Vertigo

Background: The occurrence of migraine and vertigo is common in the general population. Migraine vertigo is challenging and has several common symptoms with inner ear pathologies like Endolymphatic Hydropse. This paper presents a review of recent findings about symptoms, test results, pathophysiology and differential diagnosis. Methods: The present study is a review of 35 papers in the field of vestibular migraine. They were selected by searching the keywords vertigo, dizziness, migraine, treatment and rehabilitation in Pubmed, ScienceDirect, Scopus and Google Scholar search engines. Only human studies were included. Results: Recent findings have proposed several common pathophysiologies between vestibular system and migraine including spreading depression in the basilar artery, vasospasm in the internal auditory artery, involvement of the connection with locus coeruleus, dorsal raphe nucleus, disorder of multisensory integration and channelopathy. Conclusion: For the differential diagnosis of vestibular migraine, it appears that comprehensive case history as well as clinical testing and patient follow-up, are the best combination. In addition, it has been proven that vestibular rehabilitation is beneficial to patients with vestibular migraine.

We carried out a retrospective survey of 25 years of clinical experience with the use of clonazepam as a vestibular and tinnitus suppressant in the pharmacological treatment of vestibular or cochleovestibular disorders due to different causes. We reviewed the medical records of 3,357 outpatients treated with a 0.5 or 1.0-mg daily dosage of oral clonazepam during 60-180 days. Complete or substantial control of vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light or mild drowsiness, depression, nightmares, or lowering of libido, reported by 16.9% of the patients as adverse side effects, tended to subside with continued therapy. We concluded that clonazepam is a very useful and safe drug for the symptomatic treatment of patients suffering from cochleovestibular disorders.

Vestibular neuritis is the most common cause of acute spontaneous vertigo. Vestibular neuritis is ascribed to acute unilateral loss of vestibular function, probably due to reactivation of herpes simplex virus in the vestibular ganglia. The diagnostic hallmarks of vestibular neuritis are spontaneous horizontal-torsional nystagmus beating away from the lesion side, abnormal head impulse test for the involved semicircular canals, ipsilesional caloric paresis, decreased responses of vestibular-evoked myogenic potentials during stimulation of the affected ear, and unsteadiness with a falling tendency toward the lesion side. Vestibular neuritis preferentially involves the superior vestibular labyrinth and its afferents. Accordingly, the function of the posterior semicircular canal and saccule, which constitute the inferior vestibular labyrinth, is mostly spared in vestibular neuritis. However, because the rare subtype of inferior vestibular neuritis lacks the typical features of vestibula...

Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses.Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study.The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5 ± 3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix–Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n = 17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n = 6; 12%), benign paroxysmal positional vertigo (n = 6; 12%), psychogenic vertigo (n = 5; 10%), epilepsy (n = 3; 6%), metabolic disorders (n = 3; 6%), vestibular neuritis (n = 2; 4%), Meniere's disease (n = 1; 2%), perilymphatic fistula (n = 1; 2%), amblyopia (n = 1; 2%), and unclassifiable (n = 5; 10%).Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.