ENG may show reduced caloric response in the affected ear, but is often normal. The audiogram is the most useful diagnostic test, usually showing sensorineural loss at the low frequencies. The hearing loss fluctuates in the early stage of the disease, and progresses as time goes on, often to a moderately severe level. The disease is usually unilateral, but may become bilateral in 10–15% of cases. Patients with typical Ménière’s disease have recurring attacks of vertigo, sensorineural hearing loss, tinnitus, and, sometimes, a fluctuating fullness in the ear. Wanna, in Encyclopedia of Neuroscience, 2009 Vertigo Lasting Minutes to HoursĮpisodic vertigo is usually due to endolymphatic hydrops, distension of the inner ear membranes, and may be primary (Ménière’s disease) or secondary (otic syphilis, delayed endolymphatic hydrops, Cogan’s disease, recurrent vestibulopathy). Benign paroxysmal vertigo is a diagnosis of exclusion and has a benign, self-limited course. Many children with benign paroxysmal vertigo have a family history of migraine headaches and are thought to be at high risk for migraine headaches later in life. Benign paroxysmal vertigo is thought to be a migraine equivalent 33 (see Chapter 41, Headaches). Between episodes, these children are asymptomatic. 32 Symptoms are expected to recur and may occur daily or monthly, but typically resolve within 2 years of the onset of symptoms. Episodes are brief, typically lasting between 1 and 5 minutes. The physical examination often reveals no abnormalities except the horizontal nystagmus that occurs during an attack of vertigo. Throughout the episode, consciousness is preserved. The verbal child may describe a spinning sensation. These may manifest as the child falling or refusing to walk or sit. This disorder is characterized by a sudden onset of unsteadiness, pallor, and anxiety. Kriwanek MD, in Pediatric Emergency Medicine, 2008 Benign Paroxysmal Vertigoīenign paroxysmal vertigo typically develops in children between 1 and 3 years of age. Due to the brevity of the attacks and the benign course of these disorders, pharmacologic therapy is rarely necessary ( Langhagen et al., 2014). Paroxysmal torticollis and periodic vomiting (other migraine equivalents) may also present with vertigo and dizziness, thus mimicking BPV. Later in life, typical migraine may develop there is often a family history of migraine with aura. Typical BPV attacks begin in small children before the age of 4 and disappear spontaneously at the age of 8–10 years ( Basser, 1964 Jahn et al., 2011). The frequency of attacks can vary widely ( Headache Classification Committee of the International Headache Society (IHS), 2013). Children do not show any signs of vestibular dysfunction between attacks. Cochlear symptoms (hearing loss or tinnitus) are not typical. In some patients headache, nausea, and vomiting accompany the attack. Attacks are often associated with nystagmus and postural imbalance. BPV is characterized by recurrent brief attacks of vertigo (seconds to minutes), occurring without warning and resolving spontaneously in otherwise healthy children. The major difference between BPV of childhood and vestibular migraine is the lack of a migraine history in affected patients. The current migraine classification, however, does not contain any age criterion. This is the most common cause of episodic vertigo in children between 2 and 8 years of age ( Jahn et al., 2011 Langhagen et al., 2014). Jahn, in Handbook of Clinical Neurology, 2016 Benign paroxysmal vertigo of childhoodīPV is one of the episodic syndromes that may be associated with migraine and is often regarded as a precursor of migraine ( Batuecas-Caletrio et al., 2013 Gelfand, 2013 Prasad, 2014 ).
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