Vertigo

Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, affects one in five people at some point during their lifetime, triggering the sudden feeling like one is moving or spinning when perfectly still. Early pieces of this medical puzzle appeared in the early 19th century in studies of the inner ear, yet the cause and cure for BPPV was not clearly understood until the late 20th century and it took a few more decades before this simple cure was accepted. Vertigo: Five Physician Scientists and the Quest for a Cure follows this centuries long trek. The book follows the key discoveries made by Prosper Meniere (1799-1862) who first recognized that vertigo could originate from the inner ear, Josef Breuer (1842-1925) who conducted groundbreaking research on the inner ear during his evenings at home after he spent his days working in a busy private medical practice, Robert Barany (1876-1936) who received the Nobel Prize for his early work on the inner ear, Charles Hallpike (1900-1979) who showed that BPPV originates from the inner ear, and Harold Schuknecht (1917-1996) who provided key observations on the mechanism of BPPV. Dr. Robert W. Baloh spins together a fascinating history using detailed interviews from those close to the key investigators and historical documents previously unavailable in the English language to provide a historical approach to understanding the vestibular system and with it a better understanding of vertigo itself.

Auteur

Robert W. Baloh, MD is a professor of Neurology and Head and Neck Surgery at UCLA who has written more than 300 research articles and several textbooks focusing on the vestibular system. His interest in the history of Neurotology dates back to a series of conversations with Raphael Lorente de Nó in the early 1970s.

Contenu

Preface Acknowledgments Chapter 1. Introduction The Inner Ear Dizziness, Vertigo and the Inner Ear What is Benign Paroxysmal Positional Vertigo (BPPV)? So Who Discovered the Cure? Section 1: Prosper Ménière (1799-1862) Chapter 2. Ménière recognizes that vertigo can originate from the inner ear What was known about the inner ear in the mid 19th century? First hint that the semicircular canals may be related to balance Ménière presents his findings in 1861 The first recorded case of Ménière's disease? More evidence that vertigo can originate for the inner ear Inconsistencies in Ménière's description of the young girl with vertigo Treatments for vertigo in mid 19th century Ménière 's comments trigger heated debate Chapter 3. Ménière, a man of many interests Ménière's academic career Ménière balances academic, patient and family activities Ménière's every day life Ménière's role in French society Section 2: Josef Breuer (1842-1925) Chapter 4. Breuer discovers how the balance portion of the inner ear works Eye movements and the semicircular canals The gravity sensing otolith organs Evolutionary development of the inner ear Mach and his psychophysical experiments Breuer and Mach work together to defend their theory Crum-Brown, the model maker Who contributed most to our current understanding of the vestibular system? Chapter 5. Breuer, the Renaissance man Upbringing and formative years Breuer's medical training Breuer chooses private practice over academic medicine Breuer, the family doctor Chapter 6. Breuer's experiments on the semicircular canals and otolith organs Studies on the semicircular canals Ewald's laws The Breuer-Von Cyon feud Studies on the otolith organs Overview of the inner ear sensory receptors Chapter 7. Breuer's contributions to psychiatry and philosophy Freud's early work in neuroanatomy Anna O. and the beginnings of psychoanalysis Breuer and Freud and "Studies in Hysteria" The friendship between Breuer and Freud dissolves Breuer's philosophical beliefs The final years Section 3: Robert Bárány (1876-1936) Chapter 8. Politzer's otology clinic and the discovery of the caloric test Politzer maneuver Teaching in Politzer's clinic Robert Bárány joins Politzer's clinic Bárány discovers the caloric test Chapter 9. Bárány's formative years and the conflict in Politzer's clinic Bárány's medical training Source of conflict in Politzer's clinic Accusations against Barany Chapter 10. The war years and Bárány's decision to leave Vienna Bárány receives the 1914 Nobel Prize in Medicine Formal charges against Bárány Nobel committee response Questions regarding Bárány's caloric theory Chapter 11. Bárány 's test battery and the first description of BPPV Romberg test Pastpointing test Bárány's syndrome First description of benign paroxysmal positional vertigo (BPPV) Chapter 12. Bárány 's life in Uppsala and his work with Lorente de Nó The brain and the neuronal theory Lorente de Nó and Bárány in Spain Lorente de Nó works on central vestibular pathways with Bárány Bárány's final years Section 4: Charles Hallpike (1900-1979) Chapter 13. Hallpike and the pathology of Ménière's disease Toynebee and early efforts to study pathology of the inner ear Wittmaack and his new technique for preparing temporal bones World-wide interest in Wittmaack's technique Hallpike and Cairns report on the pathology of Ménière 's syndrome Possible causes of Ménière's syndrome Yamakawa also describes the pathology of Ménière's syndrome Chapter 14. Hallpike's formative years The Indian connection Early education and dealing with Legg-Perthes disease Medical training Personal life Hallpike the inventor Appointment at Queen Square Hallpike's colleagues at Queen Square War years Queen Square neurotology clinic Chapter 15. Hallpike's caloric test Preparing the water Hallpike's caloric chart Meaning of a Directional Preponderance Importance of tonic signals originating from the inner ears Controversy regarding the affect of cortical lesions Chapter 16. Hallpike defines the syndrome of BPPV Clinical features of BPPV Confusion regarding the direction of the positional nystagmus Strong evidence for an inner ear origin Pathology of BPPV Final years Section 5: Harold Schuknecht (1917-1996) Chapter 17. Schuknecht and his breakthrough on BPPV John Lindsay and University of Chicago otology clinic Schuknecht begins his residency at the University of Chicago Schuknecht's formative years Schuknecht becomes interested in BPPV Search for the cause of BPPV Schuknecht suggests a new mechanism for BPPV Chapter 18. Schuknecht's temporal bone bank in Boston More temporal bone specimens from patients with BPPV The cupulolithiasis theory Schuknecht was not the first to propose the cupulolithiasis theory A key question-which way does the cupula deviate? How to explain the stereotypical nystagmus Problems with the cupulolithiais theory Chapter 19. Schuknecht's crusade against myths in otology Surgical treatments of Ménière's disease Viral neurolabyrinthitis Questionable surgical procedures The final years Section 6: The pieces of the puzzle come together Chapter 20. Semont and Epley maneuvers Treatments based on the cupulolithiasis theory Semont's maneuver Cupulolithiasis vs. canalithiasis Epley 's maneuver Visualization of the free floating otolith debri Chapter 21. Evolution of treatment maneuvers for BPPV Epley's maneuver Semont's maneuver Features shared by the maneuvers Variations on the theme Horizontal canal BPPV Chapter 22. Summary and Future Directions Difficulties facing early investigators Unanswered questions Can patients do the maneuvers on their own? Glossary