Autonomic nervous system disturbance as etiological background of vertigo and dizziness

In order to investigate whether dysautonomia lies behind vertigo and/or dizziness in the neurotological clinic, an electrocardiogram (ECG) R-peak to R-peak test (R-R test) along with the Schellong test were simultaneously performed in 136 subjects. ECG data were analyzed by a microcomputer, and R-R intervals were calculated. In a dynamic test performed during postural changes from the supine to the standing position, there were 23 of 55 (41.8%) positive test results in patients with peripheral vestibular disorders, 28 of 51 (54.9%) with central vestibular disorders, and 15 of 18 (83.3%) with spinocerebellar degeneration. In a static test with the patient in the standing position, there were 13 of 55 (29.1%) positive test results in patients with peripheral vestibular disorders, 16 of 51 with central vestibular disorders, and 8 of 18 (44.4%) with spinocerebellar degeneration. A significant difference in the positive rate between spinocerebellar degeneration and both other central and peripheral vestibular disorders in the dynamic test was observed. These results also demonstrated that dysautonomia upon postural changes might play an important role in the development of vertigo and dizziness and that it is provoked by disorders of the autoregulatory mechanisms of the cerebral blood flow. This test is presumed to be excellent for detecting dysautonomia by virtue of being non-invasive, having good reproducibility and being readily available to quantitative evaluation by using a microcomputer.