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By Paul Foster MD
Jonathan A Edlow, David Newman-Toker
BACKGROUND: Emergency department (ED) patients who present with acute dizziness or vertigo can be challenging to diagnose. Roughly half have general medical disorders that are usually apparent from the context, associated symptoms, or initial laboratory tests. The rest include a mix of common inner ear disorders and uncommon neurologic ones, particularly vertebrobasilar strokes or posterior fossa mass lesions. In these latter cases, misdiagnosis can lead to serious adverse consequences for patients...
April 2016: Journal of Emergency Medicine
Benjamin Stolte, Dagny Holle, Steffen Naegel, Hans-Christoph Diener, Mark Obermann
BACKGROUND: The combination of vertigo, dizziness and balance disturbance with migraine is called vestibular migraine. Although it is estimated that up to 1% of the population suffers from this disease, it is still widely unknown and often underdiagnosed. Recently, the International Headache Society and the Báràny Society published the first joint document with mutually accepted diagnostic criteria for vestibular migraine. METHOD: This review summarizes current knowledge on vestibular migraine with regard to epidemiology, clinical presentation, pathophysiology, differential diagnosis and therapeutic options...
March 2015: Cephalalgia: An International Journal of Headache
Alex T H Lee
Dizziness is among the commonest of chief complaints. It often presents a significant challenge to the attending physician, because the symptoms and signs are often vague and non-specific. However, a robust systematic approach can usually arrive at the diagnosis. Maintaining balance requires sensory inputs from the vestibular, visual, and somatosensory systems and the cerebellum fine-tunes inaccurate motor outputs. Causes of vertigo are most commonly otological, followed by central, somatosensory, and visual...
August 2012: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Terry D Fife, Christopher Giza
Dizziness and vertigo are common symptoms following minor head trauma. Although these symptoms resolve within a few weeks in many patients, in some the symptoms may last much longer and impede ability to return to work and full functioning. Causes of persisting or recurrent dizziness may include benign paroxysmal positional vertigo, so-called labyrinthine concussion, unilateral vestibular nerve injury or damage to the utricle or saccule, perilymphatic fistula, or less commonly traumatic endolymphatic hydrops...
July 2013: Seminars in Neurology
Hyun-Ah Kim, Hyon-Ah Yi, Hyung Lee
Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30-39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10...
November 2015: Neurological Sciences
A P Casani, I Dallan, E Navari, S Sellari Franceschini, N Cerchiai
The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines...
June 2015: Acta Otorhinolaryngologica Italica
Paulus S Rommer, Gerald Wiest, Claudia Kronnerwetter, Heidemarie Zach, Benjamin Loader, Kirsten Elwischger, Siegfried Trattnig
Vestibular parxoysmia (VP) is a rare vestibular disorder. A neurovascular cross-compression (NVCC) between the vestibulochochlear nerve and an artery seems to be responsible for short attacks of vertigo in this entity. An NVCC can be seen in up to every fourth subject. The significance of these findings is not clear, as not all subjects suffer from symptoms. The aim of the present study was to assess possible structural lesions of the vestibulocochlear nerve by means of high field magnetic resonance imaging (MRI), and whether high field MRI may help to differentiate symptomatic from asymptomatic subjects...
2015: Frontiers in Neuroanatomy
Ezgi Deniz Batu, Banu Anlar, Meral Topçu, Güzide Turanlı, Sabiha Aysun
OBJECTIVE: Evaluation and management of vertigo in children vary between institutions and medical specialties. The aim of this study is to describe the characteristics of vertigo in children presenting to a pediatric neurology referral center and to investigate the relationship between vertigo and migraine. STUDY DESIGN: Patients <18 years old presenting with vertigo to Hacettepe University Ihsan Dogramaci Children's Hospital Neurology Unit between January 1996-January 2012 were included (n = 100)...
March 2015: European Journal of Paediatric Neurology: EJPN
Timothy C Hain
PURPOSE OF REVIEW: Herein we discuss the recent literature concerning cervicogenic vertigo including vertigo associated with rotational vertebral artery syndrome, as well as whiplash and degenerative disturbances of the cervical spine. We conclude with a summary of progress regarding diagnostic methods for cervicogenic vertigo. RECENT FINDINGS: Several additional single case studies of the exceedingly rare rotational vertebral artery syndrome have been added to the literature over the last year...
February 2015: Current Opinion in Neurology
Klaus Jahn, Thyra Langhagen, Florian Heinen
PURPOSE OF REVIEW: Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more alert to the frequent causes of dizziness in the young. RECENT FINDINGS: Epidemiological data confirm that migraine-related syndromes are the most common cause of vertigo in children. Vestibular migraine and benign paroxysmal vertigo have now been defined by the International Classification of Headache Disorders...
