151
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Duong Dinh TA, Wittenborn J, Westhofen M. [The Dizziness Handicap Inventory for quality control in the treatment of vestibular dysfunction]. HNO 2021; 70:19-23. [PMID: 33733711 PMCID: PMC8760199 DOI: 10.1007/s00106-021-01017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
Die Therapie peripherer vestibulärer Funktionsstörungen stellt eine Herausforderung für viele HNO-Ärzte dar. Diese besteht nicht nur in der Durchführung der differenzierten neurootologischen Diagnostik, sondern auch in der Therapie und in der Verlaufskontrolle von Patienten mit vestibulärer Funktionsstörung. Insbesondere die Qualitätssicherung solcher Therapie wird in der Regel nicht adäquat abgebildet und dokumentiert. Die deutsche, validierte Version des Dizziness Handicap Inventory (DHI) bietet eine praktikable Möglichkeit zur Evaluierung und Verlaufskontrolle der Therapieergebnisse. In einer Studie wurden die Beschwerden von Patienten, welche in der HNO-Klinik des Universitätsklinikums Aachen aufgrund einer unilateralen peripheren vestibulären Funktionsstörung behandelt wurden, prä- bzw. posttherapeutisch mittels DHI erfasst und ausgewertet. Die posttherapeutische Erhebung des DHI-Scores erfolgte telefonisch. Die Auswertung der erhobenen DHI-Scores ergab in 92 % der Fälle eine signifikante Reduzierung der Schwindelbeschwerden. Es bestätigte sich die Eignung des DHI als Instrument zur Qualitätssicherung für die Funktionsdiagnostik und die darauf folgende Therapie von vestibulären Funktionsstörungen.
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Affiliation(s)
- T A Duong Dinh
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Plastische Kopf- und Halschirurgie, Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - J Wittenborn
- Klinik für Mund-, Kiefer und Gesichtschirurgie, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - M Westhofen
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Plastische Kopf- und Halschirurgie, Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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152
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Green KE, Pogson JM, Otero-Millan J, Gold DR, Tevzadze N, Saber Tehrani AS, Zee DS, Newman-Toker DE, Kheradmand A. Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations. Neurology 2021; 96:34-38. [PMID: 33004609 PMCID: PMC7884977 DOI: 10.1212/wnl.0000000000010980] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with acute vestibular disorders are often a diagnostic challenge for neurologists, especially when the evaluation must be conducted remotely. The clinical dilemma remains: Does the patient have a benign peripheral inner ear problem or a worrisome central vestibular disorder, such as a stroke? The use of a focused history and the virtual HINTS (head impulse test, nystagmus evaluation, and test of skew) examination are key steps towards correctly diagnosing and triaging the acute vertiginous patient. When looking for signs of vestibulo-ocular dysfunction, there are important technological and practical considerations for an effective clinical interpretation.
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Affiliation(s)
- Kemar E Green
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley.
| | - Jacob M Pogson
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - Jorge Otero-Millan
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - Daniel R Gold
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - Nana Tevzadze
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - Ali S Saber Tehrani
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - David S Zee
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - David E Newman-Toker
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
| | - Amir Kheradmand
- From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley
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153
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Illarionova EM, Gribova NP, Golovanova ED. [Stabilometric diagnosis of vertigo in elderly patients with vestibular migraine.]. Adv Gerontol 2021; 34:771-774. [PMID: 34998017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of the study was to study the possibility of computer stabilometric diagnostics for the objectification of vertigo in elderly patients with vestibular migraine. The study included 57 elderly patients with vestibular migraine and 57 elderly patients with central vestibular vertigo, without migraine. Specialized tests of functional computer stabilometry were used to objectify vertigo. The study revealed the features of the basic stabilometric parameters in specialized tests in elderly patients, which can be used to obtain a quantitative assessment of vestibular dysfunction and objectification of vertigo.
