Type Of Vertigo Research Articles

More Emphasis on the Commonest Cause for Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. The history is virtually pathognomonic, and the cure can be

Intracranial tumors mimicking benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo is a common type of vertigo seen by the otolaryngologist; however, intracranial tumors can mimic benign paroxysmal positional vertigo in their presentation. A review of patients seen in the Department of Otolaryngology at The Ohio State University between July 1992 and August 1996 identified five patients with intracranial pathologic conditions mimicking benign paroxysmal positional vertigo. These patients were first seen with episodic vertigo associated with positional change. Failure of the symptoms to respond to the particle repositioning maneuver or the finding of associated auditory or neurologic symptoms prompted further evaluation by magnetic resonance imaging of the brain, which revealed intracranial pathologic conditions including two meningiomas, a vestibular schwannoma, a glioma, and a lipoma. These findings suggest that patients seen with symptoms like those of benign paroxysmal positional vertigo who do not show improvement after undergoing the particle repositioning maneuver or those who describe associated auditory or neurologic symptoms should have magnetic resonance imaging done to rule out intracranial pathologic conditions. Additionally, benign paroxysmal positional vertigo and intracranial tumors may coexist. (Otolaryngol Head Neck Surg 1998;118:429-36.)

椎骨脳底動脈循環障害とめまいの病態生理の理解のために １． ヒト椎骨脳底動脈系の血管構築・血流動態

It is well known that some types of vertigo and dizziness are caused by impairment of the vertebro-basilar systems (VBS). And, it is thought that decreases or lateral differences in blood flow in the inner ear and/or brainstem can induce an imbalance in the equilibrium function and provoke a change in the vestibular excitability in the brainstem.The vascular architecture and hemodynamics were estimated to solve the mechanism of vertebro-basilar dysfunction with some basic findings in the anatomical, morphological and hemodynamic studies of the vestibular and cochlear nuclei in the brainstem. The results are:(1) Many variations in the VBS in human posterior circulation were seen. The VBS is the only parallel vasculature in the skull. The anterior inferior cerebellar artery (AICA) originates symmetrically from the basilar artery (BA) and the posterior inferior cerebellar artery (PICA) originates from the vertebral artery (VA) in about 60% of the cases. Measurement of VAs showed that the left VA was larger across the inner diameter than the right VA.(2) The human vestibular nucleus (VN) area is supplied by some terminal arteries (the penetrating branches in the brainstem), one of which is the median pontine branch from the BA and the others penetrate the brainstem straight and from parallel arrangements with each other in the brainstem. The VN area has fewer circumferential branches and less development in the collateral circulation than the cochlear nucleus.(3) No age-related changes in blood velocity are seen in the human BA. However, the blood velocity in the VA, which has the parallel arrangement, becomes bigger. The cross section of the VA does not decrease, and the arterial wall shows an outer thickness; arteriosclerotic change is Kalk-Rohr-like. Therefore, the area supplied by the VA is easily affected by hemodynamic changes.These findings and experiments simulating the VBS (shown in a latter chapter) suggest that hemodynamics in the human posterior circulation differ from those in the anterior circulation.

Diagnostic problems in patients with benign paroxysmal positional vertigo

The steps of the examination procedure applied for a correct diagnosis of benign paroxysmal positional vertigo (BPPV) are reviewed. A precise diagnosis is important in view of treatment of this type of vertigo by rehabilitation therapy. Clinical experience supports the concept that the diagnosis has to be based not only on a typical history, but also on the presence of a reproducible vertigo and paroxysmal positioning nystagmus. In the procedure applied in the department, this nystagmus can be reproduced by the Dix-Hallpike maneuver under Frenzel's glasses, during electronystagmography (ENG) recording in the position tests, or it can be present in the vestibular habituation training test battery (a battery of 19 maneuvers applied for defining the adequate exercises in the rehabilitation treatment for BPPV). Analysis of the reviewed data in 95 patients showed that one third of the patients described the vertigo in a rather atypical way, while the further testing revealed a typical BPPV. This experience denies any absolute reliability to only history. In fact, only the finding of such a paroxysmal positioning nystagmus is conclusive for confirming BPPV. However, also the presence of such a nystagmus appeared not to be a constant datum, so that in some patients more than one examination was necessary to come to a reliable diagnosis. It is obvious that, for detecting a paroxysmal positioning nystagmus, ENG is less reliable than the Dix-Hallpike maneuver under Frenzel's glasses.

