THE TREATMENT OF VERTIGO.

It is superfluous to mention that treatment is dependent upon the cause of the vertigo. The treatment of various central nervous & psychogenic disorders is beyond the scope of this discussion. However, a broad outline of treatment, both medical & surgical, is presented here.

•  Vascular:
VBI & Basilar Artery Migraine are treated by:

Beta-blockers
Ergot alkaloids
Anti-serotonin agents e.g. methysergide.
Vasodilators e.g. Nitroglycerine.

(Above our in addition to the neurologic management)

•  Tumours:
It is incumbent upon the treating physician to realise that it is erroneous to assume that only C-P Angle tumours cause vertigo. This symptom can present because of various reasons:

Primary- Mass effect.
Organic Brain syndrome.
Diffuse meningeal carcinomatosis—this is often missed even on CT. Scan.
Lympho-proliferative tumours.

•  Trauma, drug ingestion & epilepsy should be ruled out by taking a good history.

•  Inflammatory causes:

Central –
Meningitis
Syphilis

Peripheral –
Sinus infections /
Dental infections

(Meningitis and Dental Infections rule out by: History / clinical examination Biochemistry – CSF / Haematology. Imaging – CT Scan)

•  Metabolic causes should be ruled out by: History/clinical examination /Biochemistry / Haematology..

• Haemodynamic causes should be carefully looked for. Certain manoeuvres have been described by Drachmann & Hart, which precipitate an attack of vertigo. Some of them are useful in clinical practice, while others are of use in the research labs.

Outlined below are certain common methods of precipitating vertigo:

•  Blood pressure is measured lying down & 3 minutes after standing up.

•  Valsalva Manoeuvre for 14 seconds.

•  Carotid Massage for 10 seconds. ( This is not performed by us ).

•  Vigorous head turning from side-to-side 15 times.

•  Hyperventilation for 3 minutes.

•  Nylen - Barany test for BPPV.

•  Hallpike's Manoeuvre.

•  Uenterberger's Test.

•  Barany's rotation test.

•  Any manoeuvre which reproduces the patient's vertigo.

The Treatment of vertigo due to peripheral causes.

When a patient presents with vertigo as a primary complaint, it is necessary to follow the below-mentioned proforma for a systematic narrowing down to the possible etiologies responsible for the patient's symptoms. Once it is established beyond doubt that the vertigo is indeed due to peripheral causes, one should look for the characteristics of each possible cause.

•  Vasodilators. Xanthine nicotinate derivatives.

•  Anti-vasoconstrictors. Cinnarizine & Flunarizine are known to act both centrally & peripherally.

•  Anti-histaminics. Promethazine theoclate or dimenhydrinate are commonly used.

•  Steroids.

•  Vestibular suppressants.

•  Sedatives.

•  Beta-blockers.

•  Adjuvant therapy. Low-salt diet, propantheline bromide, Vitamins & bioflavonoid compounds.

Vestibular Rehabilitation Exercises are found to be useful.