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Affiliation(s)
- E M Illarionova
- Smolensk State Medical University, 28 Krupskaya str., Smolensk 214019, Russian Federation, e-mail:
| | - N P Gribova
- Smolensk State Medical University, 28 Krupskaya str., Smolensk 214019, Russian Federation, e-mail:
| | - E D Golovanova
- Smolensk State Medical University, 28 Krupskaya str., Smolensk 214019, Russian Federation, e-mail:
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154
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Hospital Tuanku Ja’afar, Jalan Rasah, Negeri Sembilan, Malaysia
| | - Jeyanthi Kulasegarah
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
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155
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Lamas G, Vidal C, Hervochon R. [Vertigo]. Rev Prat 2020; 70:e343-e348. [PMID: 33739669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Georges Lamas
- Professeur des universités. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Catherine Vidal
- MD, PHD. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, centre Boreli-UMR 9010 CNRS, université René-Descartes, Paris, France
| | - Rémi Hervochon
- Chef de clinique assistant. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
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156
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Lamas G, Vidal C, Hervochon R. [Vertigo, in practice]. Rev Prat 2020; 70:e342. [PMID: 33739668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Georges Lamas
- Professeur des universités. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Catherine Vidal
- MD, PHD. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, centre Boreli-UMR 9010 CNRS, université René-Descartes, Paris, France
| | - Rémi Hervochon
- Chef de clinique assistant. Service d'ORL, groupe hospitalier de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
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157
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Regauer V, Seckler E, Müller M, Bauer P. Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review. BMC Geriatr 2020; 20:494. [PMID: 33228601 PMCID: PMC7684969 DOI: 10.1186/s12877-020-01899-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. METHODS A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. RESULTS A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. CONCLUSION To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making. TRIAL REGISTRATION PROSPERO 2017 CRD42017080291 .
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Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
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158
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Bouanani N, Aasfara J, Hajjij A, Ouhabi H. Hodgkin's lymphoma presenting with an unusual horizontal Nystagmus and vertigo. Tunis Med 2020; 98:869-872. [PMID: 33479986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neurological presentation of paraneoplastic syndromes is rare. They are often difficult to diagnose, especially when they precede the diagnosis of cancer. Hodgkin's lymphoma is associated with several paraneoplastic neurological syndromes such as cerebellar degeneration and dermato/polymyositis. Peripheral vestibular syndrome is uncommon presentation of these paraneoplastic syndromes. We report the case of a 52-year-old man with no prior medical history who presented to the otolaryngology clinic with vertigo precipitated by nystagmus, nausea and weight loss. Diagnostic workup revealed a nodular sclerosing variant of Hodgkin's lymphoma without paraneoplastic antibodies. The patient's symptoms resolved after institution of chemotherapy, radiotherapy and vestibular rehabilitation. Hodgkin's lymphoma has been reported to be associated with many paraneoplastic syndromes with neurological presentation in which peripheral vestibular syndrome is an uncommon one. Sometimes it can be the only presenting symptom of an unknown Hodgkin's lymphoma. This create a real diagnostic challenge for clinicians specially when paraneoplastic antibodies are negative. Chemotherapy and radiotherapy as treatment of the underlying disease is of a big benefit if started as early as possible.
