Dizziness and vertigo

1/ KỂ BA HỆ THỐNG ĐIỀU HÒA CÂN BẰNG VÀ ĐỊNH HƯỚNG KHÔNG GIAN. Hệ thị giác : mắt và các cơ nhãn cầu. Hệ nhận cảm bản thể (proprioceptive system) : các cột sau tủy sống (posterior columns), dây gân, khớp và cơ.

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All listed drugs are U.S. Food and Drug Administration approved, but most are not approved for the treatment of vertigo. b Usual oral (unless otherwise stated) starting dose in adults; maintenance dose can be reached by a gradual increase. c For acute vertigo only. d For motion sickness only. e For benign paroxysmal positional vertigo. f For vertigo other than Ménière's and positional. g For Ménière's disease. h For migraine-associated vertigo (see Chap. 15 for a listing of prophylactic antimigrainous drugs).

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Evaluation of Patients with Pathologic Vestibular Vertigo The evaluation depends on whether a central etiology is suspected (Table 22-2). If so, MRI of the head is mandatory. Such an examination is rarely helpful in cases of recurrent monosymptomatic vertigo with a normal neurologic examination. Typical BPPV requires no investigation after the diagnosis is made (Table 22-1).

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In Ménière's disease, the direction of the fast phase is variableVertigo may be a manifestation of a migraine aura (Chap. 15), but some patients with migraine have episodes of vertigo unassociated with their headaches. Antimigrainous treatment should be considered in such patients with otherwise enigmatic vertiginous episodes. Vestibular epilepsy, vertigo secondary to temporal lobe epileptic activity, is rare and almost always intermixed with other epileptic manifestations.

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Recurrent unilateral labyrinthine dysfunction, in association with signs and symptoms of cochlear disease (progressive hearing loss and tinnitus), is usually due to Ménière's disease (Chap. 30). When auditory manifestations are absent, the term vestibular neuronitis denotes recurrent monosymptomatic vertigo. Transient ischemic attacks of the posterior cerebral circulation (vertebrobasilar insufficiency) only infrequently cause recurrent vertigo without concomitant motor, sensory, visual, cranial nerve, or cerebellar signs (Chap. 364).

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Physiologic Vertigo This occurs in normal individuals when (1) the brain is confronted with an intersensory mismatch among the three stabilizing sensory systems; (2) the vestibular system is subjected to unfamiliar head movements to which it is unadapted, such as in seasickness; (3) unusual head/neck positions, such as the extreme extension when painting a ceiling; or (4) following a spin.

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Harrison's Internal Medicine Chapter 22. Dizziness and Vertigo Dizziness and Vertigo: Introduction Dizziness is a common and often vexing symptom. Patients use the term to encompass a variety of sensations, including those that seem semantically appropriate (e.g., lightheadedness, faintness, spinning, giddiness) and those that are misleadingly inappropriate, such as mental confusion, blurred vision, headache, or tingling.

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