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Book Reviews |

Vestibular Disorders: A Case Study Approach to Diagnosis and Treatment

Arch Neurol. 2010;67(12):1533. doi:10.1001/archneurol.2010.294.
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Most neurologists would probably still agree with W. B. Matthews, who, in 1963, wrote:

And yet, as Furman, et al point out in their Preface to this very useful volume,

Those of us who actually enjoy evaluating patients with dizziness would probably agree that there are 2 important prerequisites for effectively managing such individuals: a clear understanding of important principles of vestibular physiology and experience in recognizing the disorders that lead to this complaint. This book addresses both of these needs and draws on the combined experience of a neurologist (Furman), an otolaryngologist (Cass), and a physical therapist (Whitney). In an introductory section of 8 chapters, the reader can find a nice summary of the principles of vestibular anatomy and physiology and their application to the history, examination, and management of dizziness (including psychiatric dizziness). The main part of the book, however, and its main strength consists of a series of 61 case histories, which are informative and cover most aspects of the field. The first 6 are “tutorial cases,” to systematically summarize the core issues: peripheral unilateral vestibular imbalance, central vestibular disorders, impaired vestibular recovery, loss of vestibular function, psychiatric dizziness, and dizziness in the emergency department setting. Each case is arranged in the repeated form of information (eg, history, examination, or test results, such as magnetic resonance imaging), a question to the reader, and an informative answer. Each case is well documented with tables, figures, and teaching points that summarize the important information, as well as references to useful journal articles. The following chapters cover most of the conditions causing patients to present to neurologists with the complaint of dizziness, with useful reviews of benign paroxysmal positional vertigo, migraine, Ménière syndrome, disequilibrium of old age, recurrent vertigo in children, and dizziness following head injury. An especially valuable section deals with multiple diagnoses, such as benign paroxysmal positional vertigo and anxiety disorder or migraine and Ménière syndrome. Later chapters deal with less common, but important, issues such as treatment of late-stage Ménière disease with intratympanic gentamicin or surgical measures, orthostatic tremor, and drop attacks. The final 6 chapters address some thorny issues in an informed manner, such as the entity of cervical vertigo and whether patients can drive with dizziness.


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