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Rinsho Shinkeigaku = Clinical Neurology May 2021Pathophysiology of vertigo/dizziness can be understood by eye deviation (nystagmus). In benign paroxysmal positional vertigo, eye deviation of causative semicircular... (Review)
Review
Pathophysiology of vertigo/dizziness can be understood by eye deviation (nystagmus). In benign paroxysmal positional vertigo, eye deviation of causative semicircular canal stimulation is directly observed. In other peripheral vestibular disorders, eye deviation results from the sum of unilateral all semicircular canal disorders. The central vestibular pathway is controlled by the cerebellum. Thus, in vertigo/dizziness of central origin, not only eye deviation due to impairment of the central vestibular pathway but also deviation due to disinhibition of the pathway from the cerebellum is observed. The cerebellar control on the central vestibular pathway also plays an important role in vestibular compensation. When treating vertigo/dizziness, it is necessary to understand the pathophysiology of the vertigo/dizziness, to set the treatment target based on the pathophysiology, and to intervene for the target.
Topics: Benign Paroxysmal Positional Vertigo; Cerebellum; Chronic Disease; Diagnosis, Differential; Dizziness; Humans; Nystagmus, Pathologic; Semicircular Canals; Vertigo; Vestibule, Labyrinth
PubMed: 33867417
DOI: 10.5692/clinicalneurol.cn-001570 -
Seminars in Neurology Feb 2020Cerebellar dizziness and vertigo account for approximately 10% of diagnoses in a tertiary dizziness center. This term summarizes a large group of disorders with chronic... (Review)
Review
Cerebellar dizziness and vertigo account for approximately 10% of diagnoses in a tertiary dizziness center. This term summarizes a large group of disorders with chronic (degenerative, hereditary, acquired cerebellar ataxias), recurrent (episodic ataxias), or acute (stroke, inflammation) presentations. Key to the diagnosis is a comprehensive examination of central ocular motor and vestibular function. Patients with cerebellar dizziness and vertigo usually show a pattern of deficits in smooth pursuit, gaze-holding, saccade accuracy, or fixation-suppression of the vestibulo-ocular reflex. Central fixation nystagmus (e.g., downbeat nystagmus), gaze-evoked nystagmus, central positional nystagmus, or head-shaking nystagmus with cross-coupling (i.e., horizontal head shaking causing inappropriate vertical nystagmus) occurs frequently. Overlap syndromes with peripheral vestibular disorders, such as cerebellar ataxia, neuropathy, and vestibular areflexia, exist rarely. Posturography and gait analysis can contribute to diagnostic differentiation, estimation of the risk of falls, as well as quantification of progression and treatment effects. Patients with cerebellar dizziness and vertigo should receive multimodal treatment, including balance training, occupational therapy, and medication.
Topics: Cerebellar Diseases; Dizziness; Humans; Vertigo
PubMed: 31887755
DOI: 10.1055/s-0039-3400315 -
Current Neurology and Neuroscience... Oct 2022To explore recent developments in vestibular migraine (VM). (Review)
Review
PURPOSE OF REVIEW
To explore recent developments in vestibular migraine (VM).
RECENT FINDINGS
This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children.
Topics: Adult; Child; Humans; Retrospective Studies; Quality of Life; Prospective Studies; Vertigo; Migraine Disorders; Vestibular Diseases; Dizziness
PubMed: 36044103
DOI: 10.1007/s11910-022-01222-6 -
Current Opinion in Neurology Feb 2018This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. (Review)
Review
PURPOSE OF REVIEW
This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology.
RECENT FINDINGS
Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome. Diagnosis of acute combined central and peripheral vestibulopathy such as anterior inferior cerebellar artery infarction requires additional consideration whenever applying the HINTS (head impulse test, direction-changing gaze-evoked nystagmus, and test of skew). Heat illness and metronidazole have been recognized as new causes of central vestibulopathy. Some new findings have also been added to the clinical and laboratory features of central vertigo.
SUMMARY
Central vertigo is a heterogeneous group of disorders with diverse clinical spectrums. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.
Topics: Humans; Vertigo
PubMed: 29084063
DOI: 10.1097/WCO.0000000000000511 -
Emergency Medicine Clinics of North... Feb 2019This article summarizes the systematic assessment of the dizzy patient who presents with peripheral vertigo. It demonstrates the steps and tests necessary using the... (Review)
Review
This article summarizes the systematic assessment of the dizzy patient who presents with peripheral vertigo. It demonstrates the steps and tests necessary using the Triage-Timing-Trigger-Test (Triage + TiTraTe) method to accurately diagnose the underlying most probable cause while ruling out life-threatening causes. Using video support and just-in-time infographics, it demonstrates the Dix-Hallpike, Semont, Epley, and HINTS maneuvers.
