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VERTIGO IN NEUROLOGICAL DISORDERS

FREDDY SITORUS

Neuro-otology & Neuro-ophtalmology Subdivision

Department of Neurology FMUI/ RSCM

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DEFINITION OF VERTIGO

An illusion where someone feels his body is moving to the

environment or the environment is moving to him

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BALANCE

VESTIBULARSYSTEM

VISUALSYSTEM

PROPRIOSEPTIVESYSTEM

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PHYSIOANATOMY OF THE BALANCE SYSTEM

PERCEPTION CEREBRAL CORTEX

INTEGRATION BRAIN STEM

NERVES (Cranial nerve VIII, CN II Spinovestibulospinal nerves)

RECESSION RECEPTOR

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CLINICAL DIFFERENCES BETWEEN VESTIBULAR AND NON VESTIBULAR VERTIGO

SYMPTOMS VESTIBULAR VERTIGO

NON VESTIBULAR VERTIGO

Character Spinning sensation Dizziness, unsteadiness

Attacks Episodic Continuous Nausea/ vomits (+)

Hearing impairment (+)/(-)

Provoking movement

Head movement

Provoking situation (-) Crowded, traffic jam

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CLINICAL DIFFERENCES BETWEEN CENTRAL AND PERIPHERAL VESTIBULAR VERTIGO

SYMPTOMS PERIPHERAL CENTRAL

Onset Insidious Slower

Degree Severe Mild

Influence of head movement

(++) (+/-)

Autonomic focal signs (nausea, vomits, sweating)

(++) (-)

Cerebral focal signs (-) (+)

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LOCALIZATION OF NEUROLOGICAL DISORDERS :

1. CN. VIII (VESTIBULAR NERVE)..............PERIPHERAL

2. VESTIBULAR NUCLEUS – BRAIN STEM

3. CEREBELLUM

4. BRAIN

CENTRAL

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CAUSES OF VERTIGO IN NEUROLOGY

1. CN. VIII (Vestibular nerve) ie.: infection, tumor, trauma

2. Vestibular nucleus – brain stem ie.: TIA/vertebrobasilar stroke, tumor, infection, trauma, multiple sclerosis, basilar migraine3. Brain ie.: epilepsy, stroke

4. Cerebellum ie.: stroke, tumor

5. Non vestibular vertigo: refractive disorder, neuropathy, myelopathy

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CONCLUSION :

• Vertigo → determine the type, location, & etiology

• Vertigo needs careful history taking & physical examination

• Therapy: causative, symptomatic, vestibular exercise

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OPTIC NERVE DISORDER ININTRACEREBRAL DISEASE

FREDDY SITORUS

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VISUAL PATHWAY

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CONVERGENCY &ACCOMMODATION

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PUPILLARY REFLEXPATHWAY

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Examination :

1.Visual acuity

2.Color

3.Visual field

4.Occular movement occulomotor muscles

5.Funduscopy

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VISUAL ACUITY: SNELLEN CHART COLOR VISION: ISHIHARA

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VISUAL FIELD: CONFRONTATION TEST

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VISUAL FIELD: CAMPIMETRY

VISUAL FIELD: PERIMETRY (TANGENT BJERRUM)

VISUAL FIELD: AMSLER GRID

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D S

VISUAL FIELDDEFECTS

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FUNDUSCOPY

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Funduscopy

• Hypertensive fundus• Hypertensive retinopathy• Diabetic retinopathy

primary• Papil atrophy

secondary• etc

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HYPERTENSIVE FUNDUS HYPERTENSIVE RETINOPATHY

PAPIL ATROPHYDIABETIC RETINOPATHY (PROLIFERATIVE)

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Etiology

Acute : Acute infection, trauma, vascular

Chronic : - Chronic infection

primary

- Malignancy

secondary

- Degenerative

- Autoimmune

- Congenital

Therapy : - Depends on etiology

emergency

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OCCULOMOTOR TESTING

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THANK YOU