Relevance of function tests in the diagnosis of vestibular disorders.

The diagnostic value or relevance of a vestibular function test is dependent on the whole clinical and functional context of each particular case. It is not the ability to show 'abnormality' in a high number of patients complaining of whatever kind of vertigo, that indicates the relevance of a function test. Neither is relevance of a test based upon the possibility that this test can re-categorize some patients in the same way as has been done by other tests. Each test evaluates some particular functional aspect and this is very different from one test to another. A test is more relevant, i.e. indicates more abnormality when the type of vertigo caused by the dysfunction is also considered. These statements are confirmed by experience in peripheral vestibular disorders, especially benign paroxysmal positional vertigo (BPPV). A paroxysmal positional nystagmus (ppn) (nystagmus and vertigo elicited by movements and manoeuvres) is linked to the problem of provoked vertigo and gives a confirmation of this vertigo by reproducing it in some manoeuvres. Some inconstancy in the reproduction of this ppn may cause difficulties in diagnosis. Caloric tests are the clue for diagnosis of sudden unilateral loss (so-called neuronitis), whereas they give only complementary information for patients with BPPV. Posturography adds information in all categories concerning the standing position and can be interesting in the scope of rehabilitation treatment. The findings of a retrospective study in patients with BPPV (n = 95), compared with patients with Ménière's disease (n = 89) and others with sudden unilateral loss syndrome (n = 48), illustrate these concepts.

A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo.

In a prospective longitudinal study of the relationship between symptoms and anxiety in people with vertigo, 101 patients were evaluated on two occasions separated by a 7 month interval. At Time 1 the age, gender, vertigo type, duration of illness, medication, and audiovestibular test results of patients were recorded, and they completed questionnaires assessing handicap, emotional distress, predisposition to anxiety, and symptoms indicative of vertigo and of somatic anxiety. These questionnaires were re-administered at Time 2, and patients also indicated whether their vertigo was more or less severe than at Time 1. Although vertiginous symptoms at Time 2 were generally mild and intermittent, they were associated with significant handicap. Reported symptoms of somatic anxiety and arousal at Time 1 proved to be the only longitudinal predictors of perceived change in vertigo severity over the 7 month period.

Relationship Between GBST and Equilibrium Examination in Vestibular Neuronitis

Eleven patients with vestibular neuronitis were followed up from 1988 to 1990. The relationship between the GBST and other vestibular examinations was investigated. Vertiginous symptoms showed relative improvement, but in the last medical examination 4 out of 11 cases (36.4%) complained of unsteadiness when their head was rotated and fatigued. Seven patients (63.6%) presented spontaneous and positional nystagmus at the first consultation, but only one patient (9.1%) at the last one. Seven patients (63.6%) showed canal paresis to caloric stimulation, while 3 (27.3%) showed normal responses. In the galvanic body sway test (GBST), 9 patients (81.8%) showed abnormal thresholds. There was no significant relationship between vertiginous symptoms in the last medical examination and prodromes, vertigo type, nystagmus, righting reflex, caloric stimulation or the results of the GBST.

The cranial nerve vascular compression syndrome: I. A review of treatment

The author reviews current literature on microvascular decompression (MVD) for treatment of hemifacial spasm (HFS) and trigeminal neuralgia (TN), which shows that MVD is an effective treatment for these disorders. Although there are treatments for TN other than MVD that demonstrate a high rate of success, MVD is the only effective long-term treatment for HFS. MVD is also an effective treatment for glossopharyngeal neuralgia (GPN), and recently MVD has been shown to be an effective treatment for particular types of vertigo (disabling positional vertigo, DPV) and certain types of tinnitus.

Electronystagmographic Findings Following Cervical Whiplash Injuries

A group of 262 patients suffering from the after-effects of an acceleration trauma of the neck were subjected to an extensive vestibular examination. 85% of the patients complained of some type of vertigo. The visual suppression test conducted during rotation showed pathology in 37% of the cases. Visual pursuit movements were affected in 43% of the cases. In a group of 41 patients the results obtained respectively 1 and 2 years after the accident were compared. There was no significant improvement of the findings. No oculomotor system pathology was found in 99 cases (38%), and no electronystagmographic pathology at all in 55 cases (21%). The study emphasized the fact that nystagmographic examinations are able to detect central vestibular dysfunction and is therefore a suitable method to prove pathology.

