Vertigo in Patients with Degenerative Cervical Myelopathy

(1) Background: Cervical vertigo (CV) represents a controversial entity, with a prevalence ranging from reported high frequency to negation of CV existence. (2) Objectives: To assess the prevalence and cause of vertigo in patients with a manifest form of severe cervical spondylosis–degenerative cervical myelopathy (DCM) with special focus on CV. (3) Methods: The study included 38 DCM patients. The presence and character of vertigo were explored with a dedicated questionnaire. The cervical torsion test was used to verify the role of neck proprioceptors, and ultrasound examinations of vertebral arteries to assess the role of arteriosclerotic stenotic changes as hypothetical mechanisms of CV. All patients with vertigo underwent a detailed diagnostic work-up to investigate the cause of vertigo. (4) Results: Symptoms of vertigo were described by 18 patients (47%). Causes of vertigo included: orthostatic dizziness in eight (22%), hypertension in five (14%), benign paroxysmal positional vertigo in four (11%) and psychogenic dizziness in one patient (3%). No patient responded positively to the cervical torsion test or showed significant stenosis of vertebral arteries. (5) Conclusions: Despite the high prevalence of vertigo in patients with DCM, the aetiology in all cases could be attributed to causes outside cervical spine and related nerve structures, thus confirming the assumption that CV is over-diagnosed.

Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients

(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix–Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients’ psychological status.

Hypertension and Dizziness: is there a Relation?

One of the most frequent complaints of patients with hypertension (HT) is dizziness. Dizziness is understood as a variety of subjective sensations that patients define as “dizziness” – a sense of instability when walking, the illusion of rotation of surrounding objects, the feeling of approaching fainting, the inability to concentrate, and “fog” in the head. Experts share the systemic dizziness (vertigo) and non-systemic. The causes of vertigo in most cases are diseases of the inner ear (Meniere's disease, benign paroxysmal positional vertigo [BPPV], vestibular neuronitis. The most common form of dizziness is psychogenic dizziness. In the vast majority of cases, HT is not the cause of dizziness. The most common cause of vestibular (systemic) dizziness in patients with HT, as in the general population, is BPPV, and the most common cause of non-systemic dizziness is psychogenic dizziness. Among other causes of dizziness in patients with HT should be kept in mind too fast and/or intensive lowering of blood pressure, rhythm and conduction disorders, orthostatic hypotension (especially in elderly and senile patients in the presence of concomitant diabetes).

Case 95: Fluctuating Psychogenic Dizziness

Autonomic testing with cerebral blood flow velocity monitoring can be useful to evaluate psychogenic dizziness.