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159
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Viola P, Ralli M, Pisani D, Malanga D, Sculco D, Messina L, Laria C, Aragona T, Leopardi G, Ursini F, Scarpa A, Topazio D, Cama A, Vespertini V, Quintieri F, Cosco L, Cunsolo EM, Chiarella G. Tinnitus and equilibrium disorders in COVID-19 patients: preliminary results. Eur Arch Otorhinolaryngol 2020; 278:3725-3730. [PMID: 33095432 PMCID: PMC7582442 DOI: 10.1007/s00405-020-06440-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Tinnitus and equilibrium disorders such as dizziness and vertigo have been reported by patients with COVID-19; however, they have been rarely investigated. The aim of this study was to study the prevalence of subjective tinnitus and dizziness in a sample of COVID-19 patients using an online 10-item close-ended questionnaire. METHODS A multicentric study that included 15 Italian hospitals in different regions was conducted using an online 10-item close-ended questionnaire developed to identify the presence of tinnitus and balance disorders in patients with COVID-19 between May 5 and June 10, 2020. The questionnaire was administered to 185 patients in a period of > 30 - < 60 days after diagnosis of COVID-19; responses were recorded in an online Excel spreadsheet. The questionnaire was composed of three sections: (1) demographic information; (2) presence and characteristics of tinnitus and dizziness after COVID-19 diagnosis; (3) possible association with migraine. RESULTS Thirty-four patients (18.4%) reported equilibrium disorders after COVID-19 diagnosis. Of these, 32 patients reported dizziness (94.1%) and 2 (5.9%) reported acute vertigo attacks. Forty-three patients (23.2%) reported tinnitus; 14 (7.6%) reported both tinnitus and equilibrium disorders. CONCLUSION This study suggests that the presence of subjective otoneurological symptoms such as tinnitus and balance disorders can affect COVID-19 patients; further studies are necessary to investigate the prevalence and pathophysiological mechanisms underlying these subjective symptoms in COVID-19 patients.
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Affiliation(s)
- Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy.
| | - Donatella Malanga
- Laboratory of Molecular Oncology, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Interdepartmental Center of Services (CIS), Magna Graecia University, Catanzaro, Italy
| | - Domenico Sculco
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Luigi Messina
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Carla Laria
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit of Audiology, University of Naples "Federico II", Naples, Italy
| | | | - Gianluca Leopardi
- Unit of Otolaryngology, "S. Giuseppe Hospital", Empoli, Firenze, Italy
| | - Francesco Ursini
- Unit of Medicine and Rheumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna", Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Davide Topazio
- Unit of Otolaryngology, "Mazzini Hospital", Teramo, Italy
| | - Antonia Cama
- Unit of Maxillofacial Surgery, "Mazzini Hospital", Teramo, Italy
| | - Viviana Vespertini
- Unit of Infectious Diseases, "Pugliese-Ciaccio Hospital", Catanzaro, Italy
| | | | - Lucio Cosco
- Unit of Infectious Diseases, "Pugliese-Ciaccio Hospital", Catanzaro, Italy
| | - Elio Maria Cunsolo
- Unit of Otolaryngology, General Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
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160
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Kim HA, Ahn J, Park HS, Lee SM, Choi SY, Oh EH, Choi JH, Kim JS, Choi KD. Cardiogenic vertigo: characteristics and proposed diagnostic criteria. J Neurol 2020; 268:1070-1075. [PMID: 33025120 DOI: 10.1007/s00415-020-10252-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Abstract
Early identification of cardiogenic vertigo (CV) is necessary to prevent serious complications of cardiovascular diseases. However, the literature is limited to case reports without detailed clinical features or diagnostic criteria. The aim of this study was to define characteristics of CV and propose diagnostic criteria. This study included patients with CV diagnosed at Pusan National University and Keimyung University Hospitals. Demographic, clinical, laboratory, and treatment data were analyzed. Of 72 patients with clinically suspicious CV, 27 were finally included. The age ranged from 63 to 88 years (75.1 ± 7.2 years). Recurrent vertigo occurred without syncopal attacks in 52% [95% CI, 32-71], while it preceded (37% [19-58]) or followed (11% [2-29]) syncope. The patients with recurrent isolated vertigo had suffered from symptoms from 15 days to 5 years until final diagnosis (median 122 days). The vertigo lasted only for a few seconds (93% [76-99]) or a few minutes (7% [1-24]). Fourteen patients presented with spinning vertigo, and one of them showed spontaneous downbeat nystagmus during the attack. Accompanying symptoms including chest discomfort, palpitation, headache, arm twitching, and lightheadedness were found in 70% [50-86]. Between patients with and without syncope, there was no difference in clinical parameters and results of cardiac function tests. The most common cardiac abnormality during the attacks of vertigo was bradyarrhythmia (89% [71-98]). Cardiovascular diseases can develop recurrent isolated vertigo without or preceding syncope. Onset age, duration of vertigo, accompanying symptoms, and underlying cardiac diseases can aid in differentiation from other vestibular disorders. Early identification of CV would reduce morbidity and mortality associated with cardiac syncope.
