Articles: vertigo.
-
Med Klin Intensivmed Notfmed · Feb 2013
Review[Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].
Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. ⋯ The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
-
In 1986, the German neurologists Thomas Brandt and Marianne Dieterich described a syndrome of phobic postural vertigo (PPV) based on clinical observations of patients with nonvertiginous dizziness that could not be explained by then-known neuro-otologic disorders. Subsequent research by an American team led by Jeffrey Staab and Michael Ruckenstein confirmed the core physical symptoms of PPV, clarified its relationship to behavioral factors, and streamlined its definition, calling the syndrome chronic subjective dizziness (CSD). This article reviews the 26-year history of PPV and CSD and places it within the context of current neurologic practice. ⋯ A quarter century of research has established CSD as a common clinical entity in neurologic and otorhinolaryngologic practice. Its identification and treatment offer relief to many patients previously thought to have enigmatic and unmanageable cases of persistent dizziness. Internationally sanctioned diagnostic criteria for CSD are under development for the first edition of the International Classification of Vestibular Disorders, scheduled for publication in early 2013.
-
Emerg. Med. Clin. North Am. · Aug 2012
ReviewVertigo, vertebrobasilar disease, and posterior circulation ischemic stroke.
Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. ⋯ Research involving strokes of the posterior circulation has lagged behind that of the anterior cerebral circulation. Investigations of the last 20 years, using new technologies in brain imaging in combination with detailed clinical studies, have revolutionized our understanding of the clinical presentation, causes, treatments, and prognosis of posterior circulation ischemia.
-
Cochrane Db Syst Rev · Apr 2012
Review Meta AnalysisModifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV).
Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. ⋯ There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.
-
Laryngo- rhino- otologie · Mar 2012
Review[Head impulse test and vibratory test in the diagnosis of vertigo].
One of the most important questions within the field of vertigo-diagnosis is the proof or the exclusion of a vestibular impairment, the spectrum of appropriate diagnostic tools has been expanded by the head impulse test and the vibratory test in the last years. The head impulse test is a method to examine the functionality of single semicircular canals. As clinical "bedside test" it is an already established part of the diagnostic procedures, as an apparative method with registration and quantitative analysis, however, it is available for general in-office use only recently. ⋯ As a basis of a sophisticated vestibular diagnosis the test is less suitable, however, it is an absolutely valuable method to detect peripheral or central vestibular imbalances. In this regard the vibratory test is superior to other methods as for example the head shaking test. In the following article an overview concerning the physiological, methodical, and clinical aspects of the head impulse test and the vibratory test will be given.