time for example valium birth syndrome he fashion me you auntie platelets are low

21:43 molecular panel suppose if it is hammer a simple hemorrhage we give monitor or we control the hypertension or we get a neurosurgical and then finally we have the psychosomatic and functional dizziness what we call as the PPD positional perceptual busyness because of standing because of anxiety autonomic symptoms they have sympathetic to what I go but if you do on you know autological examination or testing of the vegetable opposite be normal the treatment consists of giving anti-psychotic drugs bringing on the anxiety and depression by the SSRIs set to certain reuptake inhibitors name it frosting so having understood the differential diagnosis of

22:29 what I go now let's go to the treatment before I start talking about the bereavement I need to talk precise two points one the vegetable sub presents are given only for three days maximum five days beyond which what happens you are trying to enter or into the central compensation so we should not give the vegetable X sub presence beyond three to five years point number one the second point is that for a case for all there are many types of birthing also for all in terms of vertigo that treatment is not going to be the same the treatment is according to the type of vertigo so according to the type of when I go the treatment changes so what are they now let's see we have three phase three gamut of nuts one the

23:15 antihistamines which ain't redeemed metazine dimenhydrinate and promethazine we have the benzodiazepine stabilized in common colostrum we have anticholinergic drugs like scopolamine patch which we use for motion sickness we have physical therapy wherein we use a policeman you as a repositioning magnet for bpp benign positional vertigo and for biochemistry class this form shall be him vegetable as a rehabilitative exercises for manias disease it is dying a decrease in sodium and diuretics and for wisdom of migraine we give prophylactic antimatter in drugs

24:01 like so you calculate or token it and for mr. block pneumonitis we give me that pretty swollen and for psychogenic vertigo we give SSRI lost in so as you have seen the treatment of birthday go depends upon the cause of the vertigo and the pre-printed is according to the cause of vertigo so before I conclude I would like to stress few important points the first point is that when a person comes with vertigo which see whether the central cause or a butterfly cause several common can pick it up by MRI most dangerous you have to be very very quick in giving treatment the problem when I go is less dangerous benign we use head impulse test and dynamic visual

24:47 acuity at the belfry at the bedside and we can make a diagnosis of personal cause of birding second vegetable citizens are given only for three to five days not beyond that because it is going to hinder hamper and impair the center compensate we cancel and the treatment of what they go is not the same for all cause of what they go that treatment depends upon the individual cause of vertigo and it varies according to the course of vertigo so this is such a big specialty but I try to really give all the essential points and I try to cover as much as possible regarding all points of vertigo I'm really enjoy giving you this lecture on what I go and I hope you have also enjoyed it if you have really enjoyed it please like and subscribe my youtube channel dr. Srinivas medical concepts and I meet you with the next

25:32 interesting topic bye take care