Evaluation of the Patient With Recurrent Vertigo

Abstract

The evaluation of the patient with recurrent vertigo requires knowledge of vestibular anatomy and physiology. The patient's medical history and physical examination provide the majority of the information necessary for diagnosis. Many diagnostic tests are available to the clinician to aid in the diagnosis. Videonystagmography is useful for the evaluation of peripheral vestibular function and provides some information about central processes as well. Rotary chair testing provides excellent information about central processes and can aid in diagnosing peripheral vestibular impairment. Vestibular-evoked myogenic potential testing is sensitive for testing inferior vestibular nerve and saccule function. Many different medical and surgical options are available for the patient with recurrent vertigo.

Normal Gain of VOR with Refixation Saccades in Patients with Unilateral Vestibulopathy

“…The clinical and instrumental examination of the vestibulo-ocular reflex (VOR) is a key issue for the differential diagnosis of patients with dizziness [1] . A sudden head thrust of high velocity (>150º/s) and acceleration (1-16 Hz) on the yaw axis stimulates the horizontal semicircular canal receptor of the side to which the impulse is directed.…”

Vestibular Dysfunction in Patients With Chronic Pain or Underlying Neurologic Disorders

“…28 For patients who may be at risk for falls, Jacobson et al 29 The VNG technology used in the present study allowed for noninvasive evaluation of eye movements and balance function, and like electronystagmography, it has been shown to be an acceptable method for recording findings during vestibular function testing. 9,10,[30][31][32][33][34] The series of tests used in the present study offered a quantitative, objective means for evaluating the complex vestibular system.…”

“…In the future, VNG and electroznys tagmography may also offer noninvasive, objective means for assessing drug intake, as drug-specific waveforms-termed drug-evoked potentials-have been identified for alcohol, marijuana, cocaine, tranquilizers, amphetamines, barbiturates, opiates, and hallucinogens. [28][29][30][31][32][33][34][35][36] As previously mentioned, vestibular dysfunction has been attributed to increased risk for falling, especially in the elderly population. For example, in a study of 66 consecutive, healthy patients (mean age, 67.8 years) who had sustained a wrist fracture at some time in a 10-month period, the frequency of vestibular asymmetry was higher than that in a group of 49 healthy participants (mean age, 74.9 years) (P<.001).…”

Association between the Unterberger-Fukuda test and vectoelectronystagmography

“…To this end, they often use electrophysiological recordings of corneal-retinal potential during visual and labyrinthine stimulation to evaluate the vestibular pathways. This procedure is most commonly performed using vectoelectronystagmography (VENG) 3,4 .…”