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Vertigo and Dizziness

De

After headache, vertigo and dizziness is the second most common complaint of patients. Vertigo is not a disease entity, but rather an unspecific syndrome consisting of various disorders with different causes. Most syndromes of vertigo can only be correctly diagnosed by means of a careful medical history and physical examination of the patient. The majority of these cases have a benign cause, a favorable natural course, and a positive response to therapy.

This short and concise, clinically-oriented book is for physicians of different specializations who treat patients with vertigo including neurologists and ENT specialists. Easy-to-use, it has an overview of the most important syndromes of vertigo, each with explanatory clinical descriptions and illustrations.

Target market: Physicians of different specializations who treat patients with vertigo including neurologists, neurootologic specialists, neuroophthalmology, otolaryngology, head and neck surgery, ophthalmology and ENT specialists, and general medicine practitioners.

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1 1.1 1.2 1.3
1.4 1.4.1 1.4.2 1.4.3
1.4.4 1.4.5 1.4.6
1.5 1.5.1 1.5.2
1.5.3 1.5.4
2 2.1 2.1.1 2.1.2 2.1.3 2.1.4
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introductory Remarks. . . . . . . . . . . . . . . . . . . . . . . . . Vertigo and Dizziness: Multisensory Syndromes . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neuro-ophthalmological and Neuro-otological Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Laboratory and Imaging Examinations . . . . . . . . . . . . Electronystagmography . . . . . . . . . . . . . . . . . . . . . . . . Video-oculography . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neuro-orthoptic and Psychophysical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Audiometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional Laboratory Examinations . . . . . . . . . . . . . Imaging of the Petrous Bone, the Cerebellopontine Angle and the Brainstem with Computed Tomography and Magnetic Resonance Imaging . . . . . General Principles of Therapy . . . . . . . . . . . . . . . . . . . Pharmacological Therapy . . . . . . . . . . . . . . . . . . . . . . Physical Therapy: Balance Training and Liberatory Manoeuvres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Psychological/Psychiatric Treatment . . . . . . . . . . . . .
Peripheral Vestibular Forms of Vertigo. . . . . . . . . . . Benign Paroxysmal Positioning Vertigo . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Features and Course . . . . . . . . . . . . . . . . . . . . Pathophysiology and Therapeutic Principles . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . .
v
1 1 5
11 26 26 27
29 29 30
31 37 37
37 39 39
41 41 41 42 44 47
C
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vii
viii
Contents
2.1.5
2.1.6 2.1.7 2.2
2.2.1 2.2.2 2.2.3
2.2.4 2.2.5 2.3 2.3.1 2.3.2 2.3.3
2.3.4 2.3.5 2.4 2.4.1 2.4.2 2.4.3
2.4.4 2.4.5 2.5 2.5.1 2.5.2 2.5.3
2.5.4 2.5.5 2.6 2.6.1 2.6.2 2.6.3 2.6.4 2.6.5 3 3.1 3.1.1
3.1.2
3.2
Benign Paroxysmal Positioning Vertigo of the Horizontal Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Central Positional Vertigo/Nystagmus . . . . . . . . . . . . Vestibular Neuritis (Acute Partial Unilateral Vestibular Deficit) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Features and Course . . . . . . . . . . . . . . . . . . . . Aetiology, Pathophysiology and Therapeutic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Menière’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Syndrome and Course . . . . . . . . . . . . . . . . . . Aetiology, Pathophysiology and Therapeutic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Vestibular Paroxysmia . . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Course . . . . . . . . . . . . . . . . . . . . Aetiology, Pathophysiology and Therapeutic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Bilateral Vestibulopathy . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Natural Course . . . . . . . . . . . . . Aetiology, Pathophysiology and Therapeutic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Perilymph Fistulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Course . . . . . . . . . . . . . . . . . . . . Pathophysiology and Therapeutic Principles . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . . Central Vestibular Forms of Vertigo. . . . . . . . . . . . . Central Vestibular Syndromes . . . . . . . . . . . . . . . . . . . Clinical Aspects, Course of Disease, Pathophysiology and Therapeutic Principles . . . . . . . . . . . . . . . . . . . . . Central Vestibular Syndromes in the Three Planes of Action of the Vestibulo-ocular Reflex . . . . . . . . . . . Basilar/Vestibular Migraine . . . . . . . . . . . . . . . . . . . . .
50 52 52
55 55 55
56 59 61 64 64 64
66 67 68 70 70 70
71 73 74 75 75 75
76 77 80 81 81 81 83 86 86 89 91
9
1
91 103
3.2.1 3.2.2 3.2.3 3.2.4 3.2.5 3.2.6
4 4.1 4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.2 4.3 4.4
5 5.1 5.1.1 5.1.2 5.1.3 5.1.4 5.1.5
6 6.1
6.1.1 6.1.2 6.1.3 6.2 6.3 6.4 6.4.1 6.4.2 6.4.3
6.5 6.5.1 6.5.2
Index
Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Course . . . . . . . . . . . . . . . . . . . . Pathophysiology and Therapeutic Principles . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ineffective Treatments . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . .
Traumatic Forms of Vertigo. . . . . . . . . . . . . . . . . . . . Traumatic Peripheral Vestibular Vertigo/Dizziness . . Benign Paroxysmal Positioning Vertigo . . . . . . . . . . . Traumatic Labyrinthine Failure . . . . . . . . . . . . . . . . . . Perilymph Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alternobaric Vertigo . . . . . . . . . . . . . . . . . . . . . . . . . . . Otolith Vertigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Traumatic Central Vestibular Forms of Vertigo . . . . . . Traumatic Cervical Vertigo . . . . . . . . . . . . . . . . . . . . . Post-traumatic Psychogenic Vertigo . . . . . . . . . . . . . .
Psychogenic Forms of Vertigo and Dizziness. . . . . . Phobic Postural Vertigo . . . . . . . . . . . . . . . . . . . . . . . . Patient History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Course of the Illness . . . . . . . . . Pathophysiology and Therapeutic Principles . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Differential Diagnosis and Clinical Problems . . . . . . .
Various Vertigo Syndromes. . . . . . . . . . . . . . . . . . . . Vertigo/Dizziness in Childhood and Hereditary Vertigo Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benign Paroxysmal Vertigo of Childhood . . . . . . . . . . Familial Episodic Ataxia Types 1 and 2 . . . . . . . . . . . . Motion Sickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drug-induced Vertigo . . . . . . . . . . . . . . . . . . . . . . . . . Cervicogenic Vertigo . . . . . . . . . . . . . . . . . . . . . . . . . . Motion Sickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Aspects and Pathogenesis . . . . . . . . . . . . . . . Course and Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . Pragmatic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . Height Vertigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syndromal Aspects and Pathogenesis . . . . . . . . . . . . . Course and Therapy . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
List of Videos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
103 103 105 105 106 106
109 109 109 110 111 112 112 113 113 114
115 116 116 117 118 120 121
123
123 126 126 126 127 128 129 129 131 132 134 134 136
139
147
Contents
ix
http://www.springer.com/978-1-85233-814-5