The most frequent complaints among OPD Dizziness-imbalance,headache,back pain, fatique,Mostly benign,Analyse correctly the nature of disturbance and anatomic location,A feeling of rotation,whirling,non-rotatory swaying,weakness,faintness,unsteadiness,Dizziness may mean giddiness,light head- edness,unsteadiness,swimminess,vertigo.
The specific qualities of vertigo : all subject ive and objective illusion of motion/position
Pseudo vertigo : non-rotatory giddiness
n Bipolar
¨ Peripheral terminate in hair cells crista ampu llaris SCC & macula acusticae Saccule-Utricle
¨ Central via internal auditory meatus+cochlear + 7th, terminate in the vestibular nuclei (sup-Bechterew, lat-Deiters, med-Schwalbe, inf). Some fibre from SCC project directly to the flocculonodular lobe+ adjacent vermian cortex cerebellum via the juxtarestiform body
SCC horizontal is inclined upwards 30° from the horizontal plane, detect turning
The utricle is a gravity-operated receptor which responds to tilting (out of position R)
The saccule responds to acceleration
The utricle-saccule system provides inform ation leading to correct vertical postures when sits,stands and walks
¨ Efferent fiber from cerebellum to i.l. vestibular and fastigial nucleus
¨ Efferent fiber from fastigial ncl to c.l. vestibular nuclei via juxtarestiform body
¨ Lateral and medial nuclei have important connection with the spinal cord via the uncrossed lateral vestibulospinal tract (limb muscles) and via the crossed and uncrossed medial vestibulospinal tract (axial muscles)
¨ Superior and medial nuclei influence 3rd 4th 6th CN
¨ All vestibular nuclei have afferent and efferent connections with pontin RF à subserve Vestibulo Ocular (clear vision) and Vestibulo Spinal reflex (stable posture)
¨ There are projection from the vestibular nuclei to Cerebral Cortex (intra parietal sulcus and superior Sylvian gyrus)
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