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Vertigo. Its Multisensory Syndromes

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    Vertigo. Its Multisensory Syndromes, 2nd Edition. By thomas brand. (Pp 503, US$249.00). Published by Springer, Heidelberg, 1999. ISBN 3-540-19934-9.

    Thomas Brandt's masterpiece Vertigoremains mandatory reading for clinicians interested in this symptom. The basic sciences underpinning vertigo, together with the clinical diagnosis and management of all disorders characterised by this symptom, are comprehensively reported, extensively referenced, and beautifully illustrated. The book is detailed and exhaustive in its subject matter. The only area which seems to have been omitted in any depth is that of the cardiovascular causes of dizziness and vertigo.

    There is a broad introduction covering the pathophysiology underpinning vestibular disorders, vertigo, dizziness, and falls; the clinical assessment of such a patient; and the management strategies, together with their rationale. Common disorders—namely, acute peripheral vestibular episodes and Menière's disease, are well covered, in addition to the rarer disorders such as the Ramsay-Hunt syndrome, bilateral vestibular failure, and autoimmune disorders associated with vestibular dysfunction. In this section, the author's views on certain disorders are reflected particularly in the chapters on vestibular neuritis and peripheral vestibular paroxysmia, and it is regrettable that a little more of the controversy in the literature is not highlighted. The management section of the Menière's chapter shows little in depth discussion of trials of medication which, with one or two exceptions, have been extremely poorly designed. Moreover, the incidence of hearing loss in association with gentamicin installation is not emphasised, although surgical treatments in general are well discussed. The chapter on perilymph fistulas is somewhat didactic in the light of many surgeons' views that the validity of this entity must be questioned.

    Central vestibular disorders are clearly explained with an excellent and easily understood introduction outlining vestibular disorders. in the different planes of action of the vestibulo-ocular reflex. Illustrations and diagrams make some difficult concepts accessible. There are two particularly valuable chapters on the vestibular cortex and its disorders and vestibular epilepsy, both areas that to date have been poorly investigated and understood, but which represent areas ripe for research with new imaging techniques and perceptual tests Brandt then moves on to positional and positioning vertigo which is possibly the “topic of the decade” for those with a vestibular interest, as the introduction of particle repositioning manoeuvres has provided a “cure” for a very common vestibular syndrome although, intriguingly, the underlying science of exactly what we are doing with these procedures remains elusive. The pathophysiology and mechanisms of such disorders are clearly defined and atypical presentations discussed.

    Vascular aetiologies are considered in chapters on stroke and the often overlooked association of migraine and vertigo. The overlap between migraine and familial periodic ataxia is also considered, although this latter entity is fully discussed in a separate chapter. For the general clinician interested in vertiginous disorders there are chapters of particular value, including trauma, vertigo in childhood and in elderly people, and vertigo in association with drugs. For the more specialised clinician, the chapter on visual vertigo is of particular value. Importantly, the relation between psychiatric disorders and vertigo is explored in one of the final chapters.

    Overall, this is an excellent readable book that can be dipped into for those requiring information about a particular patient, or read cover to cover for those who wish to extend their knowledge in vestibular medicine. Inevitably, in a single author book, idiosyncratic views are revealed, but, that aside, I cannot recommend this book too highly to guide both the experienced and the uninitiated through the minefield of pitfalls that beset the clinician trying to sort out vertigo. The limiting factor will be the price but certainly it is a book, and possibly the book, which should be in every library used by neurologists and otologists.

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