The diagnosis and management of vertigo is still a challenge. Vertigo is managed by heterogenous group of specialists, including Otolaryngologists, Neurologists and Physiotherapists. The cause of vertigo could be vestibular, central or cervicogenic. The current review was undertaken as an attempt to highlight the various gaps in knowledge about vertigo of varied aetiologies. Cervicogenic vertigo is caused due to neck pathologies and is considered by some authors to be one of the most common vertigo syndromes. However, there is little mention of it in otolaryngology textbooks. Barriers across the specialties and lack of communication between the specialists are an impediment in vertigo management. This review has attempted to highlight the likely multifactorial aetiologies and fallacies in the pathophysiology of Meniere’s disease. The clinical overlaps in cervicogenic and vestibular vertigo have been discussed, some of them being, the occurrence of aural symptoms and neck pain in both the entities. This review article brings out the need to revisit the pathophysiology of vestibular vertigo syndromes and include cervicogenic dizziness in the list of vertigo syndromes in Otolaryngology textbooks. The authors found a dire need of an interdisciplinary approach to elucidate the cause of vertigo of varied presentation with the goal of better patient management.
Introduction: Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin.Methods: A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo.Results: Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps.
Conclusion:The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium." Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.
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