Many descriptions are found in old Chinese medical documents about symptoms and medicines that correspond to “vertigo/dizziness” in modern medicine. Kampo is a traditional Japanese medicine. It is based on traditional Chinese medicine, but it has been developed into a unique form in Japan. Kampo formulas have spread to the extent that 80% or more of Japanese doctors prescribe them in their daily medical practice. The Kampo formula to be used for treatment is determined by the manner of diagnosis based on the pathophysiology concept of Kampo medicine. In Kampo medicine, a disease is evaluated from the perspective of yin-yang, deficiency-excess, cold-heat, exterior-interior, qi-blood-water, five viscera and location of disease. The concrete process of selecting a Kampo formula is to diagnose first, and this is mainly based on disorders in qi, blood or water. Then, whether it is yin or yang has to be identified. In case of yang, a Kampo formula with a vector directed toward yin is to be used for the treatment, and in case of yin, a medicine with a vector directed toward yang should be used for the treatment. In the end, deficiency or excess of local qi, blood or water needs to be diagnosed. The fundamental rule of treatment is that, when qi-blood-water is in a state of deficiency, it is to be supplemented, and when qi-blood-water is in a state of excess, it is to be depleted. There are Kampo formulas that serve as curative medicines for vertigo/dizziness other than the already known formulas goreisan, hangebyakujutsutemmato and ryokeijutsukanto for this condition. Curative medicines for vertigo/dizziness are expected to increase in number, on the basis of the Kampo formula being examined according to traditional diagnostic approaches.
A 36 y.o. female visited the Miyoshi ENT Clinic, with symptoms including a headache, a sensation of dizziness and sudden vomiting that morning. She had to be transferred to a nearby Neurosurgical Hospital. Her symptom was recognized as a morning headache due to increased intracranial pressure (IICP). The CT and MRI examination revealed a cystic lesion in left cerebellar hemisphere and the digital subtraction angiography was then performed to detect the feeding artery. While under this examination, unfortunately, she had a convulsive attack. An urgent craniotomy was performed and cerebellar angioblastoma was diagnosed in the patient. We must always bear in mind the potential of such a serious condition when outpatients present at the clinic with general symptoms of dizziness, headache, and vomiting/nausea.
A 42-years-old woman who had dizziness for the previous 10 days visited our hospital. She had experienced epileptic attacks and suffered from repeated seizures. She was under treatment with 4 antiepileptic drugs (phenytoin, phenobarbital, valproate, and carbamazepine). Horizontal gaze-evoked nystagmus was observed. Blood tests and imaging examinations showed no abnormal findings. The blood concentrations of these antiepileptic drugs were at their therapeutic dose. However, the concentration of phenytoin and phenobarbital blood concentrations were slightly high. Following adjustment of the drug dosage for epilepsy, her dizziness and abnormal eye movement improved. Antiepileptic drugs are usually known to cause drug-induced dizziness and eye movement abnormalities. The reduction of dosage or withdrawal of these drugs is often very effective. However, certain patients show symptoms of drug toxicity for drugs at their therapeutic dose. Phenobarbital occasionally induces an increase in phenytoin's toxicity. Although phenobarbital treatment is known to cause dizziness and nystagmus in children, very few reports indicate that phenobarbital causes similar symptoms in adults.
A diagnosis of neurofibromatosis type 1 (NF1) was clarified after Wallenberg syndrome in an 18-year-old female. The long segment of the right internal carotid artery was stenotic; however, the vertebral-basilar system was intact. Wallenberg syndrome was likely due to the vasculopathy caused by NF1. While ischemic attacks are not common in normal teenagers, they do occur in cases with NF1 because they have a high probability of both developmental abnormality of the vascular system and vasculopathy. We conclude that it is always necessary to take latent disease into consideration in a younger patient with symptoms of ischemic attack.
Fabry disease is an X-linked recessive disorder involving progressive lysosomal deposition of globotriaosylceramide (GL-3) in cells caused by a deficient activity of the enzyme α-galactosidase A (α-Gal A). Hearing loss, tinnitus, and dizziness are common symptoms in Fabry disease. We present herein on a case of Fabry disease in a 56-year-old man with bilateral hearing loss, tinnitus, and dizziness during walking. Rehabilitation therapy for adaptation of the vestibulo-ocular system was performed for dizziness during walking. The patient was examined by questioning, use of the visual analogue scale (VAS), and computerized dynamic posturography (Equitest). After 4 months of rehabilitation, VAS score and Equitest results improved. Rehabilitation therapy for adaptation of the vestibulo-ocular system may be effective for Fabry disease dizziness.
