Diagnosis and management of vertigo

Abstract

-Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Menière's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short. KEY WORDS What vertigo is and is notVertigo is an illusion of rotation caused by asymmetry of neural activity between the left and right vestibular nuclei. This can be induced in anyone• by simply spinning them at constant speed for about 20 seconds and then suddenly stopping them• by heating or cooling one labyrinth, as happens in the caloric test• by otoconial particles (calcium-containing debris: literally 'earstones') moving along semicircular canal duct, as happens in benign paroxysmal positional vertigo (BPPV). It can also be produced by sudden unilateral destruction of a normal vestibular end-organ, nerve or nucleus or vestibulo-cerebellum, a structure that normally inhibits the ipsilateral vestibular nucleus. (Bilateral simultaneous vestibular destruction does not produce vertigo -in fact, a patient with bilateral vestibular loss will never again experience vertigo from unilateral or asymmetrical vestibular stimulation.)Vertigo is always temporary. Even after the vestibular nerve on one side has been surgically severed, the resulting vertigo (and nystagmus) will abate within a few days. This is not because the vestibular nerve has re-anastomosed but because profound neurochemical changes occuring in the brainstem during the process of vestibular compensation restore symmetrical vestibular nucleus activity. Vertigo is always made worse by head movement; thus patients who are 'dizzy all the time' and are happy to move around whilst dizzy do not have vertigo.Patients with aural vertigo should not lose consciousness but some patients cannot give confident and convincing answers to such simple questions as 'Did it feel as if you were losing balance or as if you were losing consciousness? Did you feel as if you were going to pass out or fall over?' Patients with vertigo might lose consciousness if they have been vomiting a lot, or if they incurred a head injury when they fell.Witness descriptions are not much help in identifying vertigo, but can be helpful in identifying other paroxysmal disorders such as seizure and syncope. Whereas panic attacks, especially with hyperventilation, co...

The Reliability and Validity of “Dokuz Eylül University Meniere’s Disease Disability Scale”

“…Our finding was the same. Moreover, the audiological, eye movement, and bithermal caloric test findings of the patients were similar to the literature [19,35,[37][38][39][45][46][47][48][49][50][51][52] . Head-shaking nystagmus has been reported as 60% previously, though the value was 20.4% in this study [38] .…”

Vestibular Disorders in Children With Congenital Cytomegalovirus Infection

“…Our protocol included complete vestibular and neurologic clinical evaluations (including cerebellar, sensitivity, and muscular testing) 25,29 followed by instrumental testing of vestibular function. Canal function was evaluated at various frequencies with (1) bithermic caloric test (33°C and 44°C) for low frequencies, (2) earth vertical axis rotation (EVAR) with 40°/s 2 acceleration and deceleration along a vertical axis for medium frequencies, 25 and (3) head impulse test (HIT) to test the 6 semicircular canals at high frequencies.…”

An approach to acute vertigo

“…However, as evidence for viral infection is limited, some prefer the term 'acute idiopathic unilateral peripheral vestibulopathy' . [6] Unlike BPPV, spinning vertigo persists for hours to days. The sense of movement is present even with the eyes closed and is worsened by head movement; yet, it is not fully suppressed by keeping the head motionless.…”

“…This test is fairly easy to perform, and is particularly useful to confirm peripheral dysfunction. [6] Smooth pursuit movements of the eyes are intact in peripheral vestibular syndromes, although the assessment may be difficult owing to the presence of marked nystagmus. With central causes of vertigo, pursuit movements of the eyes are typically broken or jerky.…”