当科におけるめまい症例の統計的観察

A statistical analysis was conducted on 140 patients (48 males, 92 females) who visited our clinic complaining of vertigo and dizziness from June 1989 to March 1990. Vertigo and dizziness of peripheral origin accounted for 62.1%, of central origin 6.4%, others 10%, and of unknown origin 21.4%. BPPV (Benign Paroxysmal Positional Vertigo) was the most common type of vertigo seen in our clinic. In the 30 patients with disease of unknown origin (21.4%), we analyzed the reasons that we could not diagnose them and tried to classify them from the viewpoint of patterns of onset.

脳循環不全によるめまい

Dizziness is one of the commonest signs in cerebro-vascular diseases. This article describes the occurrence of dizziness in a variety of cerebrovascular diseases.1) In supra-tentorial lesions the incidence of dizziness was higher in thalamic infarction than in other diseases. Since the thalamic artery originates from the vertebro-basilar (VB) system, it is assumed that circulatory disturbances tend to occur simultaneously in the VB system. Thus, cerebellar and brainstem dysfunction causes dizziness accompanying thalamic infarction.2) Dizziness due to VB insufficiency (VBI) was the most common central type of vertigo. VBI can have many causes, such as vascular abnormality, vascular compression in the cervical vertebrae, failure of autoregulation in the posterior circulation etc. The diagnosis can be made on the basis of several signs and symptoms, including dizziness. Some characteristic features of the dizziness are short duration, ranging from a few seconds to several tens of minutes ; i. e., reversible dizziness. The most common accompanying symptoms are visual disorders (i. e. diplopia, blurring of vision), headache, autonomic dysfunction, and sensory and motor disturbances.3) Cerebellar vascular strokes (hemorrhage and infarction) with limited lesions occasionally cause signs and symptoms which mimick those of the peripheral dizziness. CNS signs are not apparent and dizzines, spinning vertigo, vomiting, nausea, and headache are major complaints in such cases. When standing and walking are not possible, and the ocular signs of central abnormality are apparent, one should examine the cerebellum and brainstem with x-ray computed tomography (CT) and magnetic resonant imaging (MRI) to rule out cerebellar stroke.

信大方式家庭内平衡訓練

We devised a series of tasks as therapy for some types of vertigo. The task are as follows: 1) keeping the head in a position that elicits vertigo,2) head movements beginning in the sitting position,3) a short rest,4) body trunk movements,5) clockwise and counterclockwise body rotations while standing with eyes closed,7) walking forwards and backwards with eyes closed.We obtained favo r able results with this therapy in one of ten patients with Meniere's disease, all seven patients with benign paroxysmal positional vertigo and six of ten patients with vertebro-basilar artery insufficiency. Our home therapy is recommended for all patients with benign paroxysmal positional vertigo and selected patients with vertebrobasilar artery insufficiency.

Vestibular Habituation Training: Exercise Treatment for Vertigo Based upon the Habituation Effect

Vestibular habituation training is an exercise treatment for positional vertigo based on the assumption that such a type of vertigo can be cured by habituation effect. The latter is produced by repeating the situation eliciting vertigo. In this way the mechanisms of adaptation and compensation are stimulated, processes of which have been considered "error controlled." Clinical experience with the vestibular habituation training test battery (consisting of 19 maneuvers) showed that in each particular patient only a limited number of responses were positive in various combinations. Selecting the exercises is then a logical consequence. Followup showed a progressive reduction of the positive cases, as well as the number of positive maneuvers. This is in accordance with the development of compensation as it has been observed in experimental conditions and with the decline of progressive responses observed in habituation experiments.

Vestibular habituation training for positional vertigo in elderly patients

Positional vertigo can be successfully treated by exercises (Vestibular Habituation Training, VHT) in elderly patients as well as in younger ones. Provided the patients have been correctly selected, this type of treatment is the only way for an adequate treatment of such a type of vertigo. Application of VHT has to be recommended also in elderly people, as the results obtained are as favourable as those in younger people. Only a slower evolution is observed, which can be correlated with a more restricted activity pattern in the elderly.

Lermoyez's syndrome. A follow-up study in 12 patients.

