Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and has a lifetime prevalence of 2.4% in the general population. Benign paroxysmal positional vertigo is caused when calcium carbonate material originating from the macula of the utricle falls into one of the semicircular canals. Due to their density relative to the endolymph, they move in response to gravity and trigger excitation of the ampullary nerve of the affected canal. This, in turn, produces a burst of vertigo associated with nystagmus unique to that canal. Recognition of this condition is important not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and effective in \u3e90% of cases. Two well-established methods of treating BPPV are discussed and explained in this article along with a brief discussion of the most commonly used method for treatment of horizontal canal BPPV. Recurrence rates approach 50% in those followed for at least 5 years

Posttraumatic Vertigo and Dizziness

Dizziness and vertigo are common symptoms following minor head trauma. Although these symptoms resolve within a few weeks in many patients, in some the symptoms may last much longer and impede ability to return to work and full functioning. Causes of persisting or recurrent dizziness may include benign paroxysmal positional vertigo, so-called labyrinthine concussion, unilateral vestibular nerve injury or damage to the utricle or saccule, perilymphatic fistula, or less commonly traumatic endolymphatic hydrops. Some dizziness after head trauma is due to nonlabyrinthine causes that may be related to structural or microstructural central nervous system injury or to more complicated interactions between migraine, generalized anxiety, and issues related to patients self-perception, predisposing psychological states, and environmental and stress-related factors. In this article, the authors review both the inner ear causes of dizziness after concussion and also the current understanding of chronic postconcussive dizziness when no peripheral vestibular cause can be identified

Mal De Debarquement Syndrome

Summary Mal de d

Causes of Imbalance and Abnormal Gait That May Be Misdiagnosed

Disorders of gait and balance are common in medicine and often lead to referral for neurologic evaluation. Because the maintenance of balance and normal gait are mediated by complex neurologic pathways as well as musculoskeletal, metabolic, and behavioral considerations, the list of possible contributing causes is very large. Much of the time, the history and neurologic examination reveal the underlying cause or causes. There are instances, however, when there are limited neurologic findings, as well as no structural abnormalities on brain or spine magnetic resonance imaging studies to explain the imbalance or gait difficulty. In this article, selected disorders that may be overlooked in the neurologic examination and imaging studies are reviewed. Possible causes of imbalance include occult drug-induced ataxia, autoimmune ataxia, ataxia associated with tremor, bilateral vestibular hypofunction, and spastic or dystonic gait disorders with normal imaging

Clinical Perspectives on Medical Marijuana (Cannabis) for Neurologic Disorders

Summary The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time

Vestibular Evoked Myogenic Potential Testing Payment Policy Review for Clinicians and Payers

Purpose of review A recent American Academy of Neurology Evidence-Based Practice Guideline on vestibular myogenic evoked potential (VEMP) testing has described superior canal dehiscence syndrome (SCDS) and evaluated the merits of VEMP in its diagnosis. SCDS is an uncommon but now well-recognized cause of dizziness and auditory symptoms. This article familiarizes health care providers with this syndrome and the utility and shortcomings of VEMP as a diagnostic test and also explores payment policies for VEMP. Recent findings In carefully selected patients with documented history compatible with the SCDS, both high-resolution temporal bone CT scan and VEMP are valuable aids for diagnosis. Payers might be unfamiliar with both this syndrome and VEMP testing. Summary It is important to raise awareness of VEMP and its possible indications and the rationale for coverage of VEMP testing. Payers may not be readily receptive to VEMP coverage if this test is used in an undifferentiated manner for all common vestibular and auditory symptoms

Bilateral Vestibular Hypofunction in Neurosarcoidosis: A Case Report

We describe the case of a 59-year-old woman who presented with progressive bilateral vestibular hypofunction and who was found to have bilateral granulomatous mass lesions of the mesial temporal lobe. Initially, her condition stabilized neurologically with corticosteroids, but a diagnosis of neurosarcoidosis was delayed because of the unusual presentation and persistently normal chest imaging results and serum angiotensin-converting enzyme (ACE) levels. Approximately 1 year after her initial presentation, the patient died of complications of a myocardial infarction and pulmonary embolism. Sarcoidosis should be considered in the differential diagnosis of idiopathic bilateral vestibular hypofunction even if the chest imaging and serum ACE levels are normal, particularly when there is evidence of a multisystem process

Bilateral Vestibular Dysfunction Associated With Chronic Exposure to Military Jet Propellant Type-Eight Jet Fuel.

We describe three patients diagnosed with bilateral vestibular dysfunction associated with the jet propellant type-eight (JP-8) fuel exposure. Chronic exposure to aromatic and aliphatic hydrocarbons, which are the main constituents of JP-8 military aircraft jet fuel, occurred over 3-5 years\u27 duration while working on or near the flight line. Exposure to toxic hydrocarbons was substantiated by the presence of JP-8 metabolit

Treatment for Vestibular Disorders: How Does Your Physical Therapist Treat Dizziness Related to Vestibular Problems?

Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Many people get dizzy when they turn their head, which can cause problems with walking and makes people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often dizziness is because of a disorder of the vestibular (or inner ear balance) system. People can get vestibular disorders from infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraines, overdoing some activities, and feeling sad can increase symptoms. New guidelines for the treatment of vestibular disorders were published in the April 2016 issue of the Journal of Neurologic Physical Therapy. The guideline describes which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear disorder

Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology.

OBJECTIVE: To determine the efficacy of medical marijuana in several neurologic conditions. METHODS: We performed a systematic review of medical marijuana (1948-November 2013) to address treatment of symptoms of multiple sclerosis (MS), epilepsy, and movement disorders. We graded the studies according to the American Academy of Neurology classification scheme for therapeutic articles. RESULTS: Thirty-four studies met inclusion criteria; 8 were rated as Class I. CONCLUSIONS: The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease. Oral cannabinoids are of unknown efficacy in non-chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications