Ménière Syndrome, Benign Paroxysmal Positional Vertigo, and Vestibular Neuritis



Ménière Syndrome, Benign Paroxysmal Positional Vertigo, and Vestibular Neuritis


Ian S. Storper



INTRODUCTION

Three of the most common causes of peripheral vertigo are Ménière syndrome, benign paroxysmal positional vertigo, and vestibular neuritis. Each syndrome has its own distinct type of vertigo. The purpose of this chapter is to explain the clinical presentation and current treatment principles of each syndrome to aid the clinician in diagnosis and management.


MÉNIÈRE DISEASE

Although Ménière disease was described over 140 years ago, little about it is understood. The condition is often progressive; with medical and surgical treatment options, however, disability may be averted or ameliorated. A recent study using health claims data from 60 million patients in the United States reports prevalence as 190 per 100,000 with a female-to-male ratio of 1.89:1 [Level 1].1 The prevalence increases with age.

This disease was first reported by Prosper Ménière in Paris in 1861 [Level 1].13 As described, patients typically suffered recurrent attacks of vertigo lasting from hours to days. Coincident with the attacks were episodes of unilateral hearing loss and roaring tinnitus. At first, the hearing loss and tinnitus occurred only with the attacks, but as the disease progressed, they became permanent. In 1943, Cawthorne added a fourth symptom: fullness in the affected ear. Table 59.1 lists the clinical features of Ménière disease. Although the cause of Ménière disease still remains unknown, it was postulated by Knapp in 1871 that symptoms were caused by dilatation of the endolymphatic compartment of the inner ear during attacks and renormalization afterward [Level 1].11 This idea is still widely accepted, as the vast majority of patients respond to sodium management.



Jul 27, 2016 | Posted by in NEUROLOGY | Comments Off on Ménière Syndrome, Benign Paroxysmal Positional Vertigo, and Vestibular Neuritis
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