Health Questions and Answers

VESTIBULAR DISEASE

What is the first step in evaluating a patient with dizziness?
The first question should be whether the problem is true vestibular dizziness or “dizziness” because of near-syncope, ataxia, or another etiology. Patients with true vestibular dizziness complain of vertigo, which is a feeling of spinning

What is the second step in evaluation of dizziness?
The next step is to determine whether the vertigo is central (due to a brain-stem lesion) or peripheral (due to an ear lesion).

How do you distinguish between central and peripheral vertigo?
Although many accompanying signs and symptoms have been promulgated to differentiate central from peripheral vertigo, none has great sensitivity or specificity. The most useful way to diagnose vertigo is by the company it keeps. Central vertigo is almost always accompanied by other signs of brain-stem dysfunction, such as double vision, weakness or numbness of the face, dysarthria, or dysphagia. Peripheral vertigo may be accompanied by tinnitus or hearing loss, but no other neurologic abnormalities.

Name the common causes of peripheral vertigo and central vertigo.

  • Peripheral
  • Ménière’s disease
  • Vestibular neuronitis
  • Local trauma
  • Drugs (antibiotics, diuretics)
  • Acoustic neuroma
  • Benign positional vertigo
  • Central
  • Stroke
  • Multiple sclerosis
  • Tumors

How is dizziness best treated?
Nonvertigo dizziness (including near-syncope, anxiety, and ataxia) should be treated by addressing the underlying cause. True vertigo can be treated symptomatically, almost regardless of the cause. Scopolamine has proved to be the best available treatment in comparative trials against other drugs and placebos. Benzodiazepines and antihistamines are of some value, including meclizine (Antivert) and diazepam. Canalith repositioning maneuvers (epley maneuvers) effectively treat benign paroxysmal positional vertigo.

References
WEB SITES
www.neuroguide.com
www.aan.com (American Academy of Neurology)
www.medmatrix.org
www.internets.com/mednets/sneurolo.htm
www.medwebplus.com/subject/Neurology.html

BIBLIOGRAPHY

  • Aminoff M: Neurology and General Medicine, 3rd ed. Philadelphia, Churchill-Livingstone, 2001.
  • Noseworthy JH (ed): Neurologic Therapeutics. London, Martin Dunitz, 2003.
  • Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, 4th ed. Philadelphia, Butterworth-Heinemann, 2004.
  • Samuels MA, Feske S (eds): Office Practice of Neurology, 2nd ed. Boston, Churchill-Livingstone, 2003.
  • Johnson RT, Griffin JW: Current Therapy in Neurologic Disease, 6th ed. St. Louis, Mosby, 2002.
  • Victor M, Ropper AH: Prinicples of Neurology, 7th ed. New York, McGraw-Hill, 2001.

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