Preface

v

1

Introductory Remarks

1

1.1

Vertigo and Dizziness: Multisensory Syndromes

1

1.2

Patient History

5

1.3

Neuro-Ophthalmological and Neuro-Otological Examination

11

1.4

Laboratory and Imaging Examinations

26

1.4.1

Electronystagmography

26

1.4.2

Video-Oculography

27

1.4.3

Neuro-Orthoptic and Psychophysical Procedures

29

1.4.4

Audiometry

29

1.4.5

Additional Laboratory Examinations

30

1.4.6

Imaging of the Petrous Bone, the Cerebellopontine Angle and the Brainstem with Computed Tomography and Magnetic Resonance Imaging

31

1.5

General Principles of Therapy

37

1.5.1

Pharmacological Therapy

37

1.5.2

Physical Therapy: Balance Training and Liberatory Manoeuvres

37

1.5.3

Surgery

39

1.5.4

Psychological/Psychiatric Treatment

39

2

Peripheral Vestibular Forms of Vertigo

41

2.1

Benign Paroxysmal Positioning Vertigo

41

2.1.1

Patient History

41

2.1.2

Clinical Features and Course

42

2.1.3

Pathophysiology and Therapeutic Principles

44

2.1.4

Pragmatic Therapy

47

2.1.5

Benign Paroxysmal Positioning Vertigo of the Horizontal Canal

50

2.1.6

Differential Diagnosis and Clinical Problems

52

2.1.7

Central Positional Vertigo/Nystagmus

52

2.2

Vestibular Neuritis (Acute Partial Unilateral Vestibular Deficit)

55

2.2.1

Patient History

55

2.2.2

Clinical Features and Course

55

2.2.3

Aetiology, Pathophysiology and Therapeutic Principles

56

2.2.4

Pragmatic Therapy

59

2.2.5

Differential Diagnosis and Clinical Problems

61

2.3

Menière’s Disease

64

2.3.1

Patient History

64

2.3.2

Clinical Syndrome and Course

64

2.3.3

Aetiology, Pathophysiology and Therapeutic Principles

66

2.3.4

Pragmatic Therapy

67

2.3.5

Differential Diagnosis and Clinical Problems

68

2.4

Vestibular Paroxysmia

70

2.4.1

Patient History

70

2.4.2

Clinical Aspects and Course

70

2.4.3

Aetiology, Pathophysiology and Therapeutic Principles

71

2.4.4

Pragmatic Therapy

73

2.4.5

Differential Diagnosis and Clinical Problems

74

2.5

Bilateral Vestibulopathy

75

2.5.1

Patient History

75

2.5.2

Clinical Aspects and Natural Course

75

2.5.3

Aetiology, Pathophysiology and Therapeutic Principles

76

2.5.4

Pragmatic Therapy

77

2.5.5

Differential Diagnosis and Clinical Problems

80

2.6

Perilymph Fistulas

81

2.6.1

Patient History

81

2.6.2

Clinical Aspects and Course

81

2.6.3

Pathophysiology and Therapeutic Principles

83

2.6.4

Pragmatic Therapy

86

2.6.5

Differential Diagnosis and Clinical Problems

86

3

Central Vestibular Forms of Vertigo

89

3.1

Central Vestibular Syndromes

91

3.1.1

Clinical Aspects, Course of Disease, Pathophysiology and Therapeutic Principles

91

3.1.2

Central Vestibular Syndromes in the Three Planes of Action of the Vestibulo-Ocular Reflex

91

3.2

Basilar/Vestibular Migraine

103

3.2.1

Patient History

103

3.2.2

Clinical Aspects and Course

103

3.2.3

Pathophysiology and Therapeutic Principles

105

3.2.4

Pragmatic Therapy

105

3.2.5

Ineffective Treatments

106

3.2.6

Differential Diagnosis and Clinical Problems

106

4

Traumatic Forms of Vertigo

109

4.1

Traumatic Peripheral Vestibular Vertigo/Dizziness

109

4.1.1

Benign Paroxysmal Positioning Vertigo

109

4.1.2

Traumatic Labyrinthine Failure

110

4.1.3

Perilymph Fistula

111

4.1.4

Alternobaric Vertigo

112

4.1.5

Otolith Vertigo

112

4.2

Traumatic Central Vestibular Forms of Vertigo

113

4.3

Traumatic Cervical Vertigo

113

4.4

Post-Traumatic Psychogenic Vertigo

114

5

Psychogenic Forms of Vertigo and Dizziness

115

5.1

Phobic Postural Vertigo

116

5.1.1

Patient History

116

5.1.2

Clinical Aspects and Course of the Illness

117

5.1.3

Pathophysiology and Therapeutic Principles

118

5.1.4

Pragmatic Therapy

120

5.1.5

Differential Diagnosis and Clinical Problems

121

6

Various Vertigo Syndromes

123

6.1

Vertigo/Dizziness in Childhood and Hereditary Vertigo Syndromes

123

6.1.1

Benign Paroxysmal Vertigo of Childhood

126

6.1.2

Familial Episodic Ataxia Types 1 and 2

126

6.1.3

Motion Sickness

126

6.2

Drug-Induced Vertigo

127

6.3

Cervicogenic Vertigo

128

6.4

Motion Sickness

129

6.4.1

Clinical Aspects and Pathogenesis

129

6.4.2

Course and Therapy

131

6.4.3

Pragmatic Therapy

132

6.5

Height Vertigo

134

6.5.1

Syndromal Aspects and Pathogenesis

134

6.5.2

Course and Therapy

136

Index

139