Clinical Manifestations of Vertigo

Clinical Manifestations of Vertigo medical treatment and therapy
       Clinical symptoms of patients suffering from dizziness and vertigo may include: symptoms of primary, secondary or non-specific symptoms. Primary symptom caused by disturbances in sensorium. Primary symptoms such as vertigo, impulsion, oscilopsia, ataxia, hearing loss symptoms.

a. Vertigo can be horizontal, vertical or rotational. Horizontal vertigo is the most common type, is caused by a dysfunction of the inner ear. If along with nystagmus, patients usually feel a sensation of movement from the opposite side of the slowest component.
b. Vertigo vertical rare, if temporary, usually caused by BPPV. However, if settled, usually coming from the central and accompanied by nystagmus with movement down or up.
c. Vertigo rotation is the most rare kind. If while usually are due BPPV, but if settled due to the central abnormality and is usually accompanied by rotator nystagmus.

Impulsion is defined as the sensation of moving, often described as a sensation pushed or lifted. Sensation impulse indicates dysfunction otolith apparatus in the inner ear or the central otolith signals

illusion of environmental movement provoked by head movement. Patients with bilateral vestibular loss will be afraid to open his eyes. While patients with unilateral vestibular loss, will complain that the neighborhood seemed to spin, when the patient turned to the impaired ear.

is unstable walking, usually universal in patients with vertigo and otologic central.

Symptoms of hearing loss 
is usually in the form of tinnitus, hearing loss or distortion reduction and full sensation in the ear.

Secondary symptoms 
include nausea, autonomic symptoms, fatigue, headache, and visual sensitivity.

Nonspecific symptoms such as giddiness and light headness.
The two terms are not too meaningful to use normally. Rarely used in patients with dysfunction of the ear, but is often used in patients with vertigo associated with problem medic.

Key information obtained from the history can be used to differentiate peripheral or central include:
a. Characteristics of dizziness
Need to be asked about the sensation felt by the patient. whether the sensation of spinning, or non-specific sensations such as giddiness or liht headness, or just a different feeling (confusion)
b. Severity
 The severity of the vertigo can also help, for example: on acute vestibular neuritis,
early symptoms are usually severe but reduced in the next few days. In Ménière's disease, the initial severity usually increases and then decreases thereafter. While the patient complained of persistent and constant vertigo may have the psychological causes.
c. Onset and duration of vertigo
Duration of each episode has a significant diagnostic value, the longer the duration of vertigo vertigo then chances towards the central becomes larger. Vertigo usually has an acute onset of peripheral than central vertigo, except for cerebrovascular attack.

The difference in onset and duration of each cause of vertigo can be seen in Table 4.

Vertigo central usually develops gradually (except in central vertigo that comes from such vascular CVA). Lesions in the central usually causes neurologic signs in addition vertigonya, causing a severe imbalance, nystagmus purely vertical, horizontal or torsional and can not be inhibited by eye fixation on an object.

Precipitating Factors
Precipitating factors and can narrow the differential diagnosis of peripheral vestibular vertigo. If symptoms occur only when the change of position, the most likely cause is BPPV. New viral infections in the upper respiratory tract is probably associated with acute vestibular neutritis
Or acute labyrhintitis.

Trigger Factors
a. migraine
Vertigo can be caused by perilymphatic fistula. perilymphatic fistula can be caused by either direct trauma or barotrauma, such as straining. Sneezing or movement will cause the ear to provoke vertigo in patients with perilymphatic fistula. Tullio's phenomenon (nystagmus and vertigo caused by noise at a certain frequency) leads to peripheral causes.
b. Psychological Stress
Severe mental stress can cause vertigo, inquire about the psychological stress, especially in patients who are at anamsesis not match the physical cause any type of vertigo.

Symptoms accompanying
 Accompanying symptoms such as hearing loss, pain, nausea, vomiting and neurological symptoms can help differentiate the diagnosis of the cause of vertigo. Most causes of vertigo with hearing loss from peripheral, except for cerebrovascular disease that affects the internal auditory artery or anterior inferior artery cebellar. The pain that accompanies vertigo may occur with acute middle ear infections, invasive disease in the temporal bone, or meningeal irritation. Vertigo often in conjunction with vomiting and nausea in the acute vestibular neuronitis and Meniere's disease are severe, also BPPV. In central vertigo, nausea and vomiting are not too severe. Neurological symptoms such as weakness, dysarthria, impaired vision and hearing loss, paresthesias, decreased consciousness, ataxia or other changes in sensory and motor function better guide to the diagnosis of central vertigo, for example cererovascular disease, neoplasm, or multiple sclerosis. Patients with migraine often experience other symptoms associated with migraine headaches typical example (throbbing, unilateral, sometimes with aura), nausea, vomiting, photophobia, and phonophobia .21-35 percent of patients with migraine complained of vertigo.

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