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el oido y el
                         equilibrio
                           prof dra graciela pepe
                     facultad de medicine unne argentina




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido    procesamiento
            interno    centralizado




                       armonia
                       simetria




Tuesday, May 8, 12
oido     VERTIGO
              interno




                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
oido     VERTIGO
              interno




                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
oido     VERTIGO
              interno




                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
oido     VERTIGO
              interno




                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
oido     VERTIGO
              interno




                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
oido     VERTIGO
              interno


                                   VOMITOS

                        NISTAGMO




                        DESEQUILIBRIO


Tuesday, May 8, 12
UN MAPA
                       PARA EL
                     TERRITORIO


Tuesday, May 8, 12
1           QUE SIENTE EL PACIENTE ?




Tuesday, May 8, 12
OIDO INTERNO




    SINCOPE                            PSICOGENOS


                           DESEQUILIBRIO
                     VERTIGO
                                           si es sincope o desmayo
                                           es un problema
                                           cardiovascular o
                                           neurovascular




Tuesday, May 8, 12
OIDO INTERNO




                                       PSICOGENOS


                           DESEQUILIBRIO
                     VERTIGO
                                           si es sincope o desmayo
                                           es un problema
                                           cardiovascular o
                                           neurovascular




Tuesday, May 8, 12
OIDO INTERNO




                           DESEQUILIBRIO
                     VERTIGO
                                       si es sincope o desmayo
                                       es un problema
                                       cardiovascular o
                                       neurovascular




Tuesday, May 8, 12
2             TRAYECTORIA DE LOS
                     SINTOMAS EN EL TIEMPO




Tuesday, May 8, 12
100

                                             86

                                             71

                                             57

                                             43

                                             29

                                             14

                                             0

                     TRAYECTORIA :SINTOMATICO DESDE
                       MINUTOS A HORAS, EN CRISIS,
                     MULTIPLES EPISODIOS, DETERIORO
                         LENTAMENTE PROGRESIVO



Tuesday, May 8, 12
                            MENIERE
100
                                             86
                                             71
                                             57
                                            43
                                            29
                                            14
                                            0


                            TRAYECTORIA : un episodio
                     inicial,SINTOMATICO POR DIAS, MEJORA
                                PROGRESIVAMENTE


                             NEURONITIS
                             VESTIBULAR
Tuesday, May 8, 12
100

                                            86

                                            71

                                            57

                                            43

                                            29

                                            14

                       TRAYECTORIA :SINTOMATICO POR
                      SEGUNDOS, EN CRISIS, VUELVE A LA
                               NORMALIDAD

                      VERTIGO POSICIONAL
                     PAROXISTICO BENIGNO
Tuesday, May 8, 12
2           DONDE LO UBICAMOS EN LA
                          “MATRIX”
                      (DR RAUCH . HARVARD USA)




Tuesday, May 8, 12
VERTIGO

                           EN CRISIS    PERSISTENTES
                          EPISODICOS


                     SI                 LABERINTITIS

HIPOACUSIA                  VERTIGO
                          POSICIONAL     NEURONITIS
                     NO   PAROXISTICO
                            BENIGNO      VESTIBULAR




Tuesday, May 8, 12
VERTIGO

                           EN CRISIS    PERSISTENTES
                          EPISODICOS

                          MENIERE
                     SI                 LABERINTITIS

HIPOACUSIA                  VERTIGO
                          POSICIONAL     NEURONITIS
                     NO   PAROXISTICO
                            BENIGNO      VESTIBULAR




Tuesday, May 8, 12
VERTIGO

                           EN CRISIS     PERSISTENTES
                          EPISODICOS

                           MENIERE
                     SI   FISTULA PL     LABERINTITIS

HIPOACUSIA                   VERTIGO
                           POSICIONAL     NEURONITIS
                     NO    PAROXISTICO
                             BENIGNO      VESTIBULAR




Tuesday, May 8, 12
3           LOS DIAGNOSTICOS
                      EXTRA “MATRIX ”




Tuesday, May 8, 12
MIGRAÑA
                                  ASOCIADA
   AL MENOS 5 EPISODIOS           A MAREO
  DURANDO 4 A 72HS

   AL MENOS DOS DE ESTAS
  CARACTERISTICAS:
  UNILATERAL
  PULSATIL
  MODERADA A SEVERA INTENSIDAD
  AGRAVADA POR ACTIVIDAD FISICA

        AL MENOS UNA DE ESTAS:
  NAUSEAS Y VOMITO
  FOTOFOBIA
  FONOFOBIA



Tuesday, May 8, 12
VERTIGO CERVICAL




     DESEQUILIBRIO
   ASOCIADO A LA EDAD

              SI NO SE AJUSTA A NINGUNA DE ESTAS SITUACIONES : DERIVE A
               NEUROLOGO Y/ O PSICOLOGO.EL PANICO, LA ANGUSTIA Y LAS
                 EMOCIONES ESTAN SIEMPRE PRESENTES Y ES MUY DIFICIL
             DIFERENCIAR EL ROL EXACTO QUE CUMPLEN EN CADA PACIENTE.


