DÄ internationalArchive43/2008Diagnosis and Treatment of Vertigo and Dizziness: The Epley Maneuver

Correspondence

Diagnosis and Treatment of Vertigo and Dizziness: The Epley Maneuver

Dtsch Arztebl Int 2008; 105(43): 747. DOI: 10.3238/arztebl.2008.0747a

Kinze, S

LNSLNS I read your review article on vertigo and dizziness with great interest. In my practice, I am often confronted with this problem on an emergency basis, because many patients with acute dizziness are sent by their ENT specialist for an urgent consultation with a neurologist. Kindly allow me to make the following remarks:

First of all, you continue to recommend the Semont maneuver for the treatment of benign paroxysmal positioning vertigo. Prof. Lempert and his collaborators, however, showed a few years ago that the modified Epley maneuver is more effective (1). Your recommendation contradicts your own statement in your publications of last year, which I have not, unfortunately, been able to read personally. Could you please comment on this matter?

Moreover, a paper by Lee et al. (2) has caused me some concern in the discussion with my ENT colleagues. It is stated there that as many as 10% of all cerebellar infarctions (usually involving the territory of the posterior inferior cerebellar artery, "PICA") present with clinical features suggesting vestibular neuritis. Because of the finite capacity of MRI scanners, it does not seem possible, in practice, to obtain an MRI scan of the head of every vertiginous patient. I could not, however, retrieve any clinical criteria from this article that would permit a reliable differential diagnosis without the aid of ancillary studies. Is an adequately reliable differential diagnosis possible, in your opinion, on clinical grounds alone?

Finally, I would like to thank you for your article, which was both highly illustrative and of practical relevance. Thanks in the name of my colleagues as well.
DOI: 10.3238/arztebl.2008.747a


Dr. med. Stephan Kinze
Unfallkrankenhaus Berlin
Klinik für Neurologie
mit Stroke Unit und Frührehabilitation
Warener Str. 7
12683 Berlin, Germany
stkbln@gmx.net
1.
Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T: Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs. Epley procedure. Neurology 2004; 63(1): 150–2. MEDLINE
2.
Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, Baloh RW: Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 2006; 67(7): 1178–83. MEDLINE
1. Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T: Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs. Epley procedure. Neurology 2004; 63(1): 150–2. MEDLINE
2. Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, Baloh RW: Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 2006; 67(7): 1178–83. MEDLINE