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Affiliation(s)
- Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea
| | - Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Seo-Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea.
- Department of Neurology, College of Medicine, Pusan National University, National University Hospital, 179, Gudeok-ro, Seo-gu, Pusan, 602-739, Korea.
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陈 元, 孙 悍, 张 清, 屈 媛, 李 健, 周 玲, 杨 萌, 路 华, 赵 龙, 孙 勍. [Clinical characteristics analysis of patients with Meniere's disease and vestibular migraine]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:820-823. [PMID: 33040507 PMCID: PMC10127737 DOI: 10.13201/j.issn.2096-7993.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 11/12/2022]
Abstract
Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.
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Affiliation(s)
- 元星 陈
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 悍军 孙
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 清华 张
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 媛怡 屈
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 健 李
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 玲玲 周
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 萌 杨
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 华玉 路
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 龙珠 赵
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 勍 孙
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
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162
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Müller M, Goeldlin MB, Gaschen J, Sauter TC, Stock S, Wagner F, Exadaktylos AK, Fischer U, Kalla R, Mantokoudis G. Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin. BMC Emerg Med 2020; 20:70. [PMID: 32867677 PMCID: PMC7460761 DOI: 10.1186/s12873-020-00361-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations. METHODS This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was 'vestibular symptoms'. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis. RESULTS A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians' work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging. CONCLUSION One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.
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Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Janika Gaschen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- Children’s Hospital of Aarau, Aarau, Switzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Medical Skills Lab, Charité Medical School Berlin, Berlin, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Roger Kalla
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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163
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Sun L, Xiang K. A review on the alterations in the brain of persistent postural-perceptual dizziness patients and non-pharmacological interventions for its management. Rev Neurosci 2020; 31:675-680. [PMID: 32286251 DOI: 10.1515/revneuro-2019-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/01/2020] [Indexed: 12/17/2022]
Abstract
Persistent postural perceptual dizziness (PPPD) is a relatively newer term, and this term is included in the International Classification of Diseases in its 11th revision. The typical features of PPPD include the presence of persistent dizziness, non-spinning vertigo, and unsteadiness, and these symptoms are exacerbated during upright posture, movement, or visual stimuli. Moreover, the structural changes have also been identified in the brains of PPPD patients, particularly in visual, vestibular, and limbic areas. These include a decrease in the volume and gyration of gray matter, a decrease in the blood flow to the cortex region, and alterations in the structural and functional connectivity, particularly in the visual-vestibular networks. Moreover, the impairment in sensory processing is restricted not only to the vestibular and visual regions; instead, there is a generalized impairment in the sensory processing, and thus, there is a multisensory dimension of sensory impairment. Selective serotonin uptake inhibitors and serotonin-norepinephrine reuptake inhibitors are the mainstay drugs for the management of PPPD patients. However, a significant proportion of PPPD patients do not show improvement in response to standard drug therapy. The employment of alternative and complementary treatment strategies, including vestibular rehabilitation therapy, cognitive behavioral therapy, and non-invasive vagal nerve stimulation, is effective in the management of PPPD patients. The present review discusses the alterations in the brains of PPPD patients along with the possible non-pharmacological treatment options in these types of patients.
