Vertigo and dizziness

Dizziness ranks among the most common complaints in medicine, affecting approximately 20% to 30% of the general population. However, the term dizziness encompasses a variety of different sensations each points in distinct diagnostic direction: rotational vertigo or other illusory sensation of motion indicates vestibular origin, whereas a sensation of light-headedness, giddiness, unsteadiness, drowsiness, or impending faint implies nonvestibular origin. Of patients older than 60 years, 20% have experienced dizziness severe enough to affect their daily activities. This article gives an overview of the historical and physical findings that help guiding to more specific diagnosis of vertigo and dizziness.     

Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea

Journal of Neurology - This study aimed to determine the etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. We analyzed the diagnoses of 21,166...     

Neurological update: dizziness

Journal of Neurology - The diagnosis and management of vertigo remains a challenge for clinicians, including general neurology. In recent years there have been advances in the understanding of...     

Spectrum of autonomic dysfunction in orthostatic dizziness

ObjectiveTo investigate the frequency and detailed spectrum of autonomic dysfunction in patients with orthostatic dizziness (OD).MethodsOver 20 months, 217 consecutive patients with OD as a presenting symptom of orthostatic intolerance were enrolled. The distribution and severity of autonomic dysfunction were measured by the composite autonomic severity score (CASS), which was derived from a standard autonomic function test including Finapres for recording of the beat-to-beat blood pressure. Sympathetic indexes (SIs) were calculated from the Valsalva maneuver (VM).ResultsApproximately 83% of patients showed at least one abnormal autonomic testing result. We classified OD into 11 groups according to the patterns of autonomic dysfunctions. The most common pattern was generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions (n = 60). Patients with delayed OH had larger BP increases during late phase II of the VM (p = 0.04), showed greater phase IV overshoot (p = 0.04), and had a smaller pressure recovery time increase (p = 0.02) than patients with classic OH. Each SI showed the strongest correlation with the CASS adrenergic subscores.ConclusionsOD can present with a board spectrum of autonomic dysfunctions.SignificanceThis investigation could be useful in understanding the pattern and mechanism of autonomic dysfunction associated with OD.     

Unexplained dizziness does not resolve in time

Only few patients with dizziness are referred to a medical specialist, who is sometimes unable to come to a conclusive cause of the dizziness. We have no information about the course of unexplained dizziness, from the literature or from our own population. We therefore undertook this follow-up study to assess the outcome of patients with unexplained dizziness, after assessment in a multidisciplinary outpatient clinic. In 292 patients (out of our total cohort of 2,244 patients), a diagnosis could not be established. The median dizziness handicap inventory (DHI) score at the diagnostic visit was 30. We sent them a questionnaire and the DHI. After a median follow-up of 62?months (range 24?C105 months), 113 of the 189 responders (60?%) reported to still suffer from dizziness, 46 patients had moderate impairments, and 16 patients indicated that they were severely impaired by their dizziness. The DHI only slightly decreased (from median 30 to 26). In 1?% of the cases, an organic explanation for the dizziness was ultimately found during follow-up by other health-care workers. Patients who have been assessed in a multidisciplinary dizziness clinic, and in whom no explanatory cause for the dizziness has been found, have a high risk of persisting impairments.     

Vestibular-evoked myogenic potential tests in orthostatic dizziness

Objective

As otolithic control of blood pressure has been the focus of recent interest, this study investigated the ocular and cervical vestibular-evoked myogenic potential (oVEMP and cVEMP) tests in patients with orthostatic dizziness.

Methods

Sixty patients with orthostatic dizziness and 20 normal controls were consecutively enrolled. All subjects received a battery of tests including audiometry, and caloric, oVEMP and cVEMP tests.

Results

Audiometry revealed normal hearing in all 60 patients. Caloric test identified hyperactive and normal responses in 35 and 65?% of patients, respectively. The oVEMP test showed normal responses in 36 patients, and abnormal (absent and reduced) responses in 24 patients (40?%). Most patients (22/24) with abnormal oVEMPs revealed asymmetrical responses. For the cVEMP test, 30 patients (50?%) had normal responses, and 23 and 7 patients showed delayed and absent cVEMPs, respectively. Significant differences existed in the abnormal percentage of oVEMP and cVEMP tests between the patient and control groups. When the oVEMP and cVEMP test results were combined, the abnormal rate increased to 70?% of the patients, resulting in stronger association as an elevated odds ratio of 13.2, greater than 12.7 and 5.7 in the corresponding individual oVEMP and cVEMP tests.

Interpretation

Patients with orthostatic dizziness may show asymmetric oVEMPs and abnormal (delayed) cVEMPs. If both test results were combined together, a high abnormality (70?%) was obtained, indicating that in addition to conventional autonomic test battery, the two VEMP tests may serve as a supplementary tool for evaluating orthostatic dizziness.     

Community based rehabilitation: special issues

The primary goal in the developing field of community based rehabilitation (CBR) for individuals with TBI / ABI is community participation and integration. At present, CBR is less than clearly defined and is represented by a set of interventions with varied types, degrees of clinical support and models of intervention that are conducted for a diverse and complex set of individuals, situations, deficits and settings. Nonetheless, holistic neurorehabilitation programs should be considered both evidence based and a practice standard. This paper attempts to address some of the significant issues relevant to optimizing long term adaptation for persons receiving CBR. The article also addresses the current need for definitions, models, program classifications and comparisons, as well as programmatic methodologies by attempting to integrate some of the best scientifically supported methodologies within an eclectic holistic rehabilitation model that is easily understood and teachable to persons with TBI, families and rehabilitation professionals. This model and associated methodologies are intended to inform best practices while offering a framework for hypothesis generation, clinical decision-making, evaluation of treatment outcomes and direction of future research.     

A simplified diagnostic approach to dizziness in children

The objective of the study was to validate the effectiveness of a questionnaire and computer-assisted algorithm in diagnosing children with dizziness or vertigo. Dizziness and vertigo are common complaints in children, causing an extensive, often unnecessary evaluation. A pediatric "dizziness questionnaire" was designed and a computer-assisted algorithm was developed to facilitate the diagnostic task. A retrospective medical record review was conducted on all children presenting to the clinic for dizziness or vertigo throughout a 2-year period. The information was used by one investigator to complete the questionnaire and by the other, the algorithm. The two diagnoses thus obtained were compared by the third investigator to the medical record diagnosis. Sixty-two records were reviewed. The final diagnoses were migraine (39%), benign paroxysmal vertigo (15%), vestibular neuronitis (14%), and anxiety (13%). In 57 patients (92%), the questionnaire-derived diagnosis was identical to the medical record diagnosis. In 52 patients (84%), the algorithm-derived diagnosis matched the medical record diagnosis. The questionnaire and computer-assisted algorithm are reliable diagnostic screening tools for children with dizziness or vertigo. When these tools combined provide a clear-cut diagnosis, no further evaluation is necessary.     

Benign course of episodic dizziness disorders in childhood

Journal of Neurology -