O N L OXFORD NEUROLOGY LIBRARY Vertigo and Dizziness O N L OXFORD NEUROLOGY LIBRARY Vertigo and Dizziness Béla Büki MD PhD Dept. of Otolaryngology County Hospital Krems Krems an der Donau, Austria Alexander A. Tarnutzer MD Dept. of Neurology University Hospital Zurich Zurich, Switzerland 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2014 The moral rights of the authors have been asserted First Edition published in 2014 Impression: 1 All rights reserved. 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Contents Foreword vii Acknowledgements ix Note to the Reader ix Abbreviations xi 1 Introduction   1 2 Dizziness as emergency   5 3 Vestibular physiology   13 4 History of complaints as a diagnostic tool   25 5 Examination methods   33 6 Three frequent peripheral causes of dizziness and vertigo   47 7 Chronic vestibular insuffi ciency   77 v 8 Diseases of the temporal bone and schwannoma of the vestibular nerve   85 9 Central causes of vertigo, dizziness, and imbalance   95 10 Medical, non-vestibular causes of dizziness or vertigo   119 11 Diagnosis of falls, dizziness in children and elderly   125 12 Controversial issues   133 Index   141 Foreword There can be few physicians so dedicated to their art that they do not experience a slight decline in spirits on learning that their patient’s complaint is of giddiness. This frequently means that after exhaustive enquiry it will still not be entirely clear what it is that the patient feels wrong and even less so why he feels it. Matthews W.B. (1963) Practical Neurology. Oxford, Blackwell. A pithy quip from Bryan Matthews (1920–2001), Professor of Clinical Neurology at Oxford (1970–1987), and one of the fi nest clinical neurologists of his day. But even then he was not quite right in his assessment of the dismal state of neuro-otology fi fty years ago. Queen Square—where Drs Hallpike, Dix, Cawthorne, and Carmichael were busily making important contributions to our understanding of the vestibular system—was not so far from Oxford. But as only one of the awesome foursome, Dr Carmichael, was a neurologist (Hallpike and Cawthorne (Sir Terence) were otolo- gists, and (Margaret) Dix was neither), Matthews probably had not heard of them; or if he had, he did not take much notice. But from that acorn, what a mighty oak has vii grown! With some understanding of basic vestibular physiology, it is now possible, in my view, to make a reasonable diagnosis on history and examination in about 80% of dizzy patients at the fi rst consultation, with only an audiogram and a video head impulse test to help; and to be able to treat successfully about 80% of them (the Pareto Principle at work). This little book distils the practical aspects of these advances, so that any practitioner with an interest in treating dizzy patients can acquire state-of-the art knowledge and have a chance of approximating this hit rate. Prof Gábor Michael Halmágyi February 2013, Sydney, Australia Acknowledgements The authors would especially like to thank Dominik Straumann from the Department of Neurology, University Hospital Zurich, Zurich, Switzerland for his useful comments during his meticulous and motivated work reviewing and correcting all chapters. They also thank Jonathan A. Edlow from the Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston for having reviewed Chapter 2 (Dizziness as emergency). Note to the Reader ix The authors report no confl ict of interest. The manuscript has been completed solely on the basis of available scientifi c evidence, without any commercial considerations.