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Affiliation(s)
- Li Sun
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, No. 20 Gongnong Street, Changchun 130000, Jilin, China
| | - Ke Xiang
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, No. 20 Gongnong Street, Changchun 130000, Jilin, China
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164
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Roberts RA, Gans RE, DeBoodt JL, Lister JJ. Treatment of Benign Paroxysmal Positional Vertigo: Necessity of Postmaneuver Patient Restrictions. J Am Acad Audiol 2020; 16:357-66. [PMID: 16178407 DOI: 10.3766/jaaa.16.6.4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Several treatment methods involving positioning maneuvers that return the otoconia to the utricle have been described. Following treatment, most patients are provided with a variety of activity restrictions. Previous studies suggest that, overall, BPPV treatment may be successful without these restrictions. The purpose of this study was to determine the necessity of postmaneuver restrictions using an experimental and control group with participants matched for age, gender, involved ear, and symptoms. A canalith repositioning maneuver was used to treat the BPPV. During postmaneuver instruction, the 21 participants assigned to the restricted group were provided with typical activity restrictions. Twenty-one participants assigned to the nonrestricted group were given no postmaneuver restrictions. Only one participant in the restricted group and two participants in the nonrestricted group were not clear at the one-week follow-up appointment. Results indicated that postmaneuver restrictions do not improve treatment efficacy.
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Affiliation(s)
- Richard A Roberts
- The American Institute of Balance, 11290 Park Boulevard, Seminole, FL 33772, USA.
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165
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Wu HY, Wang SJ, Gao ZQ, Jiang H. [Preliminary analysis of central paroxysmal positional vertigo]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 55:754-759. [PMID: 32791773 DOI: 10.3760/cma.j.cn115330-20200616-00504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.
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Affiliation(s)
- H Y Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S J Wang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Z Q Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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166
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Filippopulos FM, Huppert D, Brandt T, Hermann M, Franz M, Fleischer S, Grill E. Computerized clinical decision system and mobile application with expert support to optimize management of vertigo in primary care: study protocol for a pragmatic cluster-randomized controlled trial. J Neurol 2020; 267:45-50. [PMID: 32719973 PMCID: PMC7718197 DOI: 10.1007/s00415-020-10078-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
Vertigo and dizziness are amongst the most common symptoms in medicine and often have a major impact on activities of daily life. Although many causes of vertigo and dizziness can easily be recognized, patients often receive inappropriate and ineffective treatment. The reasons for this are various. Because vertigo/dizziness is an interdisciplinary symptom and there is a lack of standardised diagnostic tools, it is easy to lose the overview of the possible differential diagnoses. There is evidence though, that the management of patients with vertigo/dizziness can be optimized using standardized care pathways with digital support. The present study (within the framework of “PoiSe—prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health”) aims to evaluate the implementation of a program with several interlocking components. The three main components are a computerized clinical decision system, a mobile application, a counselling and interdisciplinary educational program developed by the German Center for Vertigo and Balance Disorders (DSGZ). The study is a cluster-randomized controlled trial with a parallel-group design, as well as a detailed process evaluation. Clusters comprise of primary care physician practices in Bavaria, Germany. In the scope of the study the effectiveness, acceptability and efficiency of the intervention will be evaluated. It is anticipated that the intervention will improve the quality and efficiency of the management of dizzy patients. A higher diagnostic accuracy, optimized treatment, and disease progression monitoring is expected to improve patient-relevant outcomes and reduce health-care costs.
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Affiliation(s)
- Filipp M Filippopulos
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany.
- Department of Neurology, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany.
