1	A LOGICAL APPROACH TO THE DIZZY PATIENT Dizziness and balance disorders center
2	Dizziness- Logical Approach -strategy for lecture Go into some basic principles applications and testing get into a few prominent diagnoses
3	DIZZINESS EIGHT MILLION PHYSICIAN VISITS/YR AVERAGE: 5 VISITS WITHOUT RESOLUTION OF PROBLEM LOSS OF LIVLIHOOD, FALLS INJURIES SYSTEMATIC APPROACH
4	DIZZINESS VERTIGO LIGHT-HEADEDNESS DYSEQUALIBRIUM GAIT DYSFUNCTION NEAR SYNCOPE ANXIETY
5	DIZZINESS: A MULTIDIMENSIONAL APPROACH AREAS OF EXPERTISE NEUROLOGIST OTOLOGIST REHAB SPECIALIST SHUNTING
6	VESTIBULO-OCULAR REFLEX (VOR)
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10	Vertigo or not?
11	Vertigo DDx BPPV Meniere’s Vestibular neuritis Bilateral vestibular Loss Post-traumatic vertigo (labyrinthine concussion) Perilymph fistula Migraine and epilepsy Cerebro-vascular Disease
12	Dizziness Battery Orthostatics and both arms Hallpike Fukada Head Thrust Head Shake Romberg (conventional, tandem, foam pad) Fistula test
13	Benign Paroxysmal Positional Vertigo Recurrent One ear down position Positive Hallpike Transitory positional vertigo
14	BPPV Posterior nystagmus are delayed by approximately 15 seconds (latency), peak in 20-30 seconds, and then decay, with complete resolution of symptoms. Symptoms and reversed nystagmus may recur when the patient is brought to a sitting position.Nystagmus fatigues on repeated trials. Peripheral nystagmus is latent, paroxysmal, geotropic, reversible, and fatigable. Horizontal canal BPPV nystagmus is purely horizontal and asymmetric, with its stronger component beating toward the diseased canal. Anterior canal nystagmus is rotary, with its vertical component beating downward. The vertical component of benign paroxysmal positioning nystagmus (BPPN) is best observed by asking the patient to move the eyes away from the down-most (tested) ear.
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16	Logroll maneuver for horiz canal
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18	Paroxysmal psychological Vertigo Form of Panic Attack Sensory overload “Supermarket Syndrome Sensory Overload
19	Meniere’s Severe vertigo and vomiting Hearing Loss Fullness unilateral Tinnitus Endolymphatic Hydrops
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22	Vestibular Rehabilitation Compensations Avoidance (BPPV) Substitution (Bilateral Vestibular Loss) Plasticity (Vestibular Neuritis)
23	VESTIBULAR REHABILITATION HABITUATION ADAPTATION OF OTHER SENSORY SYSTEMS
24	Neurologic Syndromes MS PD Aging Multi-sensory Deficit
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26	Multiple Sclerosis May present as typical peripheral vestibulpathy ? lesion at root entry zone
27	Multi-sensory deficit Aging Loss of neurons in CNS degenerative vascular Arthritis Peripheral nerve dysfunction Vestibular dysfunction
28	Multi-sensory deficit Physical therapy falls prevention muscle strengthening trying out assistive devices minimizing deficits
29	Acoustic Neuroma
30	Acoustic Neuroma Unilateral Hearing Loss VII and V Unsteadiness rarely paroxysmal vertigo
31	Vertebrobasilar Insufficiency Vertigo Diplopia Dysarthria Dysphagia Ataxia Sensory or Motor Loss
32	Post-Traumatic Vertigo BPPV Meniere’s “Cervical” vertigo Perilymph fistula Factitious (psychological) vertigo
33	Migraine Associated Vertigo Headache Bickerstaff
34	Autoimmune Inner Ear Disease (AIED) Hearing Loss Vertigo Bilateral “meniere’s”
35	AIED Anti HSP-70 Anti Raji Cell Sed, ANA, RF, C1Q, FTA, Lyme, Thyroids
36	Perilymph Fistula Traumatic Communication betw inner and middle ear Pressure effect Tullio: vertigo and nystagmus to loud sound strain or blowing nose Fistula test
37	Bilateral Vestibular Loss Oscillopsia Visual Dependence Aminoglycosides
38	MOTION SICKNESS CHRONIC SENSITIVITY TO MOTION OTHER PERSON DRIVING DISCOMFORT WITH MOTION VESTIBULAR REHAB: HABITUATION
39	Mal de Debarquement Persistence of perception of motion after a cruise Psychophysiological (?)