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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 -
Handbook of Clinical Neurology 2016This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based... (Review)
Review
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
Topics: Dizziness; Humans; Vertigo
PubMed: 27638063
DOI: 10.1016/B978-0-444-63437-5.00005-4 -
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 -
Medicina (Kaunas, Lithuania) Dec 2022Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by... (Review)
Review
Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.
Topics: Humans; Dizziness; Neck Muscles; Vertigo; Posture
PubMed: 36556992
DOI: 10.3390/medicina58121791 -
Practical Neurology Feb 2018Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that unifies key features of chronic subjective dizziness, phobic postural vertigo... (Review)
Review
Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that unifies key features of chronic subjective dizziness, phobic postural vertigo and related disorders. It describes a common chronic dysfunction of the vestibular system and brain that produces persistent dizziness, non-spinning vertigo and/or unsteadiness. The disorder constitutes a long-term maladaptation to a neuro-otological, medical or psychological event that triggered vestibular symptoms, and is usefully considered within the spectrum of other functional neurological disorders. While diagnostic tests and conventional imaging usually remain negative, patients with PPPD present in a characteristic way that maps on to positive diagnostic criteria. Patients often develop secondary functional gait disorder, anxiety, avoidance behaviour and severe disability. Once recognised, PPPD can be managed with effective communication and tailored treatment strategies, including specialised physical therapy (vestibular rehabilitation), serotonergic medications and cognitive-behavioural therapy.
Topics: Dizziness; Humans; Perceptual Disorders; Postural Balance; Vertigo; Visual Perception
PubMed: 29208729
DOI: 10.1136/practneurol-2017-001809 -
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 -
American Family Physician Aug 2010Dizziness accounts for an estimated 5 percent of primary care clinic visits. The patient history can generally classify dizziness into one of four categories: vertigo,... (Review)
Review
Dizziness accounts for an estimated 5 percent of primary care clinic visits. The patient history can generally classify dizziness into one of four categories: vertigo, disequilibrium, presyncope, or lightheadedness. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis. Many medications can cause presyncope, and regimens should be assessed in patients with this type of dizziness. Parkinson disease and diabetic neuropathy should be considered with the diagnosis of disequilibrium. Psychiatric disorders, such as depression, anxiety, and hyperventilation syndrome, can cause vague lightheadedness. The differential diagnosis of dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis. A final diagnosis is not obtained in about 20 percent of cases. Treatment of vertigo includes the Epley maneuver (canalith repositioning) and vestibular rehabilitation for benign paroxysmal positional vertigo, intratympanic dexamethasone or gentamicin for Meniere disease, and steroids for vestibular neuritis. Orthostatic hypotension that causes presyncope can be treated with alpha agonists, mineralocorticoids, or lifestyle changes. Disequilibrium and lightheadedness can be alleviated by treating the underlying cause.
Topics: Diagnosis, Differential; Dizziness; Humans; Medical History Taking; Physical Examination; Postural Balance; Syncope; Vertigo
PubMed: 20704166
DOI: No ID Found -
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 -
American Family Physician May 2023Dizziness is a common but often diagnostically difficult condition. Clinicians should focus on the timing of the events and triggers of dizziness to develop a...
Dizziness is a common but often diagnostically difficult condition. Clinicians should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis because it is difficult for patients to provide quality reports of their symptoms. The differential diagnosis is broad and includes peripheral and central causes. Peripheral etiologies can cause significant morbidity but are generally less concerning, whereas central etiologies are more urgent. The physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver (for patients with triggered dizziness), and the HINTS (head-impulse, nystagmus, test of skew) examination when indicated. Laboratory testing and imaging are usually not required but can be helpful. The treatment for dizziness is dependent on the etiology of the symptoms. Canalith repositioning procedures (e.g., Epley maneuver) are the most helpful in treating benign paroxysmal positional vertigo. Vestibular rehabilitation is helpful in treating many peripheral and central etiologies. Other etiologies of dizziness require specific treatment to address the cause. Pharmacologic intervention is limited because it often affects the ability of the central nervous system to compensate for dizziness.
Topics: Humans; Dizziness; Benign Paroxysmal Positional Vertigo; Neurologic Examination; Heart; Blood Pressure Determination
PubMed: 37192077
DOI: No ID Found -
Nederlands Tijdschrift Voor Geneeskunde May 2022Dizziness is a frequently occurring problem with a negative influence on quality of life. In this article, the most common causes of dizziness are discussed on the basis... (Review)
Review
Dizziness is a frequently occurring problem with a negative influence on quality of life. In this article, the most common causes of dizziness are discussed on the basis of practical questions from clinical practice. The importance of a structured anamnesis is reviewed. The clinical syndrome of benign paroxysmal positional vertigo and its treatment are covered extensively. Red flag symptoms of acute vestibular syndrome are specified, as well as symptoms that justify referral from primary to secondary care.
Topics: Benign Paroxysmal Positional Vertigo; Dizziness; Humans; Quality of Life; Referral and Consultation
PubMed: 35736381
DOI: No ID Found