Baloh and Honrubia's Clinical Neurophysiology of the Vestibular System

Robert W. Baloh, MD, FAAN is Director of the Neuro-Ontology program in the Department of Neurology at the Reed Neurological Institute, University of California, Los Angeles in Los Angeles, CA. Kevin A. Kerber, MD, is an Assistant Professor in the Department of Neurology at the University of Michigan Health Systems. Dr. Kerber joined the UM faculty in 2005, and currently directs the Department of Neurology Dizziness Clinic. Dr. Kerber's research and clinical interests center on the presentation of dizziness, which include a number of disorders that typically involve the cerebellum, brain stem, or peripheral vestibular structures. His previous research with Dr. Baloh led to important discoveries about balance disorders in the elderly, inherited and sporadic ataxia syndromes, and oculomotor physiology. Dr. Kerber's current research focus is using health services research approaches to optimize patient care and health care utilization for dizziness presentations.

PART 1 ANATOMY AND PHYSIOLOGY OF THE VESTIBULAR SYSTEM
1. OVERVIEW OF THE VESTIBULAR SYSTEM ANATOMY AND PHYSIOLOGY
PERIPHERAL VESTIBULAR RECEPTORS
CENTRAL VESTIBULAR PATHWAYS
VESTIBULAR REFLEXES
MOTION PERCEPTION AND ORIENTATION
PATHOPHYSIOLOGY OF VESTIBULAR SYMPTOMS
CENTRAL COMPENSATION FOR VESTIBULAR LESIONS
SUMMARY

2. THE PERIPHERAL VESTIBULAR SYSTEM
TEMPORAL BONE
INNER EAR (LABYRINTH)
THE HAIR CELL
THE INNER EAR VESTIBULAR RECEPTORS
PRIMARY VESTIBULAR NEURONS
EFFERENT VESTIBULAR NEURONS

3. THE CENTRAL VESTIBULAR SYSTEM
VESTIBULAR NUCLEI
VESTIBULO-OCULAR REFLEXES
CERVICO-OCULAR REFLEXES
VISUAL-VESTIBULAR INTERACTION
VESTIBULOSPINAL REFLEXES
SUBJECTIVE VESTIBULAR SENSATION

4. EPIDEMIOLOGY OF DIZZINESS
SPECIFIC DISORDERS
BURDEN ON PATIENTS
HEALTH CARE UTILIZATION
SUMMARY

PART 2 EVALUATION OF THE DIZZY PATIENT

5. THE HISTORY OF THE DIZZY PATIENT
VERTIGO
NEAR-FAINT DIZZINESS
PATHOPHYSIOLOGIC DIZZINESS (CHRONIC SUBJECTIVE DIZZINESS)
DRUG-INDUCED DIZZINESS
HYPOGLYCEMIA
DISEQUILIBRIUM
OCULAR DIZZINESS
MULTISENSORY DIZZINESS
PHYSIOLOGIC DIZZINESS
SUMMARY: DISTINGUISHING BETWEEN VESTIBULAR AND NONVESTIBULAR TYPES OF DIZZINESS

6. BEDSIDE EXAMINATION OF THE VESTIBULAR SYSTEM
EXAMINATION OF THE EAR
TESTS OF VESTIBULOSPINAL REFLEXES
TESTS OF VESTIBULO-OCULAR REFLEXES
TESTS FOR PATHOLOGIC NYSTAGMUS
TYPES OF PATHOLOGIC NYSTAGMUS
OTHER OCULAR OSCILLATIONS
OCULAR TILT REACTION

7. LABORATORY EXAMINATIONS OF THE VESTIBULAR SYSTEM
NYSTAGMOGRAPHY
ROTATIONAL TESTING OF VESTIBULO-OCULAR REFLEXES
VISUAL-VESTIBULAR INTERACTION
TESTS OF OTOLITH-OCULAR REFLEXES
VESTIBULOSPINAL TESTING
VESTIBULAR-EVOKED POTENTIALS

