Journal of the Korean neurological association (대한신경과학회지)

Korean Neurological Association (대한신경과학회)
권호 표지
DOI QR코드

DOI QR Code

Pitfalls in the Diagnosis of Vertigo

현훈 진단에 있어 함정

  • Kim, Hyun Ah (Department of Neurology, Keimyung University Dongsan Medical Center) ;
  • Lee, Hyung (Department of Neurology, Keimyung University Dongsan Medical Center)
  • 김현아 (계명대학교 동산의료원 신경과) ;
  • 이형 (계명대학교 동산의료원 신경과)
  • Received : 2018.09.11
  • Accepted : 2018.10.02
  • Published : 2018.11.30
⟨ Previous Next ⟩

Abstract

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.

Keywords

References

  1. Brandt T. Vertigo. 2nd ed. New York: Springer, 1999;1-21.
  2. Lee TK, Sung KB. Overview and history taking of dizziness. Res Vestibul Sci 2005;4:67-73.
  3. Lee H. Non-vestibular dizziness. Res Vestibul Sci 2012;11(suppl 1):S113-S117.
  4. Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 2009;19:1-13. https://doi.org/10.3233/VES-2009-0343
  5. Kim HA, Yi HA, Lee H. Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo. Neurol Sci 2015;36:1995-2002. https://doi.org/10.1007/s10072-015-2363-2
  6. Radtke A, Lempert T, von Brevern M, Feldmann M, Lezius F, Neuhauser H. Prevalence and complications of orthostatic dizziness in the general population. Clin Auton Res 2011;21:161-168. https://doi.org/10.1007/s10286-010-0114-2
  7. Newman-Toker DE, Dy FJ, Stanton VA, Zee DS, Calkins H, Robinson KA. How often is dizziness from primary cardiovascular disease true vertigo? A systematic review. J Gen Intern Med 2008;23:2087-2094. https://doi.org/10.1007/s11606-008-0801-z
  8. Choi JH, Seo JD, Kim MJ, Choi BY, Choi YR, Cho BM, et al. Vertigo and nystagmus in orthostatic hypotension. Eur J Neurol 2015;22:648-665. https://doi.org/10.1111/ene.12622
  9. Seok JI, Lee HM, Yoo JH, Lee DK. Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo. J Clin Neurol 2008;4:107-110. https://doi.org/10.3988/jcn.2008.4.3.107
  10. Kim HA, Lee H. Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo. Clin Neurophysiol 2014;125:608-614. https://doi.org/10.1016/j.clinph.2013.08.008
  11. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 1999;317:75-77. https://doi.org/10.1016/S0002-9629(15)40480-X
  12. Kim HA, Lee H, Park KJ, Lim JG. Autonomic dysfunction in patients with orthostatic dizziness: validation of orthostatic grading scale and comparison of Valsalva maneuver and head-up tilt testing results. J Neurol Sci 2013;325:61-66. https://doi.org/10.1016/j.jns.2012.11.019
  13. Lee H, Kim HA. Autonomic dysfunction in chronic persistent dizziness. J Neurol Sci 2014;344:165-170. https://doi.org/10.1016/j.jns.2014.06.048
  14. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011;21:69-72. https://doi.org/10.1007/s10286-011-0119-5
  15. Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006;67:28-32. https://doi.org/10.1212/01.wnl.0000223828.28215.0b
  16. Wieling W, Krediet CT, van Dijk N, Linzer M, Tschakovsky ME. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007;112:157-165. https://doi.org/10.1042/CS20060091
  17. Kim HA, Yi HA, Lee H. Spectrum of autonomic dysfunction in orthostatic dizziness. Clin Neurophysiol 2014;125:1248-1254. https://doi.org/10.1016/j.clinph.2013.10.022
  18. Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 2007;120:841-847. https://doi.org/10.1016/j.amjmed.2007.02.023
  19. Kim HA, Yi HA, Hong JH, Lee H. Detailed relationship between the pattern of blood pressure change during the valsalva maneuver and the degree of orthostatic hypotension during the head-up tilt test in patients with orthostatic intolerance: a retrospective case-control study. Medicine (Baltimore) 2016;95:e3608. https://doi.org/10.1097/MD.0000000000003608
