Dizziness Depot

 The two most common causes of recurrent episodes of prolonged vertigo (lasting at least 20-30 minutes) are Vestibular Migraine and Meniere’s disease.  Most practitioners make the distinction between the two by considering symptoms that accompany the vertigo attacks. Migrainuers often have visual complaints (increased sensitivity to light), and Meniere’s patient have unilateral auditory complaints (tinnitus, ear fullness, decreased and fluctuating

  As the director of a balance and vestibular clinic, I see many patients with complaints of dizziness, disorientation, and motion sensitivity related to migraine. We work closely with our neurology colleagues in managing these patients. The International Headache Society has an official classification of “vestibular migraine.” Let me start by saying that I am not a medical doctor, certainly not

In the vestibular lab, we see patients that sense motion too little, and patients that sense motion too much. Patients with chronic inner ear weakness may suffer from reduced information from the vestibular system regarding movement. They learn to rely on other information such as visual or tactile cues, and may be unsteady in situations where that information is unavailable

It appears that some investigators have done the leg work to put together winning cases regarding vestibular fraud. I commend them, and I hope it has some effect on those currently committing fraud. In the past, I have posted about Profit Centers for Primary Care regarding using VNG testing solely for cash production. I start with an excerpt from a

 Over the years, I have periodically addressed the issue of fraud in vestibular testing. Addressing it only periodically doesn’t mean it isn’t happening every day, and the impact on patient care is going to be with us for a long time. There have been some recent high profile convictions related to millions of dollars of vestibular testing fraud. It’s about

Is it Possible to Get a False Negative Dix-Hallpike for BPPV? This is a subject I have covered before, but two recent studies call for a little review. I have been preaching for years that a negative Dix-Hallpike exam does not rule out BPPV. In a patient with an otherwise normal exam and symptoms suggestive of BPPV, a negative Dix-Hallpike

Anterior canal BPPV is quite rare, and is estimated to account for 1 to 2% of cases of BPPV. The primary diagnostic feature is the fact that the nystagmus associated with anterior canal BPPV is torsional and downbeating, whereas the more common posterior canal BPPV nystagmus is torsional and upbeating. This is not always easy to detect with the naked

We continue with the case of the mysterious downbeat positional nystagmus. The patient returned after the weekend, reporting little change in his symptoms, which included brief vertigo with rolling over in bed, and ongoing unsteadiness on his feet for the past three months. At that point, I abandoned my suspicion of the otoconia having settled in the vestibule, and suspected

Last week we reviewed a post discussing the occasional finding of downbeat vertical nystagmus when bringing the patient back up to the seated position after performing canalith repositioning (AKA the Epley maneuver) for posterior canal BPPV. Well, last week, I saw a  particularly unusual presentation of that particular unusual presentation. I had a referral from a local Otolaryngologist that was comfortable

I am recycling a portion of a post I did a couple of years ago. This post discusses a particular observation that occurs periodically when performing canalith repositioning, namely a short burst of downbeat vertical nystagmus when bringing the patient back up to the seating position (position #4). We are revisiting this because I saw a patient last week with