Key topics in balance function testing are addressed, such as indications for testing, what these tests can and cannot reveal, as well as the basics on how these tests are performed and interpreted.
The pediatric section begins with a review of vestibular embryology and physiology and moves toward a comprehensive discussion of methods – both bedside and in the vestibular lab - to evaluate the child with dizziness, or “clumsiness,” concluding with an exploration of the differential diagnosis of dizziness and relevant findings. Dizziness in the adolescent points to migraine headache as a common cause, enumerates treatment strategies for migraine-associated vertigo, and offers guidelines for when to image the adolescent with dizziness.
Adult dizziness is more a compilation of the relevant diagnoses, but the section starts with dizziness that can affect young adults – especially members of our Armed Forces fighting overseas – traumatic brain injury/blast injury. This content also has relevance for patients in
motor vehicle accidents and head injury patients. Medicolegal aspects of evaluation and management of dizzy patients are succinctly
covered in “Evaluation of Dizziness in the Litigating Patient.” The final chapter in this section, “Other Causes of Dizziness,” provides
a very thorough overview of unusual causes of dizziness in the adult population.
Dizziness associated with advancing age is quite common and often multifactorial, as is highlighted in the chapter “Dizziness in the
Elderly.” A comprehensive review of the posterior cerebral circulation, transient ischemic attacks, and posterior circulation stroke is
presented in the chapter, “Vertebrobasilar Insufficiency.” No coverage of dizziness in the elderly is complete without an exposition of polypharmacy and medication effects. Other common diagnoses of dizziness in the elderly are thoughtfully reviewed along with a survey
of new and old techniques to rehabilitate the older patient with dizziness or disequilibrium.
Patients presenting with dizziness can harbor serious, if not life-threatening, conditions such as stroke, brain abscess, or severe chronic
ear disease. At the end of several articles, the reader will find a relevant table – What Not To Miss – a list of clinically significant signs
and symptoms not to ignore, or conditions (differential diagnosis) that may masquerade as that discussed in the chapter but critically
important that the practitioner should not overlook in the evaluation of the patient. Many articles in this edition start with a clinical
scenario so the reader can recognize common presenting symptoms, demographic features, and factors in the medical history that
will aid in making the diagnosis.
Assessment chapters focus on ocular motility testing, positional/positioning testing, caloric testing, rotational testing, computerized dynamic posturography, and vestibular evoked potentials. Treatment chapters examine nonmedical, medical, and surgical treatments of dizziness and vertigo, vestibular rehabilitation, and assessment of and intervention for risk of falls. Additionally, this text provides background information on the vestibular and ocular motor systems with corresponding sample cases.
New topics addressed in this edition include:Development of the vestibular systemCentral compensation following peripheral vestibular system impairmentVideo head impulse test (vHIT)Biomechanics and physiology of balanceElectrocochleography (ECochG)Pediatric vestibular system and balance assessmentEffects of age on the vestibular and balance systems
An added bonus to the second edition is the video clips, associated with the text.