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ID:40656294
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页数:38页
时间:2019-08-05
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1、VERTIGOAYESHASHAIKHPGY2EMORYFAMILYMEDICINE09.17.2008CASE31,femaledoctor,otherwisehealthy,postpartumweek5.Firstepisode,suddenfeelingofroomspinning,whileenteringpatientdataincomputer,duringFamilyMedicineClinic…Onefinedaylastyearsametime!DIZZINESSVertigoLightheadednessPresyncopeDy
2、s-equilibriumVERTIGOFALSESENSEOFMOTION,usuallyrotational.2TYPES1-CENTERALVESTIBULARCAUSES(Brainstemorcerebellum)2-PERIPHERALVESTIBULARCAUSES(Labyrinthorvestibularnerve)CAUSESOFVERTIGOCENTRALCerebellopontineangletumorCerebrovasculardiseaseMigraineMultiplesclerosisPERIPHERALAcute
3、labrynthitisVestibularneuritisBPPVCholestotomaMenier’sdiseaseOstosclerosisPerilymphaticfistulaCauses..DrugsAlcoholAminoglycosidesAnticonvulsantsAntidepressantsAntihypertensivesBarbituratesCocaine(SlowlyprogressiveUnilateral/Bilateral)HistoryTimingsDurationProvoking,aggreviating
4、factorsAssociatedsymptomsRiskfactorsforCardiovasculardiseaseQ:Whenyouhavedizzyspells,doyoufeellightheadedordoyouseetheworldspinaroundyou?Q:DurationofVertigoandassociatedsymptoms?(differentiateperipheralvscentralcauses)TypicalDurationofSymptomsforDifferentCausesofVertigoDuration
5、ofepisodeSuggesteddiagnosisAfewsecondsPeripheralcause:unilaterallossofvestibularfunction;latestagesofacutevestibularneuronitis;latestagesofMénière'sdiseaseSeveralsecondstoafewminutesBenignparoxysmalpositionalvertigo;perilymphaticfistulaSeveralminutestoonehourPosteriortransienti
6、schemicattack;perilymphaticfistulaHoursMénière'sdisease;perilymphaticfistulafromtraumaorsurgery;migraine;acousticneuromaDaysEarlyacutevestibularneuronitis*;stroke;migraine;multiplesclerosisWeeksPsychogenic(constantvertigolastingweekswithoutimprovement)*-Vertigowithearlyacuteves
7、tibularneuritiscanlastasbrieflyastwodaysoraslongasoneweekormore.Informationfromreferences3,6,and12.ProvokingFactorsforDifferentCausesofVertigoProvokingfactorSuggesteddiagnosisChangesinheadpositionAcutelabyrinthitis;benignpositionalparoxysmalvertigo;cerebellopontineangletumor;mu
8、ltiplesclerosis;perilymphaticfistulaSpontaneousepisode
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