[Vertigo--their typical clinical pictures from neurosurgical standpoints]

Although vertigo is commonly encountered in many clinical disciplines, meticulous analysis of the onset and nature of the vertigo is essential not to overlook the vertigo of brainstem or cerebral origin without any other neurological signs and symptoms. Three central vestibular projection pathways and their possible functional roles in relation to vertigo were briefly discussed. To illustrate the characteristic clinical features of vertigo of various origins, 16 typical cases were presented and discussed. Their etiology include Ménière's disease, vertigo of neurovascular compression, sudden deafness, acoustic neurinoma, Rumsay-Hunt's syndrome, BPPN (benign paroxysmal positioning nystagmus), vestibular neuronitis, brainstem infarct, MPPN (malignant persistent positional nystagmus) with brainstem midline hemorrhage, cerebellar hemorrhage followed by orthostatic hypotension, vertiginous epilepsy, TIA from MCA stenosis, intracerebral hemorrhage from a mycotic aneurysm, falx meningioma, subclavian steal phenomenon, and cervical spondylosis. It is wrong and quite dangerous to believe that vertigo of CNS origin should be associated with some definite neurological signs and symptoms and to diagnose the vertigo to be of peripheral origin merely based on normal findings of CT scan and angiography. Recently advanced detailed neurootological investigations are quite helpful in differentiating vertigo of various origins, but may totally overlook the vertigo of serious CNS pathology. For "solo vertigo," the key point is first differentiate BPPN and vertibular neuronitis from others after which careful neurosurgical and neurootological evaluation should be pursued regardless of presence or absence of concomitant neurological findings.