BPPV良性發(fā)作性位置性眩暈課件

1、BPPV良性發(fā)作性位置性眩暈BPPV良性發(fā)作性位置性眩暈BPPV良性發(fā)作性位置性眩暈Basic Anatomy2BPPV良性發(fā)作性位置性眩暈BPPV良性發(fā)作性位置性眩暈BPBasic Anatomy2Basic Anatomy233BPPVBarany 1921Dix-Hallpike 1952 important features of nystagmus Abnormal sensation of motion elicited by certain critical positionsProvocative position nystagmusAt least 20% of vertig

2、oUnderestimated 4BPPVBarany 19214BPPV Pathophysiology :Canalithiasiscupulolithiasis5BPPV Pathophysiology :5Pathophysiology (cont.)Cupulolithiasis : Harold Schuknecht 1962 Densities (otocania) adherent to cupula of crista ampullarisBasophilic particles -19696Pathophysiology (cont.)CupulolCanalithiasi

3、s :John Epley 1980Densities free floating in canal portionParnes , McClure 1991 found particles in post SCC 7Canalithiasis :7Pathophysiology8Pathophysiology8BPPV .Frequency : 10-64/100000Sex : 64% womenAge : older population ( 51-57) younger than 35 head trauma.History : sudden days-weeksoccasionall

4、y months -years episodes.9BPPV .Frequency : 10-64/1000BPPV Nystagmus : characterization and types RT / LT , vertical / horizontal , changingTortional = Rotational clockwise / counterclockwiseGeotropic- toward the earthAgeotropic opposite10BPPV Nystagmus : characterizaPhysical : neurological examinat

5、ion normal except Dix-Hallpike pathognomonic11Physical : 11Fig.6 仰臥位轉(zhuǎn)頭試驗(yàn)12Fig.6 仰臥位轉(zhuǎn)頭試驗(yàn)12BPPV的臨床類型后半規(guī)管BPPV （PC-BPPV）水平半規(guī)管BPPV （HC-BPPV）上半規(guī)管性BPPV （SC-BPPV）混合型BPPV(C-BPPV)13BPPV的臨床類型后半規(guī)管BPPV13BPPV - CausesPredisposing factors :Inactivity Acute alcoholismMajor surgeryCNS disease14BPPV - CausesPredispos

6、ing factCauses ( cont. )Idiopathic 39% Ear disease 29%OM 9%Vestibular neuritis 7%Meniers dis 7%Otosclerosis 4%Sudden SNHL 2%Trauma 21%15Causes ( cont. )Idiopathic 3BPPV - D.DMeniers diseaseInner ear concussionAlcohol intoxicationLabyrinthitisVascular loop syndromePost. Fossa lesions : acustic neurom

7、a , meningiomaCentral origion : stroke , MS , cerebellar degenerationVertibral artery insuffeciency16BPPV - D.DMeniers disease16BPPV - TreatmentWatchful waitingVestibular suppressant medicationsVestibular rehabilitationCanalith repositioningSurgery careLabyrinthectomyPost. Canal occlusionSingula neurectomy Transtympanic aminpglycoside application17BPPV - TreatmentWatchful waitiCRP Epley maneuver18CRP Epley maneuver18CRP Semont maneuver19CRP Semont maneuver19Brandt-Daroff Exsercise20Brandt-Daroff Exsercise20Vestibular rehabilitaions21Vestibular rehabi