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PART III  A SINGLE BOUT OF DIZZINESS THAT LASTS FOR DAYS THEN GRADUALLY IMPROVES This page intentionally left blank Vestibular Neuritis You notice a gradual buildup in vertigo over several minutes. You then develop generalized sweating and severe nausea followed by vomiting. You try to walk to the bathroom but have to hold on to objects to keep from falling. ­These symptoms are severe and continuous for about three days and then begin to improve gradually. Even ­ after a few weeks, you still feel slightly unsteady when walking, and you notice brief dizziness if you turn your head quickly to one side. In a classic paper published si­ mul­ ta­ neously in ­ Eng­ land and the United States in 1952, Dix and Hallpike described the typical symptoms associated with what they called vestibular neuronitis. Hallpike was an otolaryngologist in London who along with Cairns first described the inner ear pathology associated with Ménière’s disease. Margaret Dix was a young researcher working with Hallpike at the Queen Square Neurological Institute in London. She had been in surgical training but was disfigured in the bombing of London during World War II and deci­ ded to focus on a ­ career in research. Unlike Ménière’s disease, which involved recurrent attacks of vertigo, vestibular neuronitis was characterized by a single prolonged bout of vertigo lasting several days to weeks. Dix and Hallpike chose the term “vestibular neuronitis” ­ because they felt that CHAPTER  5 A Single Bout of Dizziness for Days 84 the damage causing the vertigo was prob­ ably localized to the vestibular system, the nerve cells or nerve fibers outside or inside the brain. Their conclusion was based on the observation that patients with vestibular neuronitis had isolated vertigo without hearing or neurological symptoms. The ending “-­ itis” in medical jargon suggests inflammation, and usually infection—­ thus implying an inflammation or infection of the vestibular system. Yet Dix and Hallpike admitted that they had ­ little or no information about the cause of the disorder. As in the case of Ménière’s disease, the key information regarding the cause of vestibular neuronitis came from studies of inner ear specimens obtained at autopsy from patients who had typical symptoms of vestibular neuronitis and ­ later died of other, unrelated ­ causes. The person who was most responsible for defining the pathology of vestibular neuronitis was Harold Schuknecht, the long-­ time chief of otolaryngology at the Mas­ sa­ chu­ setts Eye and Ear Infirmary at Harvard Medical School. In many ways, Schuknecht was the prototypical American success story. From his small-­ farm South Dakota beginnings where the only book in the ­ house was a bible, he attended college and the first two years of medical school at the University of South Dakota and then transferred to Rush Medical School in Chicago to complete his training while working multiple part-­ time jobs to support his education. In World War II he was a flight surgeon with the Fifteenth Air Force Division in Italy, where he received the Soldier’s Medal for rescuing a pi­ lot from a burning plane.­ After the war Schuknecht did his residency training in otolaryngology at the University of Chicago and then stayed on to develop his clinical and research skills as an assistant professor.­ After a stay at Henry Ford Hospital in Detroit, Harold Schuknecht moved to Harvard to chair the Department of Oto- Vestibul ar Neuritis 85 laryngology in 1961. He immediately set up a temporal bone (the bone at the base of the skull that contains the inner ear) laboratory and began collecting specimens at autopsy from patients with a wide range of inner ear conditions. His “Sunday school” temporal bone sessions with the resident doctors ­ were a tradition at the Eye and Ear Infirmary. Harold Schuknecht was a workaholic. He worked long days during the week and shorter days on the weekend. He read manuscripts and wrote research papers mostly at home. He slept five or six hours a night but often woke up in the ­ middle of the night and began writing. Schuknecht did not consider himself intellectually gifted, but he was proud of what he called his “intellectual stamina.” He worked harder and stuck with ­ things longer than­others. Schuknecht’s greatest academic achievement was his textbook titled Pathology of the Ear, which is still considered the definitive work on what can go wrong in the ear. In it he relied on specimens from his “temporal bone bank” to describe the pathology associated...


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