Dizziness and vertigo syndromes viewed with a historical eye.

Seasickness, fear of heights, and adverse effects of alcohol were the major areas where descriptions of vertigo and dizziness were found in Roman, Greek, and Chinese texts from about 730 BC-600 AD. A few detailed accounts were suggestive of specific vestibular disorders such as Menière's attacks (Huangdi Neijing, the Yellow Thearch's Classic of Internal Medicine) or vestibular migraine (Aretaeus of Cappadocia). Further, the etymological and metaphorical meanings of the terms and their symptoms provide fascinating historical insights, e.g. Vespasian's feelings of dizzy exultations when becoming Emperor (69 AD) after Nero's suicide or the figurative meaning of German "Schwindel" (vertigo) derived from English "swindle" to express "financial fraud" in the Eighteenth century. The growth of knowledge of the vestibular system and its functions began primarily in the Nineteenth century. Erasmus Darwin, however, was ahead of his times. His work Zoonomia, or The Laws of Organic Life in 1794 described new dizziness syndromes and concepts of sensorimotor control including the mechanism of fear of heights as well as made early observations on positional alcohol vertigo. The latter is beautifully illustrated by the German poet and cartoonist Wilhelm Busch (1832-1908) who also documented the alleviating effect of the "morning after drink". The mechanism underlying positional alcohol vertigo, i.e., the differential gravities of alcohol and endolymph, was discovered later in the Nineteenth century. The first textbook on neurology (Lehrbuch der Nervenkrankheiten des Menschen, 1840) by Moritz Romberg contained general descriptions of signs and symptoms of various conditions having the key symptom of vertigo, but no definition of vestibular disorders. Our current knowledge of vestibular function and disorders dates back to the seminal work of a group of Nineteenth century scientists, e.g., Jan Evangelista Purkinje, Ernst Mach, Josef Breuer, Hermann Helmholtz, and Alexander Crum-Brown.

Cervical Vertigo: Historical Reviews and Advances.

Vertigo is one of the most common presentations in adult patients. Among the various causes of vertigo, so-called cervical vertigo is still a controversial entity. Cervical vertigo was first thought to be due to abnormal input from cervical sympathetic nerves based on the work of Barré and Liéou in 1928. Later studies found that cerebral blood flow is not influenced by sympathetic stimulation. Ryan and Cope in 1955 proposed that abnormal sensory information from the damaged joint receptors of upper cervical regions may be related to pathologies of vertigo of cervical origin. Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in tense neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness. Further studies are needed to illustrate the complex pathophysiologic mechanisms of cervical vertigo and to better understand and manage this perplexing entity.

[Characteristics of acupoint selection of acupuncture-moxibustion for vertigo in history: a data mining research].

The data mining technique is adopted to analyze characteristics and rules of acupoint and meridian selection of acupuncture-moxibustion for treatment of vertigo at different time periods in the ancient. The data is collected from literature regarding acupuncture-moxibustion from the pre-Qin period to the end of Qing Dynasty, so as to establish a clinical literature database of ancient acupuncture-moxibustion for treatment of vertigo. Data mining method is applied to analyze the commonly used meridians, acupoints and special acupoints in different dynasties, also possible rules are explored. Totally 82 pieces of prescription of acupuncture-moxibustion for treatment of vertigo are included. In the history the leading selection of acupoitns are Fengchi (GB 20), Hegu (LI 4), Shangxing (GV 23) and Jiexi (ST 41) while that of meridians are mainly three yang meridians of foot and the Governor Vessel, especially the acupoints on the Bladder Meridian of foot yangming had the highest utilization rate, accounting for 23.04%. The acupoint selection is characterized by special acupoint, accounting for 80.6%, among which the crossing points are the most common choice. Distal-proximal acupoints combination is the most frequent method. The results indicate that the ancient acupuncture-moxibustion for treatment of vertigo focused on acupoints in the yang meridians, and the specific acupoints play an essential role in prescription; also the principle of syndrome differentiation and selecting acupoints along the meridians could be seen.

[Study on rules of acupoints selection for vertigo in ancient acupuncture].

The characteristics of selection and matching acupoint and application rules of meridians in ancient acupuncture literature for vertigo were explored. The data were collected from literature regarding acupuncture for vertigo from the pre-Qin period to Qing dynasty and then database was established. Frequency statistics method and comparison of support degree were applied to analyze and explore application rules of acupoints and meridians, while association rules in data mining was used to extract combinations of acupoints. As a result, for treatment of vertigo, according to frequency of use and support degree, generally the most selected acupoints, in turn, were Fengchi (GB 20), Shangxing (GV 23), Yanggu (SI 5), Jiexi (ST 41), Zulinqi (GB 41) and Shenting (GV 24), etc.; the most methods for matching acupoint were combination of adjacent acupoints, combination of same-meridian acupoints, combination of the superior-inferior acupoints, combination of yang-meridian and yang-meridian acupoints and combination of child-mother meridians acupoints; the most selected meridians were bladder meridian of foot-taiyang, gallbladder meridian of foot-shaoyang and governor vessel. Compared between the ancient and modern literature, it was found out that the ancient and modern clinic has same points in selection of acupoint-meridian and matching acupoints methods. However, the use of Yanggu (SI 5), Jiexi (ST 41) and Feiyang (BL 58) as well as combination of child-mother meridians acupoints were less seen in modern clinic, which could provide new reference.

