The second edition of Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management is a valuable resource for clinicians. This book provides a wealth of practical information towards the understanding of the physiological basis underlying vertigo and guides the clinical reader through the diagnostic approach and appropriate therapeutic management options. The book is not overly technical and is suitable for a multidisciplinary audience that includes experienced physicians in neurology and otolaryngology, as well as those in less specialized areas. With 21 chapters in 226 pages, topics highlight salient points succinctly in an easy to read format. Vertigo as a patient complaint can challenge clinicians particularly if symptoms are described in vague terms and abnormal findings are not readily identifiable on routine physical examination. Chapters 1 through 4 provide an excellent framework towards taking the history and examining patients with vestibular symptoms, followed by giving apt explanation of the appropriate diagnostic use of computerized and radiological tests. The role for laboratory testing, while not as commonly utilized in the workup of vestibular patients, is well summarized in Chapter 7, and provides key reminders to include autoimmune disease, syphilis, Lymes Disease, and other less common diseases within the differential diagnosis. The differential diagnosis of vertigo and disequilibrium is broad, and the book reviews both common as well as uncommon etiologies underlying vestibular pathology. An excellent overview of benign paroxysmal positional vertigo is given by Dr Judith White in which key studies of the efficacy of canalith repositioning maneuvers are reviewed and videos are provided demonstrating the nystagmus associated with the disorder. The discussion provided in Chapter 16 on vestibular migraine is also appreciated, as despite benign paroxysmal positional vertigo being fairly commonplace, it frequently remains undiagnosed and suboptimally treated. That triptans are contraindicated in the management of patients with basilar migraine was not mentioned but would have been an appropriate cautionary note to include in this chapter. Chapters covering labyrinthitis, superior semicircular canal dehiscence, allergic, autonomic, and congenital causes of dizziness are well discussed; however, notably missing are chapters covering acoustic neuroma and anxiety disorder, with the former being essential to rule out in cases of unilateral vestibular hypofunction. Chronic subjective dizziness is briefly discussed in Chapter 20, which covers medications used for treatment of acute and chronic vertigo, but given the prevalence of chronic subjective dizziness with or without dizziness associated with anxiety, a more thorough discussion of anxiety-associated dizziness would have been appreciated, particularly one providing guidelines towards the approach and treatment of these patients. View largeDownload slide View largeDownload slide A very thorough discussion of Meniere's disease that includes an up-to-date consideration of pathophysiology, approach, and treatments is provided by Dr Sujana Chandrasekhar and is arguably one of the best chapters of the book. The frontier of management options for Meniere's disease using a surgically implantable device is a welcome addition by Dr Justin Golub that expands on recent research and potential treatment options that may become mainstream in the not-too-distant future. Chapter 18 importantly discusses key diagnostic approaches to differentiating central causes of vertigo such as stroke from peripheral vestibular disorders. This review includes a discussion of the HINTS exam described in recent studies, which comprises testing for an abnormal head impulse test, nystagmus, and skew to differentiate central from peripheral vestibular disorders. With vertigo and dizziness being a common complaint for geriatric patients, points made in Chapter 14 on Aging and Dizziness are particularly helpful to clinicians with its emphasis on the importance of initiating practical treatment interventions. Benign paroxysmal positional vertigo is most common in the elderly and since canalith positioning maneuvers are typically straightforward to implement, undertreating this disorder that can otherwise give rise to falls and extended morbidity is remiss. Vestibular rehabilitation is the mainstay of treatment of many vestibular disorders. Chapter 20 summarizes research and treatment guidelines that support efficacy of vestibular rehabilitation and provides a reference regarding appropriate referrals and treatment expectations. Medications are less frequently indicated for vertigo and disequilibrium, although Chapter 19 provides highly useful guidelines for when they may be most appropriate and high yield. The last chapter of the book on implantable vestibular devices stands out with its review of exciting research and clinical progress in recent years. The author well-outlines the history of the research in this area, clarifies differentiations in device designs, and provides updated information on early human clinical trials. Overall, this book is well written by numerous subject matter experts and provides a worthy review of the clinical approach and management of patients with vertigo and disequilibrium. Both classic and recent articles are well cited and thus serve as a helpful resource for physicians, allied health care providers, residents, and students who encounter patients with these symptoms. As such, the book meets its mark in providing a timely and well-summarized reference in the care of a patient population for which too few references are otherwise available. Disclosure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Copyright © 2017 by the Congress of Neurological Surgeons
Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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