BPPV良性发作性位置性眩晕.ppt

BPPVBPPV良性发作性位置性眩晕良性发作性位置性眩晕Basic AnatomyPathophysiology(cont.)n nCupulolithiasis :Harold Schuknecht 1962 Harold Schuknecht 1962 Densities(otocania)adherent to cupula of Densities(otocania)adherent to cupula of crista ampullariscrista ampullarisBasophilic particles-1969Basophilic particles-1969n nCanalithiasis:John Epley 1980John Epley 1980Densities free floating in canal portionDensities free floating in canal portionParnes,McClure 1991 found particles in Parnes,McClure 1991 found particles in post SCC post SCC BPPV.n nFrequency:10-64/100000Frequency:10-64/100000n nSex:64%womenSex:64%womenn nAge:older population(51-57)Age:older population(51-57)younger than 35 head trauma.younger than 35 head trauma.n nHistory:History:sudden sudden days-weeksdays-weeks occassionally months-years occassionally months-years episodes.episodes.n nPhysical:neurological examination normalneurological examination normal except Dix-Hallpike except Dix-Hallpike pathognomonic pathognomonicBPPV n nNystagmus:characterization and types RT/LT,vertical/horizontal,changing RT/LT,vertical/horizontal,changingTortional=Rotational clockwise/Tortional=Rotational clockwise/counterclockwisecounterclockwiseGeotropic-toward the earthGeotropic-toward the earthAgeotropic oppositeAgeotropic oppositeBPPV n nClassic post SCC geotropic rotatory nystagmusn nHorizontal SCC purely horizontal nystagmusn nNon-fatiguing nystagmus cupulolithiasis canalithiasisClassic BPPVn nInvolved the POST SCC Geotropic NG with affected ear downGeotropic NG with affected ear downRotatory,fast phase toward the Rotatory,fast phase toward the undermost earundermost earLatency few secondsLatency few secondsDuration limited 20 secondsDuration limited 6 procedures in 2 Non-cured patients need 6 procedures in 2 weeks,should considering liberatory maneuverweeks,should considering liberatory maneuverElderly population and BPPVn nS.Angeli 2003:S.Angeli 2003:Effectiveness of CRP and VREffectiveness of CRP and VR Modified Epley:Modified Epley:n nElderly comorbidities:degenerative osteoarthritis Elderly comorbidities:degenerative osteoarthritis disease,CVA,peripheral neuropathy,cognitive and disease,CVA,peripheral neuropathy,cognitive and autonomic dysfunctionsautonomic dysfunctionsn nS/E of CRP neck torsion and extension result in S/E of CRP neck torsion and extension result in vertibrobasilar artery insufficiency,strain on the spine vertibrobasilar artery insufficiency,strain on the spine column,dislodged carotid a.embolicolumn,dislodged carotid a.embolin nAvoid liberatory maneuver Avoid liberatory maneuver 64%CRP group negative DH after a month 64%CRP group negative DH after a month Overall 77%with CRP and VROverall 77%with CRP and VRCRP Meta-Analysis B.Woodworth-2004B.Woodworth-2004n nCRP-First line of treatmentNon-invasiveNon-invasiveEasy to perform in the officeEasy to perform in the officeNo need to expensive instrumentationsNo need to expensive instrumentationsRepeat maneuver if neededRepeat maneuver if neededPotential to provide rapid relief of vertigoPotential to provide rapid relief of vertigo Meta-Analysisn n9 randomized-controlled trials n nSymptoms resolution and elimination of positive Dix-Hallpike testn nCRP more effective than control(x5)n nUntreated patients-symptoms improvements with time but positive DHn nSo Resolution of vertigo avoidance of provocative positions CRP Epley maneuverCRP Semont maneuverMastoid oscillatorBrandt-Daroff ExserciseLampert maneuver-Lat.SCC BPPVVestibular rehabilitaionsComplications of CRPn nFailure 25%(12%-56)n nRecurrence 13%in 6 monthsn nSide effects Nausea Nausea VomitingVomitingFaintingFaintingSweatingSweatingn nWorse vertigo LAT SCC PPVn nTHANK YOU 结束结束