8. CLINICAL EVALUATION OF HEARING
TYPES OF HEARING DISORDERS
BEDSIDE TESTS OF HEARING
BEHAVIORAL AUDIOMETRY
IMPEDANCE AUDIOMETRY
TYMPANOMETRY
AUDITORY-EVOKED RESPONSES
GENERATING POTENTIALS
TEST METHODOLOGY
RESULTS IN PATIENTS
CENTRAL AUDITORY SPEECH TESTS
SUMMARY OF AUDITORY TEST RESULTS

PART 3 DIAGNOSIS AND MANAGEMENT OF COMMON NEUROTOLOGIC DISORDERS
9. INFECTIOUS DISEASES
ACUTE OTITIS MEDIA AND OTOMASTOIDITIS
CHRONIC MASTOIDITIS AND CHOLESTEATOMA
BACTERIAL LABYRINTHITIS
PETROSITIS
INTRACRANIAL EXTENSION OF EAR INFECTIONS
MALIGNANT EXTERNAL OTITIS
VIRAL INFECTIONS OF THE INNER EAR
SYPHILITIS INFECTIONS OF THE EAR
TUBERCULOSIS AND MYCOTIC INFECTIONS OF THE INNER EAR

10. BENIGN POSITIONAL VERTIGO
HISTORICAL BACKGROUND
CAUSES OF BPV
POSTERIOR CANAL VARIANT OF BENIGN POSITIONAL VERTIGO
OTHER VARIANTS OF BENIGN POSITIONAL VERTIGO

11. ENDOLYMPHATIC HYDROPS (MENIERE'S SYNDROME)
BACKGROUND
OCCURRENCE
CLINICAL FEATURES
PATHOPHYSIOLOGY
ANIMAL MODELS
ETIOLOGY
DIAGNOSIS
MANAGEMENT

12. MIGRAINE
BACKGROUND
CLINICAL FEATURES
PATHOPHYSIOLOGY
DIAGNOSIS
MANAGEMENT

13. IMMUNE-MEDIATED DISEASES
AUTOIMMUNE INNER EAR DISEASE
PARANEOPLASTIC IMMUNE DISORDERS
MULTIPLE SCLEROSIS

14. VASCULAR DISORDERS
VERTEBROBASILAR ISCHEMIA
INTRALABYRINTHINE HEMORRHAGE
HEMORRHAGE INTO THE BRAIN STEM AND CEREBELLUM
VASCULAR COMPRESSION SYNDROMES

15. TUMORS
TUMORS OF THE MIDDLE EAR AND TEMPORAL BONE
TUMORS OF THE INTERNAL AUDITORY CANAL AND CEREBELLOPONTINE ANGLE
BRAIN TUMORS

16. TRAUMA
TRAUMA TO THE TEMPORAL BONE
PERILYMPH FISTULA
SEMICIRCULAR CANAL DEHISCENCE SYNDROME
BRAIN TRAUMA

17. TOXIC/METABOLIC DISORDERS
DIZZINESS AND SYSTEMIC METABOLIC DISORDERS
METABOLIC DISORDERS OF THE TEMPORAL BONE
OTOTOXINS
NEUROTOXINS

18. DEVELOPMENTAL AND GENETIC DISORDERS
THE INNER EAR
DISORDERS OF THE CRANIAL VERTEBRAL JUNCTION
INHERITED SPINOCEREBELLAR ATAXIA SYNDROMES

PART 4 SYMPTOMATIC TREATMENT OF VERTIGO

19. ANTIEMETIC AND ANTIVERTIGO DRUGS
VESTIBULAR SUPPRESSANTS
ANTIEMETIC DRUGS
SPECIFIC DRUGS

20. VESTIBULAR REHABILITATION
ADAPTIVE CONTROL OF NORMAL VESTIBULAR REFLEXES
MECHANISMS FOR COMPENSATION AFTER VESTIBULAR LOSS
SPECIAL CIRCUMSTANCES
CONTROLLED TRIALS OF VESTIBULAR EXERCISES
STRATEGY FOR DESIGNING VESTIBULAR EXERCISES
VESTIBULAR EXERCISES
FUTURE DIRECTIONS
APPENDIX 20-1. SAMPLE HOME EXERCISE PROGRAM

21. FUTURE DIRECTIONS

Index