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Semin Neurol 2011; 31(1): 029-041
DOI: 10.1055/s-0031-1271306
© Thieme Medical Publishers

Evaluation of “Dizziness” in the Neurology Office

Devon I. Rubin1 , William P. Cheshire1
  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida
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Publikationsverlauf

Publikationsdatum:
14. Februar 2011 (online)

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ABSTRACT

“Dizziness” is a common presenting symptom to a neurologist in the outpatient setting. Dizziness can occur as a result of a vestibular disorder involving the peripheral or central vestibular pathways or nonvestibular centers as the result of a disorder of balance, proprioceptive input, or autonomic nervous system dysfunction. A careful clinical history and examination along with ancillary testing can usually lead to determination of the underlying disorder and implementation of the appropriate treatment. The authors review the general approach to the “dizzy” patient in an office-based neurology practice, focusing on the clinical diagnostic features that may help to determine the etiology and treatment options for the dizzy patient.

KEYWORDS

Dizziness - vertigo - lightheadedness - autonomic

REFERENCES

  • 1 Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes.  Neurologist. 2008;  14 (6) 355-364
    CrossrefPubMedGoogle Scholar
  • 2 Colledge N R, Wilson J A, Macintyre C C, MacLennan W J. The prevalence and characteristics of dizziness in an elderly community.  Age Ageing. 1994;  23 (2) 117-120
    CrossrefPubMedGoogle Scholar
  • 3 Kroenke K, Lucas C A, Rosenberg M L et al.. Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care.  Ann Intern Med. 1992;  117 (11) 898-904
    PubMedGoogle Scholar
  • 4 Tusa R J. Dizziness.  Med Clin North Am. 2009;  93 (2) 263-271, vii
    CrossrefPubMedGoogle Scholar
  • 5 The Consensus Committee of the American Autonomic Society and the American Academy of Neurology . Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy.  Neurology. 1996;  46 (5) 1470
    CrossrefPubMedGoogle Scholar
  • 6 Zapala D A, Brey R H. Vertigo and balance. In: Daube J R, Rubin D I, eds. Clinical Neurophysiology. New York, NY: Oxford University Press; 2009: 575-612
    Google Scholar
  • 7 Karlberg M, Annertz M, Magnusson M. Acute vestibular neuritis visualized by 3-T magnetic resonance imaging with high-dose gadolinium.  Arch Otolaryngol Head Neck Surg. 2004;  130 (2) 229-232
    CrossrefPubMedGoogle Scholar
  • 8 Kanashiro A M, Pereira C B, Melo A C, Scaff M. [Diagnosis and treatment of the most frequent vestibular syndromes].  Arq Neuropsiquiatr. 2005;  63 (1) 140-144
    CrossrefPubMedGoogle Scholar
  • 9 Furman J M, Cass S P. Benign paroxysmal positional vertigo.  N Engl J Med. 1999;  341 (21) 1590-1596
    CrossrefPubMedGoogle Scholar
  • 10 Froehling D A, Silverstein M D, Mohr D N, Beatty C W, Offord K P, Ballard D J. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota.  Mayo Clin Proc. 1991;  66 (6) 596-601
    CrossrefPubMedGoogle Scholar
  • 11 Cohen H S, Kimball K T. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal.  Otol Neurotol. 2005;  26 (5) 1034-1040
    CrossrefPubMedGoogle Scholar
  • 12 Epley J M. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.  Otolaryngol Head Neck Surg. 1992;  107 (3) 399-404
    CrossrefPubMedGoogle Scholar
  • 13 Hilton M, Pinder D K. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.  Cochrane Database Syst Rev. 2004;  2 CD003162
    PubMedGoogle Scholar
  • 14 Helminski J O, Zee D S, Janssen I, Hain T C. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review.  Phys Ther. 2010;  90 (5) 663-678
    CrossrefPubMedGoogle Scholar
  • 15 Prokopakis E P, Chimona T, Tsagournisakis M et al.. Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure.  Laryngoscope. 2005;  115 (9) 1667-1671
    CrossrefPubMedGoogle Scholar
  • 16 Steenerson R L, Cronin G W, Marbach P M. Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo.  Laryngoscope. 2005;  115 (2) 226-231
    CrossrefPubMedGoogle Scholar
  • 17 Cakir B O, Ercan I, Cakir Z A, Turgut S. Efficacy of postural restriction in treating benign paroxysmal positional vertigo.  Arch Otolaryngol Head Neck Surg. 2006;  132 (5) 501-505