Abstract Childhood vertigo and disequilibrium are overlooked in many cases because children rarely complain of them. Childhood diseases and conditions differ among neonates, infants, and school children. Examination procedures are not similar to those for adults. In clinical practice, many children are brought to the Department of Pediatrics (Neurology) or the Department of Orthopedics with delayed gait, muscle hypotonia, or frequent falling-down. In this symposium, we review the diagnosis and pathogenesis of vertigo/disequilibrium during early childhood, focusing on rare diseases such as benign paroxysmal torticollis. Childhood vertigo is classified into 2 types: vertigo that children complain of (sensory disturbance) and disequilibrium-related balance abnormalities (motor control disturbance). Children aged 4 to 5 years can complain of vertigo. Rotatory vertigo is frequent. Younger children rarely complain of it. In those aged 2 to 3 years, their mothers become aware of gait disorder, frequent falling-down, or muscle hypotonia. As information obtained from asking children questions is limited, it is also necessary to interview their mothers and evaluate the motor development process. Concerning balancing dysfunction, as the central nervous system is under development, the peripheral static-sense system, myelination/maturation of the central nervous system, process of functional integration, and learning/acquisition of gross and fine motor skills at each age must be considered. During early childhood, brain tumors, especially cerebellar/brainstem tumors, cerebellitis, and acute cerebellar ataxia should be considered. In addition, the presence of congenital nystagmus must always be considered. As a type of vertigo specific to this period, childhood benign paroxysmal vertigo is frequent: rotatory vertigo initially occurs at 1 to 4 years of age, and attacks persisting for a few seconds to minutes repeatedly appear. The tendency to fall down is marked. The mechanism of migraine may be involved. This type of vertigo reflects ischemia of the vestibular nuclei involving the pons to medulla oblongata. In most cases, a spontaneous cure is achieved within a few months to years. For diagnosis, a detailed inquiry is conducted, and children's parents are requested to record their states during vertigo attacks using a home video camera. Benign paroxysmal torticollis has been recognized as a type of vertigo resembling migraine. This disease is rare, but many children are first taken to the Department of Orthopedics due to torticollis. Repeated paroxysmal torticollis appears at 1 to 5 years of age, and a tendency to fall down is observed. Ocular displacement and gait disorder are also noted. However, these symptoms resolve with development. This disease may reflect ischemia of the tegmentum mesencephali and cajal interstitial nucleus, which are adjacent to the uncertainty zone. The incidence of migraine-related vertigo, including dizziness, is reportedly 50 to 70%. In particular, childhood basilar artery-type migraine is observed in 1- to 10-year-old children. It causes astasia/gait disorder, nausea, vision disorder, occipital pain, and other neurologic symptoms. For the diagnosis of childhood vertigo/disequilibrium, it is important to conduct careful a follow-up of motor development, select diseases to be considered with respect to age, and understand their characteristics. Although examinations are difficult in many cases, various examinations should be combined, and the features of vertigo/disequilibrium must be analyzed based on the results of a parent inquiry and videotape records of attacks.
Background: The relationship of visual vestibular interaction with congenitally visual and hearing impairment in children has been discussed. The cochlear and vestibular organs are closely related anatomically and phylogenetically. Many studies have revealed the abnormal vestibular function and delayed motor development in the cases of severely hearing impaired children. Bilateral vestibular dysfunction may be manifested as the loss of postural control and the delay of development in gross motor function. In addition, congenitally blind children manifest delayed motor development due to the difficulties in space perception. Methods: The vestibular functions and gross motor development were assessed in 4 congenitally deafblind children. Of the 4 cases, one patient had congenital rubella syndrome and one had CHARGE syndrome. In all patients there was severe hearing loss with severe visual impairment. Results: Motor development in all cases was significantly delayed. None of the patients could stand up and walk by themselves until they were at least 2 years and 4 months old. The results of the rotational chair test in two patients showed no response. Conclusions: Because of loss of visual vestibular interaction, the gross motor development in all severe congenital deafblind cases was found to be delayed further than that in the cases with only congenital hearing impairment. Careful treatment and planning for rehabilitation or placement of a cochlear implant in deafblind children is needed to improve their quality of life.
Children with inner ear anomalies resulting in severe hearing impairment may show deficits in head control and independent walking. In the present study we examined the vestibular function in children with bilateral inner ear anomalies using a rotation test, and investigated the impact of the anomalies on motor development. Children with the Michel anomaly, which is characterized by a lack of inner ear differentiation bilaterally, are markedly slow in developing head control and independent walking. As muscle tonus is increased with the myelinization of motor neurons, independent walking becomes possible. On the other hand, children with severe inner ear anomalies, such as bilateral common cavity deformity and incomplete partition type I (Mondini deformity), show vestibular ocular reflex by the rotation test as they age, and normal independent walking and running become possible. These results demonstrate that, although children with inner ear anomalies may be slow in motor development in their infancy, their motor function increases to a normal level as they grow.
All organs are not fully developed in children. Children develop the ability to sit, stand and finally walk, and then continue to develop and learn how to balance in each posture. In the process of developing posture and equilibrium, children may experience disturbances of equilibrium such as dizziness. Meniere's disease and benign paroxysmal positional vertigo can occur in children and in adults, whereas benign paroxysmal vertigo of childhood is a cause of dizziness that occurs specifically in children. The pathologies of these illnesses are currently not well clarified, but they may be understood in the future as a new group of diseases. However, conducting an examination for dizziness in children is very difficult. Interviewing children with regard to their course of dizziness is problematic and it may be more useful to interview their parents. However, this requires parents to understand the symptoms of children through observation. In some cases, videotaping of the conditions of ocular nystagmus and gait of children may be needed. Continuous treatment of children is also difficult and recurrence of dizziness often occurs repeatedly in children. For these reasons, we suggest that it is essential to assess equilibrium in children.