Panel: Diagnostic criteria for vestibular migraine Patients need to meet all four of the following criteria: • At least five episodes with vestibular symptoms* of moderate or severe intensity† lasting between 5 min and 72 h • Present migraine or previous history of migraine with or without aura according to the International Classification of Headache Disorders • One or more migraine features with at least 50% of the vestibular episodes • Headache with at least two of the following characteristics: one-sided location, pulsating quality, moderate or severe pain intensity, aggravation by routine physical activity • Photophobia and phonophobia • Visualaura • Not explained by another vestibular disorder
There is moderate to strong evidence that VR is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that VR provides a resolution of symptoms and improvement in functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of VR.
• The most common causes of acute vestibular syndrome are vestibular neuritis (often called labyrinthitis) and ischemic stroke in the brainstem or cerebellum. • Vertebrobasilar ischemic stroke may closely mimic peripheral vestibular disorders, with obvious focal neurologic signs absent in more than half of people presenting with acute vestibular syndrome due to stroke. • Computed tomography has poor sensitivity in acute stroke, and diffusion-weighted magnetic resonance imaging (MRI) misses up to one in five strokes in the posterior fossa in the first 24–48 hours. • Expert opinion suggests a combination of focused history and physical examination as the initial approach to evaluating whether acute vestibular syndrome is due to stroke. • A three-component bedside oculomotor examination — HINTS (horizontal head impulse test, nystagmus and test of skew) — identifies stroke with high sensitivity and specificity in patients with acute vestibular syndrome and rules out stroke more effectively than early diffusion-weighted MRI.
< Message edited by BoPT -- February 1, 2014 9:02:50 AM >
Conclusion: Substantial demand exists for dizziness information via the internet. Future studies should seek to better characterize the population seeking this information. The magnitude of this potential demand suggests that validated and tested diagnostic and treatment tools could contribute to healthcare efficiencies and patient outcomes.
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.
This investigation reconfirms that vestibular deficiency is present in a high percentage of people with diabetes. Furthermore, this study suggests that vestibular deficiency contributes significantly more to quantitatively demonstrable disequilibrium than does proprioceptive loss resulting from peripheral nerve injury.