    CrossrefPubMedGoogle Scholar
  • 18 Santos P M, Hall R A, Snyder J M, Hughes L F, Dobie R A. Diuretic and diet effect on Menière's disease evaluated by the 1985 Committee on Hearing and Equilibrium guidelines.  Otolaryngol Head Neck Surg. 1993;  109 (4) 680-689
    PubMedGoogle Scholar
  • 19 Leveque M, Seidermann L, Tran H, Langagne T, Ulmer E, Chays A. Vestibular function outcomes after vestibular neurectomy in Meniere's disease: can vestibular neurectomy provide complete vestibular deafferentation?.  Auris Nasus Larynx. 2010;  37 (3) 308-313
    CrossrefPubMedGoogle Scholar
  • 20 Goudakos J K, Markou K D, Franco-Vidal V, Vital V, Tsaligopoulos M, Darrouzet V. Corticosteroids in the treatment of vestibular neuritis: a systematic review and meta-analysis.  Otol Neurotol. 2010;  31 (2) 183-189
    CrossrefPubMedGoogle Scholar
  • 21 Ariyasu L, Byl F M, Sprague M S, Adour K K. The beneficial effect of methylprednisolone in acute vestibular vertigo.  Arch Otolaryngol Head Neck Surg. 1990;  116 (6) 700-703
    CrossrefPubMedGoogle Scholar
  • 22 Dickins J R, Smith J T, Graham S S. Herpes zoster oticus: treatment with intravenous acyclovir.  Laryngoscope. 1988;  98 (7) 776-779
    PubMedGoogle Scholar
  • 23 Stokroos R J, Albers F WJ, Tenvergert E M. Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial.  Acta Otolaryngol. 1998;  118 (4) 488-495
    CrossrefPubMedGoogle Scholar
  • 24 Kerber K A, Brown D L, Lisabeth L D, Smith M A, Morgenstern L B. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study.  Stroke. 2006;  37 (10) 2484-2487
    CrossrefPubMedGoogle Scholar
  • 25 Kim H A, Lee H. Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy.  Stroke. 2010;  41 (7) 1558-1560
    CrossrefPubMedGoogle Scholar
  • 26 Lee H, Sohn S I, Cho Y W et al.. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns.  Neurology. 2006;  67 (7) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 27 Norrving B, Magnusson M, Holtås S. Isolated acute vertigo in the elderly; vestibular or vascular disease?.  Acta Neurol Scand. 1995;  91 (1) 43-48
    PubMedGoogle Scholar
  • 28 Baloh R W. Vertigo.  Lancet. 1998;  352 (9143) 1841-1846
    CrossrefPubMedGoogle Scholar
  • 29 Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge.  Cephalalgia. 2004;  24 (2) 83-91
    CrossrefPubMedGoogle Scholar
  • 30 Eggers S D. Migraine-related vertigo: diagnosis and treatment.  Curr Neurol Neurosci Rep. 2006;  6 (2) 106-115
    CrossrefPubMedGoogle Scholar
  • 31 Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo.  Neurology. 2001;  56 436-441
    CrossrefPubMedGoogle Scholar
  • 32 Cha Y H, Lee H, Santell L S, Baloh R W. Association of benign recurrent vertigo and migraine in 208 patients.  Cephalalgia. 2009;  29 (5) 550-555
    CrossrefPubMedGoogle Scholar
  • 33 Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine?.  J Neurol. 1999;  246 (10) 883-892
    CrossrefPubMedGoogle Scholar
  • 34 Cha Y H. Migraine-associated vertigo: diagnosis and treatment.  Semin Neurol. 2010;  30 (2) 167-174
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Anagnostou E, Varaki K, Anastasopoulos D. A minute demyelinating lesion causing acute positional vertigo.  J Neurol Sci. 2008;  266 (1-2) 187-189
    CrossrefPubMedGoogle Scholar
  • 36 Ensrud K E, Nevitt M C, Yunis C, Hulley S B, Grimm R H, Cummings S R. The Study of Osteoporotic Fractures Research Group . Postural hypotension and postural dizziness in elderly women. The study of osteoporotic fractures.  Arch Intern Med. 1992;  152 (5) 1058-1064
    CrossrefPubMedGoogle Scholar
  • 37 Rutan G H, Hermanson B, Bild D E, Kittner S J, LaBaw F, Tell G S. CHS Collaborative Research Group . Orthostatic hypotension in older adults. The Cardiovascular Health Study.  Hypertension. 1992;  19 (6 Pt 1) 508-519
    CrossrefPubMedGoogle Scholar
  • 38 Tilvis R S, Hakala S M, Valvanne J, Erkinjuntti T. Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study.  J Am Geriatr Soc. 1996;  44 (7) 809-814
    PubMedGoogle Scholar
  • 39 Wu J S, Yang Y C, Lu F H, Wu C H, Chang C J. Population-based study on the prevalence and correlates of orthostatic hypotension/hypertension and orthostatic dizziness.  Hypertens Res. 2008;  31 (5) 897-904
    CrossrefPubMedGoogle Scholar
