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exaggerated sense of motion in response to a given bodily movement While vertigo is typically experienced as a distinct spinning sensation, it may also present as a sense of tumbling or of falling forward or backward It should be distinguished from imbalance, light-headedness, and syncope, all of which are nonvestibular in origin The vertigo that results from peripheral vestibulopathy is usually of sudden onset, may be so severe that the patient is unable to walk or stand, and is frequently accompanied by nausea and vomiting Tinnitus and hearing loss may be associated and provide strong support for a peripheral (ie, otologic) origin A thorough history will often narrow down, if not confirm, the diagnosis Critical elements of the history include the duration of the discrete vertiginous episodes (seconds, minutes to hours, or days), and associated symptoms Triggers should also be sought, including diet (eg, high salt in the case of Meniere s disease), stress, fatigue, and bright lights The physical examination of the patient with vertigo includes evaluation of the ears, eye motion in response to head turning and observation for nystagmus, cranial nerve examination, and Romberg testing In acute peripheral lesions, nystagmus is usually horizontal with a rotatory component; the fast phase usually beats away from the diseased side Visual fixation tends to inhibit nystagmus except in very acute peripheral lesions or with central nervous system disease Dix-Hallpike testing (quickly lowering the patient to the supine position with the head extending over the edge and placed 30 degrees lower than the body, turned either to the left or right) will elicit a delayed onset (~15 sec) of fatigable nystagmus in cases of benign positioning vertigo Nonfatigable nystagmus in this position indicates a central etiology for the dizziness Since visual fixation often suppresses observed nystagmus, many of these maneuvers are performed with Fresnel goggles, which prevent visual fixation and often bring out subtle forms of nystagmus The Fukuda test, in which the patient consistently rotates when walking in place with eyes closed, can also demonstrate vestibular asymmetry In contrast to peripheral forms of vertigo, dizziness arising from central lesions tends to develop gradually and then become progressively more severe and debilitating Nystagmus is not always present but can occur in any direction and may be dissociated in the two eyes The associated nystagmus is often nonfatigable, vertical rather than horizontal in orientation, without latency, and unsuppressed by visual fixation ENG is useful in documenting these characteristics The evaluation of central audiovestibular dysfunction usually requires imaging of the brain with MRI Episodic vertigo can occur in patients with diplopia from external ophthalmoplegia and is maximal when the patient looks in the direction where the separation of images is greatest Cerebral lesions involving the temporal cortex may also produce vertigo, which is sometimes the initial symptom of a seizure Finally, vertigo may be a feature of a number of systemic disorders and can occur as a side effect of certain anticonvulsant, antibiotic, hypnotic, analgesic, and tranquilizing drugs or of alcohol.

A Endolymphatic Hydrops (Meniere s Syndrome)

Purpose Public property that gets the number of elements in the Stack Removes all objects from the Stack Determines whether an element is in the Stack Copies the Stack elements to an existing one-dimensional array Returns an enumerator for the Stack Returns the object at the top of the Stack without removing it Removes and returns the object at the top of the Stack Inserts an object at the top of the Stack Copies the elements to a new array

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The cause of Meniere s syndrome is unknown It presumably results from distention of the endolymphatic compartment of the inner ear Although a precise cause of hydrops cannot be established in most cases, two known causes are syphilis and head trauma The classic syndrome consists of episodic vertigo, with discrete vertigo spells lasting 20 minutes to several hours in association with fluctuating low-frequency sensorineural hearing loss, tinnitus (usually low-tone and blowing in quality), and a sensation of aural pressure Symptoms wax and wane as the endolymphatic pressure rises and falls Caloric testing commonly reveals loss or impairment of thermally induced nystagmus on the involved side Treatment involves a low salt diet and diuretics (eg, acetazolamide) In refractory cases, patients may undergo endolymphatic sac decompression or vestibular ablation either through transtympanic gentamicin, vestibular nerve section, or surgical labyrinthectomy

Kim HH et al Trends in the diagnosis and the management of Meniere s disease: results of a survey Otolaryngol Head Neck Surg 2005 May;132(5):722 6 [PMID: 15886625] Onuki J et al Comparative study of the daily lifestyle of patients with Meniere s disease and controls Ann Otol Rhinol Laryngol 2005 Dec;114(12):927 33 [PMID: 16425558]

Patients with labyrinthitis suffer from acute onset of continuous, usually severe vertigo lasting several days to a week, accompanied by hearing loss and tinnitus During a recovery period that lasts for several weeks, the vertigo gradually improves Hearing may return to normal or

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