Topics: Diagnosis, Differential; Emergencies; Humans; Patient Positioning; Vertigo
PubMed: 30454774
DOI: 10.1016/j.emc.2018.09.004 -
Neurologic Clinics Nov 2019The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo... (Review)
Review
The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo lasting seconds to days that are accompanied by migraine symptoms. Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking. In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment still lacks solid evidence. It is targeted at the underlying migraine and comprises explanation and reassurance, lifestyle modifications, and drugs.
Topics: Dizziness; Humans; Migraine Disorders; Vertigo; Vestibular Diseases
PubMed: 31563227
DOI: 10.1016/j.ncl.2019.06.003 -
La Revue de Medecine Interne Nov 2018Balance disorders presenting with symptoms of dizziness and vertigo are due to various diseases. Clinical approach gives the opportunity to identify emergency situations... (Review)
Review
Balance disorders presenting with symptoms of dizziness and vertigo are due to various diseases. Clinical approach gives the opportunity to identify emergency situations and most common causes, among them the first one being the benign paroxysmal positional vertigo. Oculomotor assessment is pertinent as major clinical orientation, particularly between peripheral and central diseases. These clinical findings support the respective indication of modern imaging and/or vestibular tests, focused on the direction of presupposed diagnosis. On elderly the risk of falls and their complications needs a specific evaluation.
Topics: Accidental Falls; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Dizziness; Humans; Risk Factors; Vertigo
PubMed: 29496272
DOI: 10.1016/j.revmed.2018.02.004 -
Journal of Vestibular Research :... 2019This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders... (Review)
Review
This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders (ICVD). The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Diagnosis of hemodynamic orthostatic dizziness/vertigo requires: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) orthostatic hypotension, postural tachycardia syndrome or syncope documented on standing or during head-up tilt test; and C) not better accounted for by another disease or disorder. Probable hemodynamic orthostatic dizziness/vertigo is defined as follows: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) at least one of the following accompanying symptoms: generalized weakness/tiredness, difficulty in thinking/concentrating, blurred vision, and tachycardia/palpitations; and C) not better accounted for by another disease or disorder. These diagnostic criteria have been derived by expert consensus from an extensive review of 90 years of research on hemodynamic orthostatic dizziness/vertigo, postural hypotension or tachycardia, and autonomic dizziness. Measurements of orthostatic blood pressure and heart rate are important for the screening and documentation of orthostatic hypotension or postural tachycardia syndrome to establish the diagnosis of hemodynamic orthostatic dizziness/vertigo.
Topics: Diagnosis, Differential; Diagnostic Techniques, Otological; Dizziness; Hemodynamics; Humans; Hypotension, Orthostatic; Postural Balance; Syncope; Terminology as Topic; Vertigo; Vestibular Diseases
PubMed: 30883381
DOI: 10.3233/VES-190655 -
Pain Physician 2015Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervical vertigo is an independent entity still remains controversial. In this... (Review)
Review
Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervical vertigo is an independent entity still remains controversial. In this narrative review, we outline the basic science and clinical evidence for cervical vertigo according to the current literature. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. Proprioceptive cervical vertigo and rotational vertebral artery vertigo have survived with time. Barré-Lieou syndrome once was discredited, but it has been resurrected recently by increased scientific evidence. Diagnosis depends mostly on patients' subjective feelings, lacking positive signs, specific laboratory examinations and clinical trials, and often relies on limited clinical experiences of clinicians. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. Treatment for cervical vertigo is challenging. Manual therapy is recommended for treatment of proprioceptive cervical vertigo. Anterior cervical surgery and percutaneous laser disc decompression are effective for the cervical spondylosis patients accompanied with Barré-Liéou syndrome. As to rotational vertebral artery vertigo, a rare entity, when the exact area of the arterial compression is identified through appropriate tests such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) or digital subtraction angiography (DSA) decompressive surgery should be the chosen treatment.
Topics: Cervical Vertebrae; Humans; Posterior Cervical Sympathetic Syndrome; Vertigo
PubMed: 26218949
DOI: No ID Found -
Drugs & Aging Aug 2021The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common... (Review)
Review
The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15-20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.
Topics: Accidental Falls; Aged; Dizziness; Humans; Vertigo; Vestibular Diseases
PubMed: 34159566
DOI: 10.1007/s40266-021-00877-z