  20. Kim DU. Orthostatic Dizziness. Res Vestib Sci 2011;10(suppl 1):S150-S154.
  21. Lee H, Kim HA. Orthostatic tachycardia with different onset time in patients with orthostatic intolerance. J Neurol Sci 2018;390:166-171. https://doi.org/10.1016/j.jns.2018.04.033
  22. Cho EB, Park KJ. Autonomic dysfunction in dizziness clinic. Res Vestibul Sci 2018;17:37-43. https://doi.org/10.21790/rvs.2018.17.2.37
  23. Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 2007;82:308-313. https://doi.org/10.1016/S0025-6196(11)61027-6
  24. Lee H, Kim HA. Orthostatic hypertension: an underestimated cause of orthostatic intolerance. Clin Neurophysiol 2016;127:2102-2107. https://doi.org/10.1016/j.clinph.2015.12.017
  25. Ward C, Kenny RA. Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med 1996;100:418-422. https://doi.org/10.1016/S0002-9343(97)89517-4
  26. Low PA, Opfer-Gehrking TL, McPhee BR, Fealey RD, Benarroch EE, Willner CL, et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc 1995;70:617-622. https://doi.org/10.4065/70.7.617
  27. Arbogast SD, Alshekhlee A, Hussain Z, McNeeley K, Chelimsky TC. Hypotension unawareness in profound orthostatic hypotension. Am J Med 2009;122:574-580. https://doi.org/10.1016/j.amjmed.2008.10.040
  28. Lee H, Low PA, Kim HA. Patients with orthostatic intolerance: relationship to autonomic function tests results and reproducibility of symptoms on tilt. Sci Rep 2017;7:5706. https://doi.org/10.1038/s41598-017-05668-4
  29. Furman JM, Jacob RG. Psychiatric dizziness. Neurology 1997;48:1161-1166. https://doi.org/10.1212/WNL.48.5.1161
  30. Lee SH. Psychogenic dizziness. J Korean Bal Soc 2008;7:113-119.
  31. Lee KK. Psychogenic vertigo. J Korean Bal Soc 2006;5:185-193.
  32. Brandt T. Phobic postural vertigo. Neurology 1996;46:1515-1519. https://doi.org/10.1212/WNL.46.6.1515
  33. Ruckenstein MJ, Staab JP. Chronic subjective dizziness. Otolaryngol Clin North Am 2009;42:71-77. https://doi.org/10.1016/j.otc.2008.09.011
  34. Lee GD. Persistent postural perceptual dizziness. Res Vestibul Sci 2016;15:70-73. https://doi.org/10.21790/rvs.2016.15.3.70
  35. Bronstein AM. The visual vertigo syndrome. Acta Otolaryngol Suppl 1995;520 Pt 1:45-48.
  36. Jacob RG, Redfern MS, Furman JM. Space and motion discomfort and abnormal balance control in patients with anxiety disorders. J Neurol Neurosurg Psychiatry 2009;80:74-78. https://doi.org/10.1136/jnnp.2007.136432
  37. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the classification of vestibular disorders of the Barany society. J Vestib Res 2017;27: 191-208. https://doi.org/10.3233/VES-170622
  38. Godemann F, Siefert K, Hantschke-Bruggemann M, Neu P, Seidl R, Strohle A. What accounts for vertigo one year after neuritis vestibularis - anxiety or a dysfunctional vestibular organ? J Psychiatr Res 2005;39:529-534. https://doi.org/10.1016/j.jpsychires.2004.12.006
  39. Heinrichs N, Edler C, Eskens S, Mielczarek MM, Moschner C. Predicting continued dizziness after an acute peripheral vestibular disorder. Psychosom Med 2007;69:700-707. https://doi.org/10.1097/PSY.0b013e318151a4dd
  40. Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 2009;164:1579-1587. https://doi.org/10.1016/j.neuroscience.2009.09.034

Cited by

  1. Reduction in Pulse Pressure during Standing Can Distinguish Neurogenic Orthostatic Hypotension vol.11, pp.8, 2021, https://doi.org/10.3390/diagnostics11081331