Table Of ContentO 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
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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.