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Margit Hermann
- AOK Bayern, Die Gesundheitskasse, Carl-Wery-Straße 28, 81739, Munich, Germany
| | - Mareike Franz
- Kassenärztliche Vereinigung Bayerns, Referat Versorgungsinnovationen, Elsenheimerstraße 39, 80687, Munich, Germany
| | - Steffen Fleischer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Eva Grill
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
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167
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Abstract
BACKGROUND Positional manoeuvres are an important part of the neurological examination, particularly in patients with vertigo where the presence and characteristics of provoked nystagmus can help differentiate central from peripheral neurological disorders. METHODS Case series of functional positional eye and eyelid movements. RESULTS We report four patients with functional eye and eyelid movements provoked during positional manoeuvres. The range of abnormalities observed included positional convergence spasm, brief functional saccadic oscillations, and excessive positional blinking mimicking upbeat nystagmus. The functional movements described were present on a background of pre-existing peripheral or central nystagmus, or positional vertigo. CONCLUSION Functional positional eye and eyelid movements may co-exist with organic nystagmus that renders an accurate interpretation of the manoeuvre more challenging. A thorough understanding of the clinical features that differentiate these two categories of eye/eyelid movements makes the analysis easier, thus preventing misdiagnosis and avoiding unnecessary investigations.
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Affiliation(s)
- Mohamed Mabrouk Mustafa
- Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Pharmacology Department, Faculty of Medicine and Health Science, Omdurman Islamic University, Omdurman, Sudan
| | - Harry Akram
- Department of Neuro-Otology, Royal National Ear Nose and Throat Hospital, University College London Hospitals, Huntley Street, London, UK
| | | | - Diego Kaski
- Department of Neuro-Otology, Royal National Ear Nose and Throat Hospital, University College London Hospitals, Huntley Street, London, UK.
- Department of Clinical and Motor Neurosciences, University College London, 33 Queen Square, London, UK.
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168
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Winkel A. Calculated Decisions: HINTS for stroke in acute vestibular syndrome. Emerg Med Pract 2020; 22:CD3-CD4. [PMID: 33112578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The HINTS score identifies potential stroke in patients with acute vestibular syndrome.
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Affiliation(s)
- Antony Winkel
- Department of Neurology, Sunshine Coast University Hospital, Sunshine Coast, Australia
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169
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Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, Strupp M, Kim JS. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria. J Vestib Res 2020; 29:45-56. [PMID: 30883381 PMCID: PMC9249281 DOI: 10.3233/ves-190655] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders (ICVD). The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Diagnosis of hemodynamic orthostatic dizziness/vertigo requires: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) orthostatic hypotension, postural tachycardia syndrome or syncope documented on standing or during head-up tilt test; and C) not better accounted for by another disease or disorder. Probable hemodynamic orthostatic dizziness/vertigo is defined as follows: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) at least one of the following accompanying symptoms: generalized weakness/tiredness, difficulty in thinking/concentrating, blurred vision, and tachycardia/palpitations; and C) not better accounted for by another disease or disorder. These diagnostic criteria have been derived by expert consensus from an extensive review of 90 years of research on hemodynamic orthostatic dizziness/vertigo, postural hypotension or tachycardia, and autonomic dizziness. Measurements of orthostatic blood pressure and heart rate are important for the screening and documentation of orthostatic hypotension or postural tachycardia syndrome to establish the diagnosis of hemodynamic orthostatic dizziness/vertigo.
