Vertigo (medical): Difference between revisions
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==Common conditions causing vertigo== | ==Common conditions causing vertigo== | ||
Benign paroxysmal positional vertigo (BPPV) is "the most common cause of recurrent vertigo".<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url= |issn=}}</ref> | Benign paroxysmal positional vertigo (BPPV) is "the most common cause of recurrent vertigo".<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url=http://www.neurology.org/cgi/content/full/70/22/2067 |issn=}}</ref> | ||
==Unusual diagnoses causing vertigo== | ==Unusual diagnoses causing vertigo== | ||
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===Benign positional vertigo=== | ===Benign positional vertigo=== | ||
[[Image:Gray924.gif|right|thumb|350px|{{#ifexist:Template:Gray924.gif/credit|{{Gray924.gif/credit}}<br/>|}}The membranous labyrinth (lateral view of the right inner ear).<br>• The external semicircular canal is also called the '''horizontal''' or lateral canal.<br>• The superior semicircular canal is also called the '''anterior''' canal.]] | [[Image:Gray924.gif|right|thumb|350px|{{#ifexist:Template:Gray924.gif/credit|{{Gray924.gif/credit}}<br/>|}}The membranous labyrinth (lateral view of the right inner ear).<br>• The external semicircular canal is also called the '''horizontal''' or lateral canal.<br>• The superior semicircular canal is also called the '''anterior''' canal.]] | ||
Most cases of benign positional vertigo are due to canaliths or otoliths (calcium carbonate crystals) in the posterior canal that stimulate the cupula. Disease of the horizontal canal accounts for 10-17% of cases.<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url= |issn=}}</ref> | Most cases of benign positional vertigo are due to canaliths or otoliths (calcium carbonate crystals) in the posterior canal that stimulate the cupula. Disease of the horizontal canal accounts for 10-17% of cases.<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url=http://www.neurology.org/cgi/content/full/70/22/2067 |issn=}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
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===Benign positional vertigo=== | ===Benign positional vertigo=== | ||
The Dix–Hallpike maneuver can diagnose positional vertigo (BPPV):<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url= |issn=}}</ref> | The Dix–Hallpike maneuver can diagnose positional vertigo (BPPV):<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url=http://www.neurology.org/cgi/content/full/70/22/2067 |issn=}}</ref> | ||
* Posterior canal BPPV causes "upbeating and torsional nystagmus with the top pole of rotation beating toward the affected (downside) ear"<ref name="pmid18505980"/> | * Posterior canal BPPV causes "upbeating and torsional nystagmus with the top pole of rotation beating toward the affected (downside) ear"<ref name="pmid18505980"/> | ||
* Horizontal canal BPPV causes "horizontal geotropic (toward the ground) or apogeotropic (away from the ground) direction-changing paroxysmal positional nystagmus"<ref name="pmid18505980"/> Disease of the horizontal canal is better detected by the supine head roll test or (Pagnini–McClure maneuver).<ref name="pmid18505980"/> | * Horizontal canal BPPV causes "horizontal geotropic (toward the ground) or apogeotropic (away from the ground) direction-changing paroxysmal positional nystagmus"<ref name="pmid18505980"/> Disease of the horizontal canal is better detected by the supine head roll test or (Pagnini–McClure maneuver).<ref name="pmid18505980"/> | ||
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==Treatment== | ==Treatment== | ||
===Benign positional vertigo=== | ===Benign positional vertigo=== | ||
[[Clinical practice guideline]]s by the American Academy of Neurology address the treatment of benign positional vertigo.<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url= |issn=}}</ref> The guidelines state: | [[Clinical practice guideline]]s by the American Academy of Neurology address the treatment of benign positional vertigo.<ref name="pmid18505980">{{cite journal |author=Fife TD, Iverson DJ, Lempert T, ''et al'' |title=Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=22 |pages=2067–74 |year=2008 |month=May |pmid=18505980 |doi=10.1212/01.wnl.0000313378.77444.ac |url=http://www.neurology.org/cgi/content/full/70/22/2067 |issn=}}</ref> The guidelines state: | ||
* For posterior semicircular canal disease, [http://www.neurology.org/cgi/content/full/70/22/2067/F29 canalith repositioning procedure] may be used. | * For posterior semicircular canal disease, [http://www.neurology.org/cgi/content/full/70/22/2067/F29 canalith repositioning procedure] may be used. | ||
* For horizontal semicircular canal disease, [http://www.neurology.org/content/vol70/issue22/images/small/9FF5.gif the roll maneuver] (Lempert maneuver or barbecue roll maneuver) may be used. | * For horizontal semicircular canal disease, [http://www.neurology.org/content/vol70/issue22/images/small/9FF5.gif the roll maneuver] (Lempert maneuver or barbecue roll maneuver) may be used. | ||
Revision as of 09:30, 29 May 2008
Vertigo is a well-recognized medical condition that consists of the illusion of movement, usually of turning. Most often, patients with vertigo "see" the room and world spinning around them, but sometimes that hallucination of movement is centered on the body, instead, and the patient feels as if he or she is spinning within the room or other setting. In severe vertigo, there is often nausea and even vomiting.
Common conditions causing vertigo
Benign paroxysmal positional vertigo (BPPV) is "the most common cause of recurrent vertigo".[1]
Unusual diagnoses causing vertigo
Pathophysiology
Benign positional vertigo
Most cases of benign positional vertigo are due to canaliths or otoliths (calcium carbonate crystals) in the posterior canal that stimulate the cupula. Disease of the horizontal canal accounts for 10-17% of cases.[1]
Diagnosis
Skew deviation (vertical misalignment) suggests a central lesion.[2]
Benign positional vertigo
The Dix–Hallpike maneuver can diagnose positional vertigo (BPPV):[1]
- Posterior canal BPPV causes "upbeating and torsional nystagmus with the top pole of rotation beating toward the affected (downside) ear"[1]
- Horizontal canal BPPV causes "horizontal geotropic (toward the ground) or apogeotropic (away from the ground) direction-changing paroxysmal positional nystagmus"[1] Disease of the horizontal canal is better detected by the supine head roll test or (Pagnini–McClure maneuver).[1]
- Anterior canal BPPV
Treatment
Benign positional vertigo
Clinical practice guidelines by the American Academy of Neurology address the treatment of benign positional vertigo.[1] The guidelines state:
- For posterior semicircular canal disease, canalith repositioning procedure may be used.
- For horizontal semicircular canal disease, the roll maneuver (Lempert maneuver or barbecue roll maneuver) may be used.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Fife TD, Iverson DJ, Lempert T, et al (May 2008). "Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (22): 2067–74. DOI:10.1212/01.wnl.0000313378.77444.ac. PMID 18505980. Research Blogging.
- ↑ Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M (2008). "Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis"". J. Neurol. Neurosurg. Psychiatr. 79 (4): 458-60. DOI:10.1136/jnnp.2007.123596. PMID 18344397. Research Blogging.