The experiments behind the Tullio phenomenon.

BACKGROUND: Professor Pietro Tullio was a director at the Laboratory of Experimental Physiology in Bologna during the early twentieth century. His experimental studies resulted in the description of the Tullio phenomenon, which is characterised by sound-induced vertigo and/or eye movements. OBJECTIVE: The experimental studies behind his contribution to vestibular physiology are described within this paper, as are some of the further developments that have been made.

Historical Aspects of Inner Ear Anatomy and Biology that Underlie the Design of Hearing and Balance Prosthetic Devices.

This review presents some of the major historical events that advanced the body of knowledge of the anatomy of the inner ear and its sensory receptors as well as the biology of these receptors that underlies the sensory functions of hearing and balance. This knowledge base of the inner ear's structure/function has been an essential factor for the design and construction of prosthetic devices to aid patients with deficits in their senses of hearing and balance. Prosthetic devices are now available for severely hearing impaired and deaf patients to restore hearing and are known as cochlear implants and auditory brain stem implants. A prosthetic device for patients with balance disorders is being perfected and is in an animal model testing phase with another prosthetic device for controlling intractable dizziness in Meniere's patients currently being evaluated in clinical testing. None of this would have been possible without the pioneering studies and discoveries of the investigators mentioned in this review and with the work of many other talented investigators to numerous to be covered in this review.

A curiosity in the history of sciences: the words "megrim" and "migraine".

Vertigo has been described by medical doctors since Antiquity, but the condition is not limited to human medicine. It is also interesting to note that vertigo-related disorders were long only mentioned in the descriptions of migraine: however, in the Corpus Hippocraticum, a pain with vertigo (odunê kai skotodiniê) was not considered as hemicrania; in Aretaeus medical text, scotoma was clearly another disease than heterocraniê; although there could be metastases between them (pain could be followed by vertigo, as Boerhaave translated from Greek to Latin); Caelius Aurelianus, Ibn Zuhr of Seville, Isma'il Jurjani considered vertigo as a separate entity from "migraine" as well. One had to wait until 1831 for "ophthalmic migraine" (Piorry) to take systematically this disorder into account (to more or less causally relate it to migraine), and 1988 for the International Headache Society to acknowledge vertigo as a symptom of aura in "basilar migraine," which was given the better name of basilar-type migraine in 2004. From this point of view, veterinary medicine presents a particular interest because, for centuries, diseases mainly affecting horses - called in French "migraine," "mal de tête" (headache), "douleur de tête" (head pain), or in English "megrim(s)," "head-ach," "pain," and for which it is not self-evident that they are in any way related with the conditions that bear these names in humans - have been connected with vestibular impairments. Whatever is the relationship between the human and animal pathologies and, although it is impossible to interpret animal signs (abnormal behavior) with human symptoms (complaints), some impressive descriptions, written by Anglo-Saxon authors for the most part, seem to have played a significant role in the history of migraine. The purpose is to examine how a word in its English veterinary medical sense could have influenced French medical descriptions.

[Medical history of Martin Luther].

Martin Luther achieved great success in religious reformation, though he was said to have suffered from many kinds of diseases during his lifetime. Unfortunately, however, his medical history has never been reported in Japan. Since the second half of his thirties, he was suffering from severe constipation, causing hemorrhoids and anal prolapse. At the beginning of his forties he had vertigo, tinnitis and headaches, which were the signs of chronic purlent otitis media and ended in left otorrhea and pyorrhea of the left mastoiditis. Nearly at the same time, he started to suffer from anginal pain, colic and dysuria due to urinary uric acid stones, gout and left leg ulcer, which were all caused by metabolic syndromes. The last 1/3 of his life was affected by the shadow of diseases, and his religious activities were frequently disturbed. He died from myocardial infarction at the age 63, in February 1546.

The Darwins and Wells: from revolution to evolution.

In the biography of his grandfather (Erasmus Darwin), Charles Darwin hinted that his father (Robert Darwin) had received parental assistance in conducting and writing his medical thesis (which concerned afterimages). The experiments also involved visual vertigo, and they were elaborated by the senior Darwin in his Zoonomia, published in 1794. Erasmus Darwin's interpretation was in terms of trying to pursue peripheral afterimages formed during rotation; it was at variance with one published two years earlier by William Charles Wells, who had investigated the visual consequences of body rotation when the body is subsequently still. Wells penned two retorts to the Darwins' theory; although they were not accepted by Erasmus, he did devise a human centrifuge, models of which were employed in later studies of vertigo. Wells's ideas on evolution were expressed in a paper delivered to the Royal Society (in 1813) but not published in its Transactions. Commenting on the case of a white woman, part of whose skin was black, he proposed a process of change that was akin to natural selection. His ideas were acknowledged by Charles Darwin in the fourth edition of On the Origin of Species.