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Affiliation(s)
- Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo M. Bronstein
- Department of Neuro-otology, Division of Brain Sciences, Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | | | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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170
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Çelik O, Tanyeri Toker G, Eskiizmir G, İncesulu A, Şahin Süyür N. The Effectiveness of Medical Prophylactic Treatment on Vestibular Migraine and Its Effect on the Quality Of Life. J Int Adv Otol 2020; 16:28-33. [PMID: 31347507 PMCID: PMC7224423 DOI: 10.5152/iao.2019.6522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/08/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of the present study was to determine the efficacy of propranolol treatment in patients with vestibular migraine by the Visual Analog Scale, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale, and Vestibular Disorders Activities of Daily Living Scale (VADL) and its effect on the quality of life. MATERIALS AND METHODS The study population consisted of 38 patients with vertigo/dizziness who underwent routine evaluation and vestibular examinations, were diagnosed with definitive vestibular migraine, and received the same medical treatment protocol (propranolol). The questionnaires and scales that were applied to the patients before and after treatment were evaluated. The results were evaluated with 95% confidence interval, and p<0.05 was accepted as statistically significant. RESULTS The mean age of the patients was 47.55 (18-75) years, and 27 (71%) patients were female, and 11 (29%) were male. The mean total scores of the DHI before and after treatment were 50.21±22.39 (range: 8-92) and 9.31±9.86 (range: 0-58), respectively (p<0.001). The degree of disability after treatment was low in all patients (p<0.001). The total scores of the VADL before and after treatment were 186.63±79.65 (range: 32-280) and 55.52±51.89 (range: 28-273), respectively (p<0.001). There was no correlation between these two scales (p=0.235). CONCLUSION To our knowledge, this is the first study to evaluate both the efficacy of propranolol treatment and its effects on the quality of life in vestibular migraine. The severity, frequency, and number of attacks and disability scores were reduced, and the quality of life was improved in patients with vestibular migraine with propranolol treatment.
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Affiliation(s)
- Onur Çelik
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa Turkey
| | - Gökçe Tanyeri Toker
- Department of Otorhinolaryngology, İzmir Katip Çelebi University, Ataturk Training and Research Hospital, İzmir, Turkey
| | - Görkem Eskiizmir
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa Turkey
| | - Armağan İncesulu
- Department of Otolaryngology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Nevin Şahin Süyür
- Clinic of Otorhinolaryngology, Ağrı Diyadin State Hospital, Ağrı, Turkey
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171
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Hassannia F, D Carr S, A Rutka J. Transient Vertigo with Horizontal Nystagmus to Loud Noise and Pressure: Utricular Hydrops or Vestibular Atelectasis? J Int Adv Otol 2020; 16:127-129. [PMID: 32401208 PMCID: PMC7224419 DOI: 10.5152/iao.2019.6283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022] Open
Abstract
We present an unusual case of a patient with a positive Tullio phenomenon, brief Valsalva-induced transient horizontal nystagmus, reduced left caloric response, and bilateral vestibulo-ocular reflex loss. This study discusses the pathophysiology and differential diagnosis concerning the suspected pathology for the phenomenon of utricular hydrops or vestibular atelectasis and presents a literature review.
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Affiliation(s)
- Fatemeh Hassannia
- Department of Otolaryngology, Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Simon D Carr
- Department of Otolaryngology, Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - John A Rutka
- Department of Otolaryngology, Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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172
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Ahmed A, Aqeel M, Ahmed B. Tinnitus and Vertigo Symptoms: Precursors of Psychiatric Suffering. J Coll Physicians Surg Pak 2020; 30:346. [PMID: 32169155 DOI: 10.29271/jcpsp.2020.03.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Ammar Ahmed
- Department of Psychology, Foundation University, Islamabad, Pakistan
| | - Muhammad Aqeel
- Department of Psychology, Foundation University, Islamabad, Pakistan
| | - Bashir Ahmed
- Department of E.N.T, Hearts International Hospital, Rawalpindi, Pakistan
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173
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Boniver R. [Semiology and pathophysiology of vertigo and dizziness : guide for evaluating invalidity and incapacity]. Rev Med Liege 2020; 75:171-175. [PMID: 32157842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
After a reminder of the semiology and pathophysiology of balance disorders (vertigo and dizziness), the author considers the disabilities and incapacities that result from these disturbances.
