November 27, 2008

How To Treat Vertigo

In Neurology, found by way of Women's Health magazine October 2008, and no I'm not ashamed to admit it.


Vertigo can have numerous causes, so that's unfortunate.

One type, benign paroxysmal positional vertigo, is characterized by brief episodes triggered by changes in head position vs. gravity in the absence of other causes.  E.g. lying down.

dix-hallpike.JPG

In this test, the doctor (the older man with the white hair, obviously) is testing the right side: he turns the patient's head 45 degrees to the right, and then quickly lays her down.  Nystagmus occurs; you have veritgo!



What is happening?

Balance_Disorder_Illustration_A.JPG



God decided to make those canals be orthogonal-- the horizontal canal laying horizontally, and the other two vertically separated by 90 degrees.  They are filled with fluid, which swish around as you move.  In essence, the swishing is what the brain reinterprets as movement.

Little calcium carbonate crystals (otoliths) dislodge from the utricle and fall into the posterior canal.  Now you have a little rock in your fluid filled tube, which causes all sorts of swishing on its own.  Now you have vertigo.

Gravity is the key.  Since the posterior canal is the most likely place for the crystal to go, and the posterior canal is mostly upright, the biggest effect of the swishing crystal will be when you lie down (and it is free to move.)



What do you do about it?


marble maze game.JPG

Practice.

There are several maneuvers used to literally roll the crystal out of the semicircular canal.  Here's one:


canalith repositioning.JPG


Steps in and 2 are just like the test. 
Step 3: turn the head 90 degress to the unaffected side, and hold for 30 seconds
Step 4: then turn the head (and body) another 90 degrees so the head is face down (not well depicted in this drawing)- hold for 30 seconds
Step 5: sit up.

One study found the awesomeness of this maneuver to be 88% vs. sham maneuver 26% one month after treatment.  Not bad for no meds.

Keep in mind the body position is irrelevant, what matters is accurate head positioning.  The crystals are very sensitive to the force of gravity, so the more accurately you can move the head, the better.  NB: this maneuver is will cause the very veritgo you're trying to treat, so bring a bucket.


















Comments

"God decided to make those ... (Below threshold)

November 27, 2008 5:53 PM | Posted by shrinkology: | Reply

"God decided to make those canals be orthogonal"

This is a joke, right?

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Relax, you'll get it eventu... (Below threshold)

November 27, 2008 11:11 PM | Posted, in reply to shrinkology's comment, by polisciguy: | Reply

Relax, you'll get it eventually.

Aside: someone was developing a hat that had some sort of wire tracking system with a ball, so that as you manuever the ball from one end of the system to the other, you would replicated the motions necessary to knock the otoliths loose.

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Developing?Hell. We ... (Below threshold)

November 28, 2008 3:05 AM | Posted by Anonymous: | Reply

Developing?
Hell. We made those in school. With wire loops attached to a ball cap.
I know it sounds like a "walked uphill in the snow both ways" type thing, but it worked quite well, and everyone from my class excels at those maneuvers.

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I got to do this once as a ... (Below threshold)

November 29, 2008 1:24 PM | Posted by beelicious: | Reply

I got to do this once as a med student on my family rotation. It totally worked. And was way cool :-)

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A useful video of the Epley... (Below threshold)

November 30, 2008 8:22 AM | Posted by Brett: | Reply

A useful video of the Epley maneuvre is here: http://www.australianprescriber.com/upload/issue_files/2804_epley.mov

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Got vertigo a while back, m... (Below threshold)

December 1, 2008 11:52 PM | Posted by V: | Reply

Got vertigo a while back, made an appointment to see a doctor about it. Then I was looking it up on Wikipedia and found this maneuver, which fixed the vertigo before my appointment. Then I canceled the appointment.

The internet is the future, and the future is now.

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Vertigo is illusionary stat... (Below threshold)

July 8, 2010 12:51 AM | Posted by Abel: | Reply

Vertigo is illusionary state in which you feel the environment is spinning around. Regular exercise can prevent vertigo. Practice Looking up, down, to the right, then to the left daily for 20 times. First try it slowly and afterwards increase the speed. Shrug your shoulder up, down and then twist it round. Do this, it will help you. To know more exercises visit: What is Vertigo

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This always did good for my... (Below threshold)

January 13, 2012 5:20 AM | Posted by om: | Reply

This always did good for my vertigo http://howtofixstuff.blogspot.com/2012/01/how-to-fix-vertigo.html

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