Vertigo:  the illusion of movement without stimulation

 

Equilibrium is performed by three systems:  eyes, proprioception and vestibular apparatus (each is one third)

 

 

Eyes: 

 

Proprioceptive input:  upper cervical

 

Examination:  gait and vertigo tests, c spine, cranial nerves, complete neurological, eyes, ears, nose and throat, vitals, history

 

C spine examination: trigger points, hypertonicity, arthritis, and joint irritation

Nose and throat examination:  URI, sinusitis can cause vertigo

Otoscopic exam:  eustachian tube dysfunction or any ear disease

Romberg’s:  The eyes are closed depriving the patient of this input.  It is positive for loss of proprioception or peripheral vestibular disturbance.

Blood pressure:  may reveal postural hypotension—low blood pressure, may not necessarily won't to raise the blood pressure

Vertigo tests [see later notes]

§         Hauntant's—arms straight out, close eyes, extend and laterally flex the head; look of pronator drift

§         Cranial nerves

§         EENT

§         Be careful and slow when evaluating the c/s

 

 

History:

Setting: changing position, worse when riding in car, turning over, veering when walking

Sympathetic symptoms:  nausea, vomiting, perspiration, and sense of fear

Other S&S:  fever, paresis, slurred speech, change in vision, sensory impairment, hearing loss, tinnitus

 

Sensation:  imbalance, spinning

 

            Rotary              vertigo                          peripheral vestibular disease

                                                                        [acoustic neuroma, Meniere’s (may look like

  they're drunk, etc.]

 

            fainting/            lightheadedness             postural hypotension

            woozy                                                   antihypertensives and other Rx

                                                                        psychiatric – including anxiety

                                                                        alcohol

 

unsteady gait     unsteadiness                  aging- cervical Spondylosis (DJD and facet

arthrosis)—Tia Chi, special exercises, walking

[proprioception and constriction of vertebral artery]

                                                                        poor sight, TIAs

                                                                        migraine, head injury,

                                                                        middle ear diseases

 

            blacking out       LOC                             neurologic or cardiac arrhythmias

                                                                        epilepsy and other seizures

 

           

Length of episode: can be one of the most important clues

           

Seconds                        benign paroxysmal vertigo

                                                Postural hypotension

                                                Cervical spondylosis, cervical joint irritation

                                                Myofascitis, cervical strain/sprain

 

            Minutes                        Meniere’s Disease

            to hours                                    Labyrinthitis

 

            Hours                           ototoxicity

            to days                          central vestibular disease [brain stem]

                                                labyrinth failure

 

 

 

 

 

1.       Benign paroxysmal vertigo- postural or positional vertigo

 Seconds in duration

Induced by certain head positions

Often with nausea, vomiting and ataxia

Due to granulation masses in posterior semicircular cupula

See testing section

 

2.       Postural hypotension

Seconds           

Occurs after extended periods of sitting or lying, dehydration, low blood pressure

Patient experiences brief lightheadedness upon standing or walking short distance then stopping

Perform standing, seated and recumbent blood pressure

 

3.       Cervical spondylosis, cervical strain/sprain, cervical joint irritation

Seconds           

Due to aberration in proprioception

Changes in joints interrupts proprioception and the changes in motion alters the muscular length which complicates and may worsen the symptoms.

Treat with adjustments, full body exercises, and cervical range of motion, wobble board

Treat cervical injuries appropriately.

Note:  the patient may be able to walk and perform well on the wobble board but if the head is rotated to irritate the offending structures, the patient may veer or have trouble maintaining balance.

 

4.       Myofascitis

Seconds           

Sensation of disagreeable motion on turning the head or other cervical motions

Associated with trigger points

 

q       Typically the clavicular division of the SCM

The patient may fall when bending forward or stooping.

Nausea is common.

Also: Carsickness, frontal headaches,

May be activated by: turning over in bed, holding the phone with the shoulder, painting, sleeping on two pillows, sports, scoliosis, emphysema, neckties.

Dramamine relieves the nausea but not the dizziness.

 

q        

 

                        Meniere’s Disease        Minutes to hours           

                        Labyrinthitis Minutes to hours

 

                                    ototoxicity Hours to days           

                        central vestibular disease [brain stem] Hours to days