Common Cause Of Vertigo Research Articles

NEUROTOLOGY

As in most areas of clinical medicine, the history often is the key to determining the diagnosis in patients presenting with neurotologic symptoms. The most common cause of vertigo--benign positional vertigo--can be diagnosed at the bedside based on the characteristic history and the finding of fatigable positional nystagmus on the Dix-Hallpike positional test. Furthermore, it can be cured with a simple positioning maneuver. Quantitative auditory and vestibular function tests are important for documenting the site and severity of deficit in patients with chronic neurotologic symptoms. Only a few presentations (listed in section on acute vertigo) require immediate neuroimaging.

Vestibular and auditory disorders.

Benign positional vertigo, the most common cause of vertigo, can now be cured with a simple bedside maneuver. A series of recent publications have clarified the pathophysiology of benign positional vertigo and documented the efficacy of particle repositioning maneuvers for treating the condition. The number of genetic loci and abnormal genes associated with inherited auditory and vestibular disorders is rapidly expanding. Within the past years, genes have been identified for Usher syndrome, Alport syndrome, deafness with fixation of the stapes and familial periodic ataxia. These discoveries should lead to improved diagnosis and, eventually, specific treatments for these disorders.

Vestibular neuritis spares the inferior division of the vestibular nerve.

Acute unilateral vestibulopathy, or vestibular neuritis, is the second most common cause of vertigo. To quantify the involvement of the different semicircular canal (SCC) afferents in this disease, we studied the three-dimensional (3D) properties of the vestibuloocular reflex (VOR) in 16 patients 3-10 days after onset of symptoms. Using 3D magnetic search coil eye movement recordings, we measured the speed and axis of eye rotation during spontaneous nystagmus and during rotation in the planes of the different SCCs. In all patients, spontaneous nystagmus axes clustered between the direction expected with involvement of just one horizontal SCC and the direction expected with combined involvement of the horizontal and anterior SCC on one side. Likewise, dynamic asymmetries were found only during rotations about axes which stimulated the ipsilesional horizontal or ipsilesional anterior SCCs. No asymmetry was found when the ipsilesional posterior SCC was stimulated. Thus, both measurements suggest that vestibular neuritis is a partial and not a complete unilateral vestibular lesion and that this partial lesion affects the superior division of the vestibular nerve which includes the afferents from the horizontal and anterior SCCs.

Atypical Forms of Paroxysmal Positional Nystagmus

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and has a typical constellation of physical findings. Atypical forms of paroxysmal positional nystagmus (APPN) also exist, and are thought to represent conditions which are in fact not "benign". We studied 100 consecutive patients with positional vertigo in order to learn whether APPN differed from classic BPPV in etiology or clinical fate, and to learn the incidence of central nervous system (CNS) disorders in these patients. APPN was present in 38% of these patients with diverse causes. One-fourth had CNS disorders or vascular insufficiency, the remainder, otogenic or idiopathic. APPN was more likely than BPPV to have a prolonged (persistent or recurring) clinical course. Although most cases eventually resolved, duration of symptoms tended to be longer, regardless of etiology. We conclude that APPN has a less favorable prognosis than typical BPPV, and that a CNS etiology should be suspected in prolonged cases.

Does This Dizzy Patient Have a Serious Form of Vertigo?

<h3>CLINICAL SCENARIOS: COMMON CAUSES OF VERTIGO</h3><h3>Patient 1</h3> A 52-year-old woman was admitted to the hospital because of nausea, a constant spinning sensation, and vomiting of 24 hours' duration. Any movement of her head made these symptoms worse. On examination, she had bilateral horizontal spontaneous nystagmus. Two days later, after symptomatic improvement, she was dismissed. At follow-up 2 weeks later, her symptoms and nystagmus had completely resolved. <h3>Patient 2</h3> A 70-year-old woman had a 4-month history of an intermittent whirling sensation when turning her head and especially when rolling over in bed. On examination, a left-side-down head-hanging maneuver elicited rotatory nystagmus, with the fast component to the left ear (Figure). There was a latency of about 3 seconds before the onset of nystagmus, which lasted approximately 10 seconds. <h3>WHY EVALUATE VERTIGO?</h3> "Vertigo" is defined in Webster's dictionary²as a disturbance "in which the external world seems to revolve around

Exercise therapy for positional vertigo.

We present a common cause of vertigo, benign positional paroxysmal vertigo (BPPV), and its history, diagnosis, and therapy. BPPV is suggested by history, readily diagnosed by office examination, and cured by appropriate exercise therapy. Since the condition is so common and often unrecognized, physicians are encouraged to consider BPPV as a possible cause of treatable dizziness.

Dizziness in older people.

Patients use the term dizziness to describe a sensation of altered orientation in space. Because visual, proprioceptive, somatosensory and vestibular signals provide the main information about the position of the head and body in space, damage to any of these systems can lead to a complaint of dizziness. Changes in the brain centers that integrate these orienting signals can also result in a sensation of dizziness. This review focuses on the pathophysiology, diagnosis, and management of the common causes of dizziness in older people.

History taking in dizziness. The most important diagnostic step.

When faced with a complaint of dizziness, the primary care physician may be tempted to assume that the cause is inner ear dysfunction and that the patient needs to be referred to an otologist. According to Dr Hybels, however, most dizzy patients do not have an ear problem and a carefully executed history is likely to pinpoint the correct diagnosis. The following article delineates the fine points of history taking and discusses some of the most common causes of dizziness.