The Rational Clinical Examination
David L. Simel, Drummond Rennie
Vertigo
David A. Froehling, Marc D. Silverstein, David N. Mohr, Charles W. Beatty
Origins of Nystagmus
Topics Discussed:
pathologic nystagmus, vertigo
Excerpt:
"The maintenance of the sense of balance and spatial orientation
depends on input from the vestibular labyrinth, visual system, and
proprioceptive nerves arising from tendons, muscles, and joints.9 The
vestibular nuclei, which are in the medulla and lower pons, receive
input from the vestibular labyrinth via the vestibular branch of
cranial nerve VIII and from the cerebellum.10 The
vestibular nuclei, in turn, send efferent fibers to the cerebellum,
the medial longitudinal fasciculus, and the vestibulospinal tract.
Visceral manifestations of vertigo (such as nausea and vomiting)
are caused by altered input to the dorsal nucleus of the vagus nerve
from the vestibular nuclei. Conscious awareness of vertigo resides
in the superior temporal gyrus of the cerebral cortex9 and
involves a mismatch between input to the cerebral cortex from the
visual, proprioceptive, and vestibular systems.11 Lesions
in various locations, including the inner ear, brain stem, and cerebellum,
may all be manifested as vertigo...."
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