Evaluating the Dizzy Patient: Bedside Examination and Laboratory Assessment of the Vestibular System

Scott D. Z. Eggers; David S. Zee

doi:10.1055/s-2003-40751

Seminars in Neurology, Table of Contents

Semin Neurol 2003; 23(1): 047-058
DOI: 10.1055/s-2003-40751

Evaluating the Dizzy Patient: Bedside Examination and Laboratory Assessment of the Vestibular System

Scott D.Z. Eggers¹ , David S. Zee²

¹Senior Associate Consultant, Department of Neurology, Mayo Clinic and Mayo Foundation, and Assistant Professor of Neurology, Mayo Medical School, Rochester, Minnesota
²Professor of Neurology, Otolaryngology, Head and Neck Surgery, Ophthalmology and Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland

Abstract

ABSTRACT

Dizziness and imbalance are common presenting complaints to the neurologist. The lack of a systematic approach to the examination and laboratory evaluation of the vestibular system often leads to incorrect diagnoses and suboptimal care. With a basic understanding of vestibular physiology and proper examination techniques, a correct diagnosis can generally be made at the bedside. We review the principles of the neuro-otological examination, including assessment for static vestibular imbalance, dynamic vestibular function, provocative maneuvers, ocular motor examination, and vestibulospinal testing. The use of additional vestibular laboratory testing and neuroimaging is then considered to further localize and quantify abnormalities.

KEYWORDS

Dizziness - vestibular - ocular motor - physical examination

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References

REFERENCES

1 Leigh R J, Zee D S. The Neurology of Eye Movements. 3rd ed. New York: Oxford University Press 1999
2 Baloh R W, Honrubia V. Clinical Neurophysiology of the Vestibular System. 3rd ed. New York: Oxford University Press; 2001
3 Brandt T, Dieterich M. Vestibular syndromes in the roll plane: topographic diagnosis from brain stem to cortex. Ann Neurol . 1994; 36 337-347
4 Halmagyi G M, Curthoys I S. A clinical sign of canal paresis. Arch Neurol . 1988; 45 737-739
5 Hain T C, Spindler J. Head-shaking nystagmus. In: Sharpe JA, Barber HO, eds. The Vestibulo-Ocular Reflex and Vertigo New York: Raven Press 1993: 217-228
6 Epley J M. Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg . 1995; 112 154-161
7 Brandt T, Steddin S, Daroff R B. Therapy for benign paroxysmal positioning vertigo, revisited. Neurology . 1994; 44 796-800
8 Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol . 1988; 42 290-293
9 Baloh R W, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology . 1993; 43 2542-2549
10 Fife T D. Recognition and management of horizontal benign positional vertigo. Am J Otol . 1998; 19 345-351
11 Walker M F, Zee D S. The effect of hyperventilation on downbeat nystagmus in cerebellar disorders. Neurology . 1999; 53 1576-1579
12 Sakellari V, Bronstein A M, Corna S, Hammon C A, Jones S, Wolsley C J. The effects of hyperventilation on postural control mechanisms. Brain . 1997; 120 1659-1673
13 Minor L B, Solomon D, Zee D S, Zinreich J S. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg . 1998; 124 249-258
14 Brazis P. Ocular motor abnormalities in Wallenberg's lateral medullary syndrome. Mayo Clin Proc . 1992; 67 365-368
15 Baloh R W, Yee R D, Honrubia V. Eye movements in patients with Wallenberg's syndrome. Ann N Y Acad Sci . 1981; 374 600-613
16 Baloh R W, Halmagyi G M. Disorders of the Vestibular System. New York: Oxford University Press 1996
17 Belden C J, Weg N, Minor L B, Zinreich S J. CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo. Radiology . 2003; 226 337-343
18 Colebatch J G. Vestibular evoked potentials. Curr Opin Neurol . 2001; 14 21-26
19 Ferber-Viart C, Dubreuil C, Duclaux R. Vestibular evoked myogenic potentials in humans: a review. Acta Otolaryngol (Stockh) . 1999; 119 6-15