Hallaran's circulating swing.

William Saunders Hallaran (c.1765-1825) was physician superintendent at the County and City of Cork Lunatic Asylum for 40 years, where he distinguished between mental insanity and organic (systemic) delirium. In treatment he used emetics and purgatives, digitalis and opium, the shower bath and exercise, and argued that patients should be saved from 'unavoidable sloth' by mental as well as manual occupation. However, it is as an exponent of the circulating swing, proposed by Erasmus Darwin and used by Joseph Cox, that he is remembered. His best results were achieved, as he recorded in An Enquiry in 1810, by inducing sleep in mania of recent onset, but perhaps his most enduring observation was that some of his patients enjoyed the rotatory experience, and he had enough sense to allow the use of the swing as a mode of amusement.

Chapter 32: sensory and perceptual disorders.

Disorders of perception can be examined appropriately only after the normal operations of the senses have been appreciated. There was a long descriptive history of perceptual phenomena before theories were formed and experiments were performed. The phases through which phenomena pass in progressing from description to dissection are charted. The first stage is a description of phenomena, followed by attempts to incorporate them into the body of extant theory. Finally, the phenomena are accepted and utilized to gain more insights into the functioning of the senses and of the brain. In many cases, the phenomena have been described in the distant past, and no clear origin can be determined. In others, there is an obvious break with the past and a phenomenon is described and investigated for the first time. For most of the history of the senses, interest was usually restricted to illusions or oddities of experience: the commonplace characteristics of constant perception were ignored. These factors are taken into consideration with regard to the classification of the senses, phantom limbs, vertigo, and developmental disorders. Imposing some order on the senses was a long but necessary precursor to examining their disorders. Once order was established then a range of fascinating phenomena came to light (particularly in vision). Others that had long been known became open to more detailed scrutiny.

La Mettrie's soul: vertigo, fever, massacre, and The Natural History.

La Mettrie's materialist and monistic philosophy is that of a military doctor, knowing what dysentery did to his own mind, watching his regiment destroyed at Fontenoy, running French field hospitals in Flanders. He learned brain science in the injuries of his fellows. He knew pain and that man's main positive drive was sex. He despised the prudish hypocrisies of feeble materialists like Diderot and Voltaire. His brutal military life and his hedonism made him the most coherent monist against Cartesian dualism. His study of vertigo is sound clinical medicine, which well accords with one trend in today's medical practice.

Benign paroxysmal vertigo, and Bárány's caloric reactions.

The Nobel Prize winner Robert Bárány described benign positional vertigo and related it to the otoliths in 1921. Dix and Hallpike further elucidated this clinically distinctive, common disorder in 1952. The displacement of otoliths from the utricle or saccule into one of the semicircular canals later proved to be the underlying mechanism, described by Schuknecht and utilised therapeutically by Semont and Epley.

The history of neuro-otology. A personal perspective.

I realize I practiced otology and neuro-otology during a golden era, but I have to admit that I didn't appreciate how important it was until I sat down to outline this article. How fortunate I was to have lived and practiced during these developing years of neuro-otology. How fortunate to have worked with the likes of Howard and William House, James Sheehy, James Crabtree, David Austin, and John Shea. How fortunate to have had the opportunity to teach residents and fellows in association with my private practice. So I envy the young otologist-neuro-otologist and the future you have. You stand on the brink of great discoveries. And like my generation, you stand on the shoulders of giants. Good luck.

Betahistine in the treatment of vertigo. History and clinical implications of recent pharmacological researches.

A short profile of betahistine and its activity in treatment of Menière's disease and other forms of peripheral vertigo is presented. The clinical efficacy of betahistine is documented by a series of more than twenty controlled clinical studies, performed in the years 1966-2000. Basic researches initially proved that bethaistine acts trough a vasodilating action on inner ear and cerebral blood flow (Suga and Snow, 1969; Martinez, 1972). In the following years this activity was confirmed using the modern laser doppler flowmetry technique (Laurikainen et al, 1998). Further recent studies proved that betahistine acts on the central vestibular histaminergic system as a weak H1 agonist and a strong H3 antagonist (Arrang et al., 1985), improving the process of vestibular compensation (Tighilet et al., 1995) as well as on peripheral labyrinthine receptors, reducing the spontaneous firing rate but not the activity induced by thermal or mechanical stimulation (Botta et al., 1998). More than forty years after its discovery, this series of studies carried out in the second half of the 90s leads to the conclusion that betahistine is a drug which maintains its scientific interest and its pharmacological potential in the treatment of vertigo.

Benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo has been recognized as the most common vestibular disorder. The evolution of its pathophysiological concepts has led to current therapeutic strategies that have made it the most successfully treatable cause of vertigo.