Clinical studies were performed in 12 patients with the Lermoyez syndrome during a close follow-up of 2 to 31 years. The nature and temporal sequences of the symptoms of these patients are described. The incidence of Lermoyez's syndrome, as compared with Meniere's disease, is almost 18%. This is much higher than usually is assumed. In 6 out of 12 patients typical Meniere attacks were found besides their Lermoyez attacks. Almost every one of the 12 patients showed, besides the Lermoyez attacks, also hearing fluctuations without vertigo, and vertigo without hearing fluctuations. The type of vertigo was usually rotating, often with unsteadiness and in 3 patients dropping attacks were sometimes observed. The typical Lermoyez attack lasted several hours. The preceding hearing loss lasted for days to months. The hearing recovered after the attacks and remained stable for days to months. An improved hearing was noticed within some hours after the vertiginous attack in 9 out of 12 cases. Three patients noticed the hearing improvement already during the attack. In 8 out of 12 cases the disease became bilateral.

Benign paroxysmal positional vertigo in the elderly. Treatment by habituation exercises.

Exercise treatment has become generally accepted as therapy for some types of vertigo. Benign paroxysmal positional vertigo (BPPV) has been very successfully treated by vestibular habituation training (VHT). This is an exercise treatment whereby the patient is repeatedly exposed to the maneuvers eliciting vertigo. Elderly patients treated by VHT also showed very satisfying results, albeit the therapeutic effect developed somewhat slower than in the younger patients. In the scope of the problem of "falling in the elderly," the therapeutic effect for BPPV is worth emphasizing.

鼓室乳突部手術後の乳突開放腔患者にみられた遅発性のめまいについて

We reviewed the details of the clinical history of 31 patients with vertigo who had been operated on by (modified) radical mastoidectomy. Fifteen patients continued to experience dizziness, which was divided into three types.1) paroxysmal vertigo (3 cases), which resembled the first attack of Meniere's disease; 2) positional vertigo (5 cases); and 3) unsteadiness, provoked by rapid body movement or visual fatigue in some patients.Although the main cause of these dizzy spells was labyrinthitis due to the accumulation of keratinizing substance in the open cavity, a more detailed explanation seemed to be possible, according to the results of the examinations. The mechanism of paroxysmal vertigo, non-progressive endo-lymphatic hydrops (Schuknecht) seemed to be the most likely one, and positional vertigo might be explained by degenerative changes in the membranous labyrinth. However, merely pathological changes of the labyrinth could not account for the dizziness of type 3.The percentage of patients who continued to experince dizziness (48%) was higher than in former reports. Moreover, the percentage of those with the true rotatory vertigo types 1 and 2 among these 15 patients (53%) was higher than in former reports, although these reports described mainly preoperative findings. Our results should be considered when canal wall down methods are employed in order to prevent chronic infection from penetrating into the labyrinth during mastoidectomy.

Acupuncture in Auditory and Related Disorders

Acupuncture is of no use, or for the optimist of perhaps marginal use, in sensorineural hearing loss, contrary to what is popularly described in China. 5% or less of patients with tinnitus are helped. It is of moderate help in certain types of vertigo, acute labyrinthitis and some aspects of Meniere's disease, whilst it is of great benefit in motion sickness.The treatment is of moderate benefit in ‘nasal catarrh’, sinusitis and recurrent tonsillitis. It is the treatment of first choice in most forms of headache.May I take this opportunity to endorse the critical commentary of Dr. Beagley and his colleagues of the Rawson Report as expressed in your Journal and Hearing and also in the B.M.J, I will add a few of my own comments concerning what are, in my opinion, yet further deficiencies of this otherwise informative and well written report.

Decompression and Drainage of the Endolymphatic Sac

This is a brief statement of the principles underlying the concept of opening the endolymphatic sac, which is presented from the standpoints of technique, pathogenesis, and selection for surgery according to the type of vertigo. Opening the endolymphatic sac is only indicated when the diagnosis of typical Meniere's disease is certain, ie, when attacks of labyrinthine hydrops occur. As this operation does not have as good a result in the long run as destruction of the posterior part of the labyrinth, it is logical to prefer the latter in cases where the patient is already almost completely deaf but a patient with vertigo of peripheral origin that cannot definitely be labeled as Meniere's disease should have a neurectomy (scarpectomy) of the eighth cranial nerve.

Electroencephalographic Changes in Children with Migraine

THE concept of migraine as a seizure manifestation, based on clinical picture of a paroxysmal disorder, often with a preceding aura, followed by various clinical manifestations, including neurologic signs and symptoms and a postictal phase of sleepiness, has considerable antiquity. The first published suggestion of a linkage between migraine and epilepsy is probably that of Liveing.1 Gowers2 was first to use term Borderland of Epilepsy to include both migraine and certain types of vertigo. Hughlings Jackson3 also had clearly considered such a relation when he demonstrated a case illustrating the relationship between certain cases of migraine and . . .