Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management, 2nd Edition

Weber PC. Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management. 2nd ed. Thieme; 2016; 248 pp; 167 ill; $129.99

Cover of Weber

The second edition of Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management, authored and edited by Dr. Peter C. Weber, takes on the challenging task of summarizing the diagnosis, pathophysiology, and treatment of the various etiologies of vertigo and disequilibrium in a mere 230 pages. Although vertigo and disequilibrium are relatively common complaints, their work-up is a daunting and intimidating task for most physicians. Dr. Weber describes the vestibular system as a poorly understood “black box” because of limited exposure to its anatomy and pathophysiology during medical school and residency training. This book successfully addresses common misunderstandings and lays out a systematic approach to the assessment, diagnosis, and treatment of various etiologies accounting for vertigo and disequilibrium. The chapters are short, concise, clear, well-written, well-organized, and supplemented with helpful figures and tables, as well as updated references for more in-depth reading. The book ends with an appendix of practical frequently asked questions, which would be of use to both physicians and patients alike. The supplemental online videos, which have been expanded from the first edition, provide examples of common procedures, treatment maneuvers, physical examination techniques, and signs.

The first 6 chapters lay the groundwork for the rest of the book by succinctly summarizing important aspects of the medical history, physical examination, computerized testing, radiology work-up, anatomy, physiology, and laboratory testing in patients with vertigo and disequilibrium. At the beginning of Chapter 1, Dr. Weber stresses the paramount importance of a medical history: “The diagnosis of a patient with vertigo or dizziness can almost always be ascertained 80% of the time by taking an accurate history.” In the very first paragraph of the book, the author also offers words of encouragement to the novice, stating that “a physician who can master the three most common vestibular diagnoses—benign paroxysmal vertigo, vestibular neuronitis, and Meniere disease—can manage 80% of all vestibular complaints.” This makes the task of opening the “black box” that is the vestibular system appear less daunting and puts the reader at ease. Chapter 4 provides an excellent overview of the various inner ear imaging modalities, as well as their strengths, weaknesses, and appropriateness in particular clinical settings. The chapter also highlights key imaging examples of temporal bone trauma, inflammatory disorders, congenital anomalies, benign and malignant tumors, vascular etiologies of vertigo and disequilibrium, acquired CNS pathologies, and osseous lesions of the temporal bone. All images within the chapter (approximately 90) are of excellent resolution and are supplemented with concise and easy-to-follow labels and legends. One may argue that this chapter is more clear and informative than the majority of available neuroradiology journal reviews on the topic. It is an excellent supplement for otolaryngology and radiology residents, neuroradiology and neurotology fellows, and even seasoned neurotologists and neuroradiologists.

Chapters 7–18 provide a detailed overview of common (e.g., Meniere’s disease, benign paroxysmal positional vertigo, and labyrinthitis) and rare (e.g., superior semicircular canal dehiscence, autoimmune vestibular dysfunction, perilymph fistulas, mal de debarquement syndrome, ototoxicity, Cogan syndrome, etc.) causes of vertigo and disequilibrium and expand on the groundwork laid in the first 6 chapters. They offer clinical, imaging, and treatment pearls that many neuroradiologists may find useful for making their interpretations more clinically relevant. For example, the common teaching in neuroradiology is that Meniere’s disease is a clinical diagnosis. Imaging studies in patients with suspected Meniere’s are primarily aimed at excluding retrocochlear pathology and are usually negative. Chapter 7 acknowledges this paradigm, but also points out that some patients with Meniere’s disease may have subtle imaging findings supportive of the presumed clinical diagnosis, such as narrowing of the vestibular aqueduct on high-resolution CT of the temporal bone or enlargement of the scala media on MR imaging. Chapters 14 and 15 discuss pathologies specific to the pediatric and elderly populations, while Chapter 16 covers the entity of vestibular migraine—a relatively common but overlooked cause of vertigo. Chapters 19–21 cover the neuropharmacology of vertigo and disequilibrium, vestibular rehabilitation, and implantable vestibular devices.

This book is an excellent resource for neurotologists, neuroradiologists, internists, family practitioners, neurologists, cardiologists, audiologists, and physical therapists.  Because of space limitations, this is by no means a comprehensive review of the pathophysiology of the vestibular system. However, the book provides an excellent and sufficiently detailed overview with a plethora of references for more in-depth reading. Dr. Weber’s and his many contributors’ mastery of their field is evidenced by the book’s exquisite organization, succinct summary of all pertinent topics, and ability to provide a logical and understandable roadmap to the work-up of vertigo and disequilibrium.

Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management, 2nd Edition
Book Reviews • American Journal of Neuroradiology

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