Vertigo
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
This chapter provides clinicians with a diagnostic and management algorithm for the evaluation of patients with vertigo and proposes to classify the type of vertigo according to the timing, possible triggers. The final intent is to localize the lesion responsible within the peripheral or central vestibular system and to treat the specific cause of vertigo in relation to the underlying pathophysiology. A challenge for the clinician is to determine what is meant by dizziness. Moreover, attempting to differentiate dizziness from vertigo based on the patient's history is not helpful with regard to developing a differential diagnosis. Vertigo may occasionally relate to cerebrovascular disease, primarily transient ischemia, or infarction affecting brainstem or cerebellar territories. A comprehensive approach to developing a differential diagnosis for patients with vertigo has emerged from accumulating work in the area of evidence-based, targeted bedside examinations for specific clinical presentations.
Vertigo
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
True vertigo is a sensation that the patient or his or her surroundings are rotating. It should be distinguished from 'light-headedness' or pre-syncope. Dizziness is a non-specific term that should be further clarified before pursuing a differential diagnosis. The perception of linear or rotatory acceleration is one of the functions of the vestibular system, which comprises the vestibular apparatus of the inner ear, the vestibular nerve and the brainstem. Although many cases of acute vertigo are caused by relatively benign peripheral disorders, such as vestibular neuritis or benign paroxysmal positional vertigo, it is important to diagnose serious central causes, such as neoplasia, haemorrhage or ischaemia affecting the brainstem. Eye movements and nystagmus. Nystagmus due to peripheral lesions is usually horizontal and rotatory, and is lessened by gaze fixation, whereas central nystagmus is purely horizontal, vertical or rotatory, and is not lessened by gaze fixation.
Comorbidity in Mood Disorders
Dr. Ather Muneer in Mood Disorders, 2018
Mood disorders are highly prevalent conditions affecting about 20% of the general population, and the increased morbidity and mortality associated with these ailments is not just explained by suicide. Rather, mood disorder subjects are greatly predisposed to physical illnesses, chief among which are the metabolic syndrome and the related cardiovascular diseases. General medical comorbidities have a significant negative impact on illness with a more complicated course, increased cost of treatment and greater workplace disability. In addition to medical comorbid conditions mentioned thus far, it is important to note that major mood disorders are often coupled with several neurological diseases, chief among which are migraine, idiopathic neuropathic pain, vertigo, dizziness and restless legs syndrome. Reasons for the chronic activation of the immune system in mood disorders and its overall impact on general health may involve several aspects, both recognized and obscure.
Role of inferior colliculus in vestibular vertigo induced by water caloric irrigation
Published in Acta Oto-Laryngologica, 2020
Yu Song, Shan Xiong, Xin Fan, Ying Xin, Furong Ma
Background: Vestibular vertigo is a common clinical symptom; however, the central neural mechanism of it is still poorly understood. Objective: To demonstrate the changes of neural excitability and ascorbate in inferior colliculus (IC) in a rat vertigo model induced by water caloric irrigation. Methods: In vertigo model induced by water caloric irrigation, we recorded the changes of spontaneous firing rate (SFR) of IC. Then a technique that combining in vivo microanalysis with an online electrochemical system (OECS) was employed to monitor the changes of extracellular ascorbate in IC. Results: Electrophysiological studies showed that after vestibular ice water stimulation, the level of SFR in IC significantly increased, reaching (989 ± 9) % and (941 ± 62) % respectively at 2.0 h after contralateral ice water vestibular stimulation and ipsilateral ice water vestibular stimulation. However, the level of ascorbate in IC dramatically decreased after ice stimulation, decreased to (30 ± 12) % and (57 ± 24) % of the basal level respectively in the contralateral group and ipsilateral group. Conclusions and significance: These findings suggest that inferior colliculus plays a role in peripheral vertigo, which would appear useful for uncovering neural mechanisms of vertigo and help finding novel therapeutic targets for vertigo.
Clinical and epidemiological study on inpatients with vertigo at the ENT Department of Kyoto University Hospital
Published in Acta Oto-Laryngologica, 2010
Hideaki Ogita, Akiko Taura, Kazuo Funabiki, Makoto Miura, Juichi Ito
Conclusion: The number of studies on inpatients with vertigo is limited. This study provides useful information for clarifying the underlying causes of vertigo. Objective: To investigate the epidemiological features of patients with vertigo. Methods: This retrospective study investigated 78 patients who had been emergently hospitalized in the Otolaryngology Department of Kyoto University Hospital with vertigo. Results: The number of female patients was significantly higher than the number of male patients. Meniere's disease was the most common underlying pathology among hospitalized patients. Mean patient age was 56.1 years, with no significant difference between male and female patients.
A case of cerebellar arteriovenous malformation presented with vertigo, hearing loss, and headache
Published in Acta Oto-Laryngologica Case Reports, 2017
Sakurako Komiyama, Toshihisa Murofushi, Eriko Yoshimura
We report a 48-year-old man presented with episodic rotatory vertigo accompanied by right hearing loss and headache. He did not have medical history of migraine. His hearing loss was progressive. He showed unilateral (right-sided) absence of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) to the right ear stimulation, while his caloric tests were normal on both sides. His signs and symptoms were suggestive of right peripheral vestibular vertigo except for headache. MRI revealed cerebellar arteriovenous malformation (AVM). Headache might be a sole cue for correct diagnosis. On the diagnosis of vertigo patients with headache, vertigo associated with secondary headache must be considered.
Related Knowledge Centers
- Dizziness
- Inner Ear
- Labyrinthitis
- Vestibular Labyrinth
- Temporal Lobe
- Neurologic Manifestations
- Vestibular Diseases