It is well known that stress induces or aggravates vertigo/dizziness and that dizzy patients have often comorbid psychiatric diseases such as anxiety and depression. Dizziness-associated psychiatric disease is not idiopathic but is usually an adjustment disorder to stressful life events. Stress can be divided into two groups: physical and psychological stress. Psychological stress activates the amygdala, which is a center for emotion discriminating discomfort from comfort, followed by hypothalamic-pituitary-adrenal axis (HPA axis) activation. In dizzy patients, sensory mismatch signals arising from multimodal sensory systems, including the vestibular, visual, and proprioceptive systems, would also activate the amygdala. Together with psychological stress, sensory mismatch signals judged as discomfort signals by the amygdala may drive the HPA axis and bring about dizziness. This scheme can well explain why psychological stress induces or aggravates vertigo and dizziness. In treating dizzy patients with stress-induced anxiety and depression, it is important to take care of comorbid psychiatric diseases and the cause of stress regardless of the existence or absence of organic vestibular diseases.
We devised a method to calculate the rotatory angle in the Foulage test. The middle of both thenar eminences, the pivot of the body rotation, is fixed at 5 cm forward from the center of the stabilometer. A mean deviation of the last 10 seconds period (X, Y) in the 60 seconds examination is almost the whole body's center of gravity of the end. The rotatory angle (θ) can be calculated as follows. θ=tan-1(-X)/(5-Y) The calculated angles (θ) of 43 vertigo patients rotated over 10 degrees were correlated very strongly with the angles measured manually with a protractor (y=0.84x+0.39 R2=0.87).
A body of patients who develop episodic vertigo concurrently with migraine is being increasingly reported. This clinical condition has recently proposed as migraine-associated vertigo, which is considered to have a common pathophysiology with migraine. We treated 14 patients who fulfilled the diagnostic criteria for migraine-associated vertigo. All patients were treated with oral medications, rizatriptan for headache, and the combination of lomerizine and valproic acid for migraine-associated vertigo. We evaluated the effect of the therapy based on the combination of frequency of episodic headaches and improvement in vertigo with the dizziness handicap inventory (DHI) scores. In 67% of the patients the frequency of episodic headaches was reduced, and 50% of the patients had significant improvement in their DHI scores. Although the pathophysiology of migraine-associated vertigo remains unclear, some patients with migraine are considered to develop vertigo due to disorders in the central or peripheral vestibular systems. Clinically, we should always keep migraine-associated vertigo in mind for the patients suffering from both vertigo and headache together.
The diagnosis was investigated in 1,339 patients, who had visited the Department of Neurotology in Kitasato University East Hospital (KUEH) during a recent18 month period from July 2014 to December 2015. The patients in our department were classified into 5 groups by diagnosis; peripheral vestibular disorders (51.2%), diseases of the central nervous system (1.4%), generalized disorders (3.8%), diagnosis from symptom (41.7%), and unknown (1.9%). The number of the patients suffering from Meniere's disease, who had been treated with our original therapy, increased remarkably. On the other hand, diseases of the central nervous system decreased. Although generalized disorders showed no change, psychogenic vertigo increased. Under the legacy system in Kitasato University Hospital (KUH), it took a long time for patients to visit the neurotological clinic from the otorhinolaryngological clinic and impaired early treatment. Openning our department enabled early treatment. This is a merit. On the other hand, it was difficult for patients to consult the Departments of Neurology, Neurosurgery or Emergency and Critical Care Medicine that treat diseases of the central nervous system, because they are in KUH which is distant from KUEH. This is a demerit. Therefore, we found both merits and demerits of our department based on the results of this investigation.