Tuesday, May 8, 12

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El paciente mareado

  • 1. el oido y el equilibrio prof dra graciela pepe facultad de medicine unne argentina Tuesday, May 8, 12
  • 2. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 3. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 4. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 5. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 6. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 7. oido procesamiento interno centralizado armonia simetria Tuesday, May 8, 12
  • 8. oido VERTIGO interno NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 9. oido VERTIGO interno NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 10. oido VERTIGO interno NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 11. oido VERTIGO interno NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 12. oido VERTIGO interno NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 13. oido VERTIGO interno VOMITOS NISTAGMO DESEQUILIBRIO Tuesday, May 8, 12
  • 14. UN MAPA PARA EL TERRITORIO Tuesday, May 8, 12
  • 15. 1 QUE SIENTE EL PACIENTE ? Tuesday, May 8, 12
  • 16. OIDO INTERNO SINCOPE PSICOGENOS DESEQUILIBRIO VERTIGO si es sincope o desmayo es un problema cardiovascular o neurovascular Tuesday, May 8, 12
  • 17. OIDO INTERNO PSICOGENOS DESEQUILIBRIO VERTIGO si es sincope o desmayo es un problema cardiovascular o neurovascular Tuesday, May 8, 12
  • 18. OIDO INTERNO DESEQUILIBRIO VERTIGO si es sincope o desmayo es un problema cardiovascular o neurovascular Tuesday, May 8, 12
  • 19. 2 TRAYECTORIA DE LOS SINTOMAS EN EL TIEMPO Tuesday, May 8, 12
  • 20. 100 86 71 57 43 29 14 0 TRAYECTORIA :SINTOMATICO DESDE MINUTOS A HORAS, EN CRISIS, MULTIPLES EPISODIOS, DETERIORO LENTAMENTE PROGRESIVO Tuesday, May 8, 12 MENIERE
  • 21. 100 86 71 57 43 29 14 0 TRAYECTORIA : un episodio inicial,SINTOMATICO POR DIAS, MEJORA PROGRESIVAMENTE NEURONITIS VESTIBULAR Tuesday, May 8, 12
  • 22. 100 86 71 57 43 29 14 TRAYECTORIA :SINTOMATICO POR SEGUNDOS, EN CRISIS, VUELVE A LA NORMALIDAD VERTIGO POSICIONAL PAROXISTICO BENIGNO Tuesday, May 8, 12
  • 23. 2 DONDE LO UBICAMOS EN LA “MATRIX” (DR RAUCH . HARVARD USA) Tuesday, May 8, 12
  • 24. VERTIGO EN CRISIS PERSISTENTES EPISODICOS SI LABERINTITIS HIPOACUSIA VERTIGO POSICIONAL NEURONITIS NO PAROXISTICO BENIGNO VESTIBULAR Tuesday, May 8, 12
  • 25. VERTIGO EN CRISIS PERSISTENTES EPISODICOS MENIERE SI LABERINTITIS HIPOACUSIA VERTIGO POSICIONAL NEURONITIS NO PAROXISTICO BENIGNO VESTIBULAR Tuesday, May 8, 12
  • 26. VERTIGO EN CRISIS PERSISTENTES EPISODICOS MENIERE SI FISTULA PL LABERINTITIS HIPOACUSIA VERTIGO POSICIONAL NEURONITIS NO PAROXISTICO BENIGNO VESTIBULAR Tuesday, May 8, 12
  • 27. 3 LOS DIAGNOSTICOS EXTRA “MATRIX ” Tuesday, May 8, 12
  • 28. MIGRAÑA ASOCIADA AL MENOS 5 EPISODIOS A MAREO DURANDO 4 A 72HS AL MENOS DOS DE ESTAS CARACTERISTICAS: UNILATERAL PULSATIL MODERADA A SEVERA INTENSIDAD AGRAVADA POR ACTIVIDAD FISICA AL MENOS UNA DE ESTAS: NAUSEAS Y VOMITO FOTOFOBIA FONOFOBIA Tuesday, May 8, 12
  • 29. VERTIGO CERVICAL DESEQUILIBRIO ASOCIADO A LA EDAD SI NO SE AJUSTA A NINGUNA DE ESTAS SITUACIONES : DERIVE A NEUROLOGO Y/ O PSICOLOGO.EL PANICO, LA ANGUSTIA Y LAS EMOCIONES ESTAN SIEMPRE PRESENTES Y ES MUY DIFICIL DIFERENCIAR EL ROL EXACTO QUE CUMPLEN EN CADA PACIENTE. Tuesday, May 8, 12