Grab some popcorn and welcome to CONTINUUM at the movies! In this issue of Continuum: Lifelong Learning in Neurology, we introduce an exciting new feature. For the first time, readers can access video links illustrating cases or points discussed in the text with the simple click of a mouse—a feature available either online or via your iPad. This feature will allow future CONTINUUM authors, too, to provide the immediacy of videos to help you consolidate your understanding of the subject matter. This new tool, which will be used whenever possible from issue to issue, will replace the former CDs, which were produced with only one issue annually. We’re excited about this enhancement to your learning experience and welcome your comments.
This issue, devoted to neuro-otology, focuses on one of the most common neurologic scenarios—the dizzy patient. Guest Editor Dr Kevin Kerber has chosen to kick off the issue by acknowledging some of his personal heroes in the field, Drs Robert Baloh, Michael Halmagyi, and David Zee. In turn these physicians pay homage to some of neuro-otology’s pioneers, such as Prosper Me´nie`re, Josef Breuer, and Robert Ba´ra´ny. Next, Dr David Newman-Toker, in his article “Symptoms and Signs of Neuro-otologic Disorders,” provides a novel way of classifying dizziness as well as describing important techniques for use at the bedside in making a proper diagnosis of the dizzy patient.
Dr Kerber himself then discusses “Acute Constant Dizziness,” with particular attention to acute vestibular neuritis but with clues to recognizing the more serious situation of an ischemic etiology. Benign paroxysmal positional vertigo (BPPV) is an extremely common ailment for which specific and rather simple bedside maneuvers offer marked symptom relief. Dr Terry Fife offers a thorough discussion of this subject in his article “Positional Dizziness.” Episodic vertigo can also be of longer duration than that of BPPV, and Dr Thomas Lempert describes such conditions as Me´nie`re syndrome, as well as other causes, in his article “Recurrent Spontaneous Attacks of Dizziness.”
Sensitivity to motion often coexists in patients who experience migraine headaches, which themselves may manifest as vertigo, as discussed by Drs Joseph Furman and Dawn Marcus. Perhaps the most vexing type of dizzy patient is the one with no objective findings but persistent complaints. Dr Jeffrey Staab addresses this puzzling situation in his article entitled “Chronic Subjective Dizziness.” In the final review article, Dr Yoon-Hee Cha discusses some of the less common neuro-otologic disorders, including the enigmatic mal de débarquement syndrome, in which patients continue to perceive self-motion after having disembarked from a moving vessel. In addition, she addresses bilateral vestibulopathy, particularly due to antibiotic toxicity, cerebellar ataxia, and vestibular schwannomas.
Imagine your terror if you knew that the pilot of the commercial airline in which you were a passenger suddenly experienced an attack of incapacitating vertigo! In the Ethical Perspectives section, Drs Matthew Kirschen and Joel Friedlander describe a situation in which a pilot seeks medical attention for episodic vertigo and wishes to avoid informing the aviation authorities of his condition. In the Practice section, Dr Fife returns to discuss a situation in which anxiety complicates the condition of a dizzy patient, emphasizing proper physician communication with the patient. The importance of the subject of BPPV and our ability to treat it is further highlighted in “Coding for Vestibular Tests,” in which Dr Fife assures that physicians will be able to bill appropriately for vestibular testing and treatment, as well as by an article on “Guidelines in Practice: Therapies for Benign Paroxysmal Positional Vertigo,” in which Dr Anant Shenoy illustrates the appropriate clinical use of an evidence-based guideline developed by the American Academy of Neurology.
Completion of the challenging, clinically based multiple-choice questions, developed for this issue by Drs Ronnie Bergen and Eduardo Benarroch, will not only enrich your educational experience, but also help you earn up to 10 AMA PRA Category 1 CreditsTM for continuing medical education (CME). You can add another 2 credits by working through the Patient Management Problem, emphasizing a patient with subacute dizziness—yet another contribution by Dr Kerber.
The dizzy patient represents an extremely common problem. Thanks to Dr Kerber and his collaborators it is now much less likely to be a problem for you.
—Aaron E. Miller, MD