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[Vertigo of vascular origin]
1Services des urgences cérébro-vasculaires, hôpital de la Salpêtrière, Paris.
The concept of vascular origin in vertigo and equilibrium disorders is only a pragmatic clinical tool used to initiate and direct complex, complementary clinical investigation to determine the location (peripheral, central or mixed), the pathophysiological mechanisms and the multiple etiologies of the vestibular disorder. The concept includes focal and systemic ischemic processes and haemorrhagic processes of the posterior fossa. If the vertigo is associated with central neurological signs, the method can lead to certain diagnosis. If such signs are not detected by neurological screening of all the intra-axial signs of the vertebrobasilar regions, the diagnosis is uncertain clinical. Screening associated CT scan and MRI is more reliable than neuro-otological quantification. The major diagnostic difficulty involves TIA. Vertebrobasilar appears to be more heterogeneous than carotid ischemia. Schematic distinction is possible to differentiate thrombo-embolic from hemodynamic TIA. It is based on methodic clinical analysis and complementary investigations that are of unequal value.
The concept of vascular origin in vertigo and equilibrium disorders is only a pragmatic clinical tool used to initiate and direct complex, complementary clinical investigation to determine the location (peripheral, central or mixed), the pathophysiological mechanisms and the multiple etiologies of the vestibular disorder. The concept includes focal and systemic ischemic processes and haemorrhagic processes of the posterior fossa. If the vertigo is associated with central neurological signs, the method can lead to certain diagnosis. If such signs are not detected by neurological screening of all the intra-axial signs of the vertebrobasilar regions, the diagnosis is uncertain clinical. Screening associated CT scan and MRI is more reliable than neuro-otological quantification. The major diagnostic difficulty involves TIA. Vertebrobasilar appears to be more heterogeneous than carotid ischemia. Schematic distinction is possible to differentiate thrombo-embolic from hemodynamic TIA. It is based on methodic clinical analysis and complementary investigations that are of unequal value.