Vertigo

Migrainous vertigo (MV) is accepted as a common cause of episodic vertigo. The peripheral or central vestibular localization of the deficit as well as the pathophysiology is unclear. This prospective study was designed to assess the clinical features of MV and to search for the localization of the vestibular pathology. Thirty-five patients with MV, 20 patients with migraine and 20 healthy volunteers were studied. Comprehensive neurotological tests were performed between attacks. None of the normal controls or the patients with migraine had ocular motor deficits or caloric test abnormalities. Three patients in the MV group showed saccadic pursuit (8.6%), in one of whom saccadic hypometria was also present. Caloric test results revealed unilateral caloric hypofunction in seven patients (20%). Static posturography results revealed increased sway velocity when the eyes were closed or the platform was distorted in patients with MV. These findings during the symptom-free period revealed that peripheral vestibular dysfunction was more common than a central deficit. ᮀ Migraine, migrainous vertigo, posturography, video-oculography Neşe Çelebisoy MD,

Background: The occurrence of migraine and vertigo is common in the general population. Migraine vertigo is challenging and has several common symptoms with inner ear pathologies like Endolymphatic Hydropse. This paper presents a review of recent findings about symptoms, test results, pathophysiology and differential diagnosis. Methods: The present study is a review of 35 papers in the field of vestibular migraine. They were selected by searching the keywords vertigo, dizziness, migraine, treatment and rehabilitation in Pubmed, ScienceDirect, Scopus and Google Scholar search engines. Only human studies were included. Results: Recent findings have proposed several common pathophysiologies between vestibular system and migraine including spreading depression in the basilar artery, vasospasm in the internal auditory artery, involvement of the connection with locus coeruleus, dorsal raphe nucleus, disorder of multisensory integration and channelopathy. Conclusion: For the differential diagnosis of vestibular migraine, it appears that comprehensive case history as well as clinical testing and patient follow-up, are the best combination. In addition, it has been proven that vestibular rehabilitation is beneficial to patients with vestibular migraine.

Benign paroxysmal positional vertigo (BPPV) is a high-prevalence vestibular end-organ disorder caused by the detachment of utricular otoconia which float in the posterior or lateral semicircular canal. In the majority of cases the etiology of BPPV is unknown and it may follow viral infection, vascular disorders or head trauma. BPPV may be recurrent, with some authors demonstrating a correlation between recurrence and female gender. We report herein on ten cases (out of 289 diagnoses of BPPV) of recurrent idiopathic BPPV, occurring in healthy women receiving oral contraceptive treatment, which ceased after treatment suspension. It has been hypothesized that the impaired water and electrolyte balance, the variations of endolymphatic pH and the impairment of glucose or lipid metabolism induced by oral contraceptive treatment may cause otoconial degeneration and subsequent otoconia detachment and BPPV. The rarity of the finding (10/289) could account for the poor attention paid to the hormonal pathogenesis of BPPV.

We carried out a retrospective survey of 25 years of clinical experience with the use of clonazepam as a vestibular and tinnitus suppressant in the pharmacological treatment of vestibular or cochleovestibular disorders due to different causes. We reviewed the medical records of 3,357 outpatients treated with a 0.5 or 1.0-mg daily dosage of oral clonazepam during 60-180 days. Complete or substantial control of vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light or mild drowsiness, depression, nightmares, or lowering of libido, reported by 16.9% of the patients as adverse side effects, tended to subside with continued therapy. We concluded that clonazepam is a very useful and safe drug for the symptomatic treatment of patients suffering from cochleovestibular disorders.

Vestibular neuritis is the most common cause of acute spontaneous vertigo. Vestibular neuritis is ascribed to acute unilateral loss of vestibular function, probably due to reactivation of herpes simplex virus in the vestibular ganglia. The diagnostic hallmarks of vestibular neuritis are spontaneous horizontal-torsional nystagmus beating away from the lesion side, abnormal head impulse test for the involved semicircular canals, ipsilesional caloric paresis, decreased responses of vestibular-evoked myogenic potentials during stimulation of the affected ear, and unsteadiness with a falling tendency toward the lesion side. Vestibular neuritis preferentially involves the superior vestibular labyrinth and its afferents. Accordingly, the function of the posterior semicircular canal and saccule, which constitute the inferior vestibular labyrinth, is mostly spared in vestibular neuritis. However, because the rare subtype of inferior vestibular neuritis lacks the typical features of vestibula...

Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses.Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study.The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5 ± 3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix–Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n = 17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n = 6; 12%), benign paroxysmal positional vertigo (n = 6; 12%), psychogenic vertigo (n = 5; 10%), epilepsy (n = 3; 6%), metabolic disorders (n = 3; 6%), vestibular neuritis (n = 2; 4%), Meniere's disease (n = 1; 2%), perilymphatic fistula (n = 1; 2%), amblyopia (n = 1; 2%), and unclassifiable (n = 5; 10%).Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.

Au Nord-Cameroun, comme dans l'ensemble des zones semi-arides africaines, les agriculteurs ont depuis longtemps défriché les savanes arborées pour les mettre en culture. Ce défrichement a souvent été sélectif : les cultivateurs ont conservé les arbres peu gênants ou utiles. Par la suite, ils ont parfois enrichi ces systèmes agroforestiers en introduisant de nouvelles espèces ou en conservant une partie de la régénération naturelle. En fonction de la composition du peuplement arboré d'origine, des conditions écologiques, des savoirs et des besoins des populations et de leur environnement socio-économique, différents types de parcs arborés se sont ainsi construits, dont les plus connus sont les parcs à faidherbia (Faidherbia albida) et les parcs à karité (Vitellaria paradoxa). De 1950 à 1990, les Administrations forestières ont surtout cherché à protéger les arbres situés dans les champs et dans les formations naturelles, en interdisant la coupe. Ces politiques de conservation, si elles ont permis le maintien des parcs, ont eu aussi un effet contreproductif car les agriculteurs se sont sentis dépossédés de la gestion de leur patrimoine, si bien qu'ils n'ont plus conservé ou planté de jeunes arbres et que les peuplements ont vieilli. Des actions de recherche-développement montrent qu'il est possible de re-dynamiser la gestion de ces systèmes agroforestiers, à l'échelle des exploitations agricoles et à celle des communautés villageoises. Cela suppose une sécurisation des droits sur l'arbre qui peut passer par la création de "forêts communautaires", instituées par la loi forestière camerounaise de 1994, et pouvant inclure le parc agroforestier villageois. Dès lors, il y a transfert de propriété des arbres de l'Etat vers la communauté, ce qui ouvre le droit à leur exploitation dans le respect d'un plan de gestion. Afin de préparer cette démarche, les pratiques traditionnelles raisonnées de gestion des arbres ont été décrites ; une méthode d'émondage conciliant conservation et développement du tronc, production de feuilles, de fruits et de bois a été testée, ce qui a permis de mesurer le stockage de biomasse sur pieds et la production annuelle. Une réflexion sur la combinaison des techniques de gestion dans le cadre d'un aménagement des parcs a été conduite et des pistes pour des modèles d'aménagement simplifié des parcs ont été proposées. Ces aménagements permettraient de concilier notamment la production par émondage de bois de feu, ressource rare, et la pérennité des parcs. Cette démarche recueille aussi l'appui des hauts responsables de l'Administration et des organismes de recherche et de développement, malgré la réticence d'une partie des agents administratifs de base qui craignent d'y perdre leur pouvoir et leurs avantages. Ces enjeux de changements demandent donc à être soutenus et devraient trouver un appui favorable auprès du Fonds pour l'Environnement Mondial puisqu'ils rentrent dans le champ de plusieurs conventions internationales : convention pour la diversité biologique, convention sur le changement climatique, convention de lutte contre la désertification. Mots clés : parc arboré, agroforesterie, aménagement forestier, Faidherbia albida, ressource ligneuse, traitement, gestion durable, Cameroun. Abstract: In North-Cameroon, as in all semi-arid regions of Africa, farmers have for a long time been clearing wooded savannah land in order to cultivate it. This clearing has often been selective, in that farmers have retained the trees that cause them least trouble and those that are useful. They sometimes enrich these agroforestry systems later by introducing new species or by conserving part of the natural regeneration. Various types of wooded parklands have been created, depending on the composition of the original tree population, the ecological conditions, the know-how and requirements of the local populations and their socio-economic environment. The most well known are the faidherbia parklands (Faidherbia albida) and the shea parklands (Vitellaria paradoxa). Between 1950 and 1990, the forestry Department had a policy to protect trees located in fields and in indigenous forests, by prohibiting the cutting of trees. Although these conservation policies were effective in preserving the parklands, they also had a counterproductive effect because farmers felt they were being deprived of the right to manage their tree heritage, with the result that they stopped conserving and planting young trees and the stands aged. Research, development and teaching activities conducted in North-Cameroon by various projects have shown that it is possible to revitalise the management of these agroforestry systems at the farm and village community level. The rights of stakeholders to exploit these trees need to be secured, and this could involve the creation of "community forests", provided for in the Cameroonian forestry law of VertigO -La revue en sciences de l'environnement, Vol6 no2, septembre 2005