Guidelines on vertigo

1. Introduction

2. Patient history 2.1. Vertigo or dizziness ·     ·   

2. Patient history 2.1. Vertigo or dizziness ·     ·   

2. Patient history 2.2. Otologics symptoms (for each complain, look for the laterality and the temporality with vertigo) ·     ·   

2.3. Visual manifestations (*) 2. Patient history 2.3. Visual manifestations (*) ·     ·   

2.4. Neurological manifestations (precise temporality with vertigo) 2. Patient history 2.4. Neurological manifestations (precise temporality with vertigo) ·     ·   

2. Patient history 2.5. Prior history ·     ·   

2. Patient history 2.6. Treatment ·     ·   

3.2. Oculomotor and nystagmus 3. Clinical examination 3.1. Otorhinologic 3.2. Oculomotor and nystagmus

3.2. Oculomotor and nystagmus 3. Clinical examination 3.2. Oculomotor and nystagmus

3. Clinical examination 3.3. Other cranial nerves 3.4. Members

3. Clinical examination 3.5. Stato-kinetic tests

4. Diagnostic Progression 4.1. Isolated Vertigo

4. Diagnostic Progression 4.1. Isolated Vertigo

4. Diagnostic Progression 4.2. Vertigo and hearing signs

4. Diagnostic Progression 4.3. Vertigo and neurological symptoms

4. Diagnostic Progression 4.3. Vertigo and neurological symptoms

4. Diagnostic Progression 4.3. Vertigo and neurological symptoms

4. Diagnostic Progression 4.3. Vertigo and neurological symptoms

4. Diagnostic Progression 4.4. Other vertigo

4. Diagnostic Progression 4.5. Imbalance without vertigo

5. Laboratory examination (Following §4 Diagnostic criteria indications) 5.1. Hearing test Tonal, vocal, supraliminar depending on pathology 5.2. Tympanometry/Stapedial (acoustic) reflex 5.3. Auditory brainstem response 5.4. Electrocochleography (If Meniere desease or perilymph fistula suspected) 5.5. Otoacoustic-emissions 5.6. Vestibular-evoked myogenic potentials (VEMP) (*)

5.7. VNG or ENG (*norminative data) 5. Laboratory examination (Following §4 Diagnostic criteria indications) 5.7. VNG or ENG (*norminative data)

5. Laboratory examination (Following §4 Diagnostic criteria indications) 5.8. Vertical or horizontal visual perception test (*) 5.9. Posturography 5.9.1. Static 5.9.2. Dynamic 5.10. Vibratory nystagmus (*) 5.11. Otolith linear and rotatory test (*) 5.11.1. Excentric rotative test 5.11.2. OVAR

6. Treatment Strategy 6.1. Medical treatment (*) 6.2. Vestibular rehabilitation : soon in BE-ENT (Symposium in november 2005) 6.3. Psychologic approach (*) 6.3.1. Anxiolytic 6.3.2. Relaxation 6.3.3. Comportemental 6.3.4. Psychotherapia 6.4. Surgical Treatment (*)

Norminative data in ENG and VNG Benign paroxysmal nystagmus:diagnosis and treatment Neuro-ophtalmological symptoms in vertigo and dizziness Head shaking nystagmus Vibration induced nystagmus Tullio’s phenomenom Vestibular evoked myogenic potentials Unilateral centrifugation Static and dynamic balance clinical investigation Vertigo and psychological troubles Medical treatment of vertigo Surgical treatment of vertigo Index

References Brandt Th. Vertigo. Its Multisensory Syndroms Springer Verlag Edit., 2th edition, 2000, ISBN, 3-540-19934-9 Leigh R.J., Zee D.S. The Neurology of Eye Movement. Oxford University Press, 1999, 3th edition Balow R.W., Honrubia V. Clinical Neurophysiology of the Vestibular System. Oxford University Press, 2001, 3th edition Luxon L. Text book of Audiological Medicine. Clinical Aspects of Hearing and Balance. Martin Dunitz edit. London : 2003.

References Brandt Th., Strupp M. General Vestibular Testing. Clinical Neurophysiology 2005, 116, 406-426 Fife T.D., Tusa R.J., Furman J.M., Zee D.S., Frohman E., Baloh R.W., Hain T., Goebel J., Demer J., Eviatar L. Assessment: Vestibular testing techniques in adults and children. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2000; 55: 1431-1441 Expertise Médicale en Oto-Rhino-Laryngologie. Recommandations. Acta O.R.L. Belgica, 1986, 40, 907-915. Vertiges chez l’Adulte : Stratégies diagnostiques. Place de la rééducation vestibulaire. On te Website www.anaes.fr in Publications:Neurologie:Septembre 1997 ISBN 2 910653-33-1

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