  • 40 Ooi W L, Hossain M, Lipsitz L A. The association between orthostatic hypotension and recurrent falls in nursing home residents.  Am J Med. 2000;  108 (2) 106-111
    CrossrefPubMedGoogle Scholar
  • 41 Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson P M, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project).  Eur Heart J. 2010;  31 (1) 85-91
    CrossrefPubMedGoogle Scholar
  • 42 Mader S L, Josephson K R, Rubenstein L Z. Low prevalence of postural hypotension among community-dwelling elderly.  JAMA. 1987;  258 (11) 1511-1514
    CrossrefPubMedGoogle Scholar
  • 43 Low P A, Benrud-Larson L M, Sletten D M et al.. Autonomic symptoms and diabetic neuropathy: a population-based study.  Diabetes Care. 2004;  27 (12) 2942-2947
    CrossrefPubMedGoogle Scholar
  • 44 Winston N, Vernino S. Autoimmune autonomic ganglionopathy.  Front Neurol Neurosci. 2009;  26 85-93
    PubMedGoogle Scholar
  • 45 Robertson D, Hollister A S, Biaggioni I, Netterville J L, Mosqueda-Garcia R, Robertson R M. The diagnosis and treatment of baroreflex failure.  N Engl J Med. 1993;  329 (20) 1449-1455
    CrossrefPubMedGoogle Scholar
  • 46 Gilman S, Wenning G K, Low P A et al.. Second consensus statement on the diagnosis of multiple system atrophy.  Neurology. 2008;  71 (9) 670-676
    CrossrefPubMedGoogle Scholar
  • 47 Stefanova N, Bücke P, Duerr S, Wenning G K. Multiple system atrophy: an update.  Lancet Neurol. 2009;  8 (12) 1172-1178
    CrossrefPubMedGoogle Scholar
  • 48 Senard J M, Raï S, Lapeyre-Mestre M et al.. Prevalence of orthostatic hypotension in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 1997;  63 (5) 584-589
    CrossrefPubMedGoogle Scholar
  • 49 Bonuccelli U, Lucetti C, Del Dotto P et al.. Orthostatic hypotension in de novo Parkinson's disease.  Arch Neurol. 2003;  60 (10) 1400-1404
    CrossrefPubMedGoogle Scholar
  • 50 Jamnadas-Khoda J, Koshy S, Mathias C J, Muthane U B, Ragothaman M, Dodaballapur S K. Are current recommendations to diagnose orthostatic hypotension in Parkinson's disease satisfactory?.  Mov Disord. 2009;  24 (12) 1747-1751
    CrossrefPubMedGoogle Scholar
  • 51 Ziemssen T, Reichmann H. Cardiovascular autonomic dysfunction in Parkinson's disease.  J Neurol Sci. 2010;  289 (1-2) 74-80
    CrossrefPubMedGoogle Scholar
  • 52 Thaisetthawatkul P, Boeve B F, Benarroch E E et al.. Autonomic dysfunction in dementia with Lewy bodies.  Neurology. 2004;  62 (10) 1804-1809
    PubMedGoogle Scholar
  • 53 Shishido T, Ikemura M, Obi T et al.. alpha-synuclein accumulation in skin nerve fibers revealed by skin biopsy in pure autonomic failure.  Neurology. 2010;  74 (7) 608-610
    CrossrefPubMedGoogle Scholar
  • 54 Schondorf R, Benoit J, Stein R. Cerebral autoregulation in orthostatic intolerance.  Ann N Y Acad Sci. 2001;  940 514-526
    CrossrefPubMedGoogle Scholar
  • 55 Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance.  Am J Med Sci. 1999;  317 (2) 75-77
    CrossrefPubMedGoogle Scholar
  • 56 Shannon J R, Flattem N L, Jordan J et al.. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency.  N Engl J Med. 2000;  342 (8) 541-549
    CrossrefPubMedGoogle Scholar
  • 57 Gibbons C H, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance.  Neurology. 2006;  67 (1) 28-32
    CrossrefPubMedGoogle Scholar
  • 58 Fisher A A, Davis M W, Srikusalanukul W, Budge M M. Postprandial hypotension predicts all-cause mortality in older, low-level care residents.  J Am Geriatr Soc. 2005;  53 (8) 1313-1320
    CrossrefPubMedGoogle Scholar
  • 59 Luciano G L, Brennan M J, Rothberg M B. Postprandial hypotension.  Am J Med. 2010;  123 (3) 281, e1-e6
    PubMedGoogle Scholar
  • 60 Figueroa J J, Basford J R, Low P A. Preventing and treating orthostatic hypotension: As easy as A, B, C.  Cleve Clin J Med. 2010;  77 (5) 298-306
    CrossrefPubMedGoogle Scholar
  • 61 Low P A, Singer W. Management of neurogenic orthostatic hypotension: an update.  Lancet Neurol. 2008;  7 (5) 451-458
    CrossrefPubMedGoogle Scholar
  • 62 Singer W, Sandroni P, Opfer-Gehrking T L et al.. Pyridostigmine treatment trial in neurogenic orthostatic hypotension.  Arch Neurol. 2006;  63 (4) 513-518
    CrossrefPubMedGoogle Scholar

Devon I RubinM.D. 

Department of Neurology, Mayo Clinic

4500 San Pablo Road, Jacksonville, FL 32224

eMail: rubin.devon@mayo.edu