February 2015: Current Opinion in Neurology
Nadine Lehnen, Thyra Langhagen, Florian Heinen, Doreen Huppert, Thomas Brandt, Klaus Jahn
Vestibular paroxysmia due to neurovascular compression is a syndrome consisting of frequent short episodes of vertigo in adults that can be easily treated. Here we describe the initial presentation and follow-up of three children (one female, 12y; two males, 8y and 9y) who experienced typical, brief, vertiginous attacks several times a day. Nystagmus was observed during the episodes. Cranial magnetic resonance imaging revealed arterial compression of the eighth cranial nerve. The attacks ceased after administration of low-dose carbamazepine (2-4mg/kg daily)...
April 2015: Developmental Medicine and Child Neurology
Alexandra Molnar, Steven McGee
Dizziness is a common presenting concern in primary care practice. The most useful diagnostic approach in distinguishing different types of dizziness is a thorough history and physical examination; additional tests are rarely necessary. Effective treatments exist for many causes of dizziness, and these treatments are often accomplished in the clinic or at home without the need for medication.
May 2014: Medical Clinics of North America
Jennifer Wipperman
Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease.
March 2014: Primary Care
Michael Strupp, Olympia Kremmyda, Thomas Brandt
Vertigo and dizziness are with a life-time prevalence of ~30% among the most common symptoms and are often associated with nystagmus or other oculomotor disorders. The prerequisite for a successful treatment is a precise diagnosis of the underlying disorder. In this overview, the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and oculomotor disorders including nystagmus are described. There are basically seven groups of drugs that can be used (the "7 As"): antiemetics; anti-inflammatory, anti-Menière's, and antimigraine medications; antidepressants, anticonvulsants, and aminopyridines...
July 2013: Seminars in Neurology
Christoph Best, Joachim Gawehn, Heidrun H Krämer, Frank Thömke, Tugba Ibis, Wibke Müller-Forell, Marianne Dieterich
BACKGROUND: Vestibular paroxysmia (VP) is defined as neurovascular compression (NVC) syndrome of the eighth cranial nerve (N.VIII). The aim was to assess the sensitivity and specificity of MRI and the significance of audiovestibular testing in the diagnosis of VP. METHODS: 20 VP patients and, for control, 20 subjects with trigeminal neuralgia (TN) were included and underwent MRI (constructive interference in steady-state, time-of-flight MR angiography) for detection of a NVC between N...
December 2013: Journal of Neurology, Neurosurgery, and Psychiatry
Michael Strupp, Thomas Brandt
PURPOSE OF REVIEW: First, to update the diagnosis, pathophysiology, and treatment of the most frequent peripheral vestibular disorders. Second, to identify those disorders for which the diagnostic criteria are still deficient and treatment trials are still lacking. RECENT FINDINGS: Bilateral vestibulopathy can be reliably diagnosed by the head-impulse test, caloric irrigation, and vestibular-evoked myogenic potentials. A new frequent subtype has been described: cerebellar ataxia, neuropathy, and vestibular areflexia syndrome...
February 2013: Current Opinion in Neurology
Alexander X Lo, Caroline N Harada
Dizziness affects one in five people over the age of 65 years and is associated with substantial healthcare costs. Serious causes of dizziness are found in 20% of patients over 50 years. The approach to the patient with dizziness is challenging as physical exam and diagnostic tests have suboptimal sensitivities. The risk of vascular events is higher in the first 30 days than after, suggesting some missed diagnoses. Medications and vestibular rehabilitation may serve as treatment options for dizziness, but data on their efficacy in older patients is lacking...
February 2013: Clinics in Geriatric Medicine
Ronald J Tusa, Russell Gore
The cause of dizziness in patients seen in the emergency room can usually be determined by a focused evaluation that consists of identifying three key features in the history and five key elements of the clinical examination. This article discusses the most common causes of dizziness, how to use this approach, and management of these cases in the emergency room.
February 2012: Neurologic Clinics
Daogong Zhang, Zhaomin Fan, Yuechen Han, Mingming Wang, Lei Xu, Jianfen Luo, Yu Ai, Haibo Wang
OBJECTIVE: To investigate the diagnostic value of vestibular test and high stimulus rate auditory brainstem response (ABR) test and the possible mechanism responsible for benign paroxysmal vertigo of childhood (BPVC). METHODS: Data of 56 patients with BPVC in vertigo clinic of our hospital from May 2007 to September 2008 were retrospectively analyzed in this study. Patients with BPVC were tested with pure tone audiometry, high stimulus rate auditory brainstem response test (ABR), transcranial Doppler sonography (TCD), bithermal caloric test, and VEMP...
January 2012: International Journal of Pediatric Otorhinolaryngology
K Jahn, T Langhagen, A S Schroeder, F Heinen
Vertigo and balance disorders are not uncommon in children. The prevalence of vestibular vertigo in 10-year-Dolds is estimated to be 5.7%. The most common cause is vestibular migraine which accounts for almost 40% of the diagnoses. In adolescents, the incidence of somatoform vertigo syndromes increases. Vestibular function can be reliably evaluated at the bedside by the head-impulse test for vestibulo-ocular reflex function, ocular motor testing of the central vestibular system, and balance tests for vestibulo-spinal function...
August 2011: Neuropediatrics
2015-08-19 21:26:33
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