Triad Of Vertigo Research Articles

Ménière's: why its diagnosis calls for more careful evaluation.

The triad of vertigo, tinnitus, and deafness is a familiar presentation in a GP surgery, but diagnosis and treatment remain a challenge. ‘Difficulty with everything in general practice is spotting the unusual from the commonplace, and continuity of care is really important’ , says Dr Henrietta Hughes, GP and National Guardian for the NHS. ‘If a patient comes back to see several different people, they might all try something to fix the immediate problem rather than seeing the whole picture’ (personal communication, January 2017). There is no definitive test for Meniere’s syndrome and it is not at all uncommon for people to be misdiagnosed. The classic symptoms are fluctuating hearing loss, low-pitch tinnitus, fullness in the ear, and episodic spinning vertigo that lasts at least 20 minutes, but typically 2–3 hours. (The whole attack should be over in less than 24 hours.) A number of recent studies examining the experiences of dizzy patients1–3 have indicated that doctors frequently diagnose it when they see any vertigo they don’t understand, and there are patients diagnosed with Meniere’s syndrome who simply never get evaluated for anything else. Taking the history of a dizzy patient is essential to differentiate the possible aetiologies of vertigo, and a systematic approach must be used. The mnemonic ‘SO STONED’4 has been proposed, summarising the key factors that allow a first approximation of diagnosis identification: Symptoms, Often (frequency), Since, Trigger, Otology, Neurology, …

Vestibular nerve section in a child with intractable Menière's disease

Clinical presentation of Menière's disease in children is not as typical as in adults. The triad of vertigo, tinnitus and deafness are not usually elicited, diagnosis often being made after years of follow up and batteries of investigation. A case of Menière's disease in a 3-year-old boy is presented. The diagnosis was only obvious at the age of 8 when the triad of vertigo, deafness and tinnitus were present. His disease progressed despite a trial of intratympanic gentamicin injections and endolymphatic sac decompression. Vestibular nerve section was subsequently performed for his intractable disease. Following the procedure he was asymptomatic and able to attend school.

Menire's disease

Menière's disease is an idiopathic condition classically described as a triad of vertigo, deafness and tinnitus. A wide differential diagnosis exists, but acoustic neuroma must be actively excluded. Various medical and surgical treatment options are available, although two-thirds of patients spontaneously resolve with time.

Cerebellar infarction. Clinical and anatomic observations in 66 cases.

Cerebellar infarction displays different clinical features, depending on the vascular territory involved. We studied patients with infarcts in the territories of the posterior inferior cerebellar artery or the superior cerebellar artery to compare their clinical presentation, course, and prognosis. We retrospectively analyzed the clinical features, laboratory data, and imaging studies of 66 patients with cerebellar infarction collected consecutively at five institutions. All the cerebellar infarcts were documented on computed tomographic scan or magnetic resonance imaging. Two distinct profiles emerged, depending on the vascular territory involved. In 36 patients with posterior inferior cerebellar artery territory infarcts, a triad of vertigo, headache, and gait imbalance predominated at stroke onset. Computed tomography showed severe cerebellar mass effect in 11 cases (30%), with associated hydrocephalus in seven. In these seven patients (19%), postinfarct swelling led to brain stem compression that resulted in four deaths. In 30 patients with superior cerebellar artery infarcts, gait disturbance predominated at onset; vertigo and headache were significantly less common. The clinical course was usually benign. Computed tomography showed marked cerebellar mass effect, hydrocephalus, and brain stem compression in only two instances (7%). Presumed cerebral embolism was the predominant stroke mechanism in patients with superior cerebellar artery distribution infarcts, whereas in those with posterior inferior cerebellar artery distribution infarcts, the stroke mechanism was equally divided between cardiogenic embolism and posterior circulation arterial disease. Cerebellar infarcts in the posterior inferior cerebellar artery and superior cerebellar artery distribution have distinct differences in clinical presentation, course, and prognosis. These differences should help in the selection of appropriate monitoring and treatment strategies.