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Affiliation(s)
- R Boniver
- Faculté de Médecine, ULiège, Belgique
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174
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Weiland MTD, van Oosterhout WPJ, Bakker SD. [Vertigo as the first manifestation of ovarian cancer]. Ned Tijdschr Geneeskd 2020; 164:D3982. [PMID: 32186813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Vertigo is a common complaint and may rarely be the presenting symptom of a paraneoplastic neurological syndrome (PNS). CASE DESCRIPTION A 76-year-old woman presented at the ER with subacute cerebellar syndrome and severe vertigo. Laboratory testing revealed mild anaemia. A cerebral CT scan showed no intracranial pathology. The patient was admitted for observation. History-taking revealed she been suffering from general malaise and had unintentionally lost 16 kg in weight over recent months. Further PET-CT investigations revealed multiple enlarged mediastinal and abdominal lymph nodes with high metabolic activity. Histopathological investigation of a lymph node biopsy showed a malignancy originating from the genital tract. Positive anti-neuronal antibodies (anti-Yo) and an elevated CA-125 concentration were found in peripheral blood. We diagnosed paraneoplastic cerebellar degeneration as the first manifestation of hitherto undiagnosed occult ovarian cancer. CONCLUSION In a patient with subacute, cerebellar syndrome with severe vertigo, after ruling out other causes, the diagnosis of PNS should be considered. Determination of anti-neuronal antibodies can help in the diagnosis. Early recognition of PNS is important for the diagnosis and treatment of the underlying malignancy.
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Affiliation(s)
- M T D Weiland
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Zaandam
- Contact: M.T.D. Weiland
| | - W P J van Oosterhout
- Zaans Medisch Centrum, afd. Neurologie, Zaandam (tevens: OLVG, afd. Neurologie, Amsterdam)
| | - S D Bakker
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Zaandam
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175
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Abstract
So common is vertigo that diverse healthcare professionals, from audiologists to orthopedic surgeons, will eventually encounter it in their patients, if not in themselves. So treatable are vestibular disorders that it is an immense advantage to know how to assess the vestibular system. This review summarizes the history and physical examination that will help diagnose common vestibular disorders presenting with vertigo.
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176
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Yun SY, Lee JY, Kwon EJ, Jung C, Yang X, Kim JS. Compression of both vertebral arteries during neck extension: a new type of vertebral artery compression syndrome. J Neurol 2019; 267:276-278. [PMID: 31612320 DOI: 10.1007/s00415-019-09576-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022]
Affiliation(s)
- So-Yeon Yun
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju Young Lee
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun-Jin Kwon
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Peking, China
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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177
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Affiliation(s)
- Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Louisa Murdin
- Ear, Nose and Throat Department, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
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178
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Hassan M, Khan IQ, Khan BA, Siddique EU. Near missed diagnosis of extensive aortic dissection in a young patient presenting with non-specific symptoms. J PAK MED ASSOC 2019; 69:1376-1379. [PMID: 31511729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute aortic dissection is a frequently fatal condition that rarely involves young individuals. It has an estimated worldwide prevalence of 0.5-2.95 per 100,000 persons per year, with a mean incidence at around age 60. Of all the aortic dissections, less than 10% involve patients younger than 40 years of age. We present the case of a forty-yearold male who presented in the emergency department with non-specific complaints of nausea and lightheadedness. The patient being hemodynamically and clinically stable was discharged after supportive treatment. However after 5 hours the patient presented again in the emergency department with a neck pain, hypotension and sweating. CT angiography revealed a massive aortic dissection involving ascending, arch and descending aorta up to the bifurcation of iliac arteries. The patient was immediately taken for surgery for the replacement of ascending aorta and resuspension of aortic valve. The patient tolerated surgery well and was discharged after being clinically and haemodynamically stable.
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179
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Ata N, Öztürk K, Gezgin B. Comparison of the effects of the temperature of intratympanic dexamethasone injections on vertigo. Am J Otolaryngol 2019; 40:653-655. [PMID: 31130271 DOI: 10.1016/j.amjoto.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to compare if vertigo improved in patients when the dexamethasone used in the intratympanic (IT) injection was applied at body temperature or at room temperature. METHODS The study included 54 patients who had undergone intratympanic treatment due to sudden hearing loss and tinnitus. The IT injection was administered to all patients, 2 times with 1-day intervals. Two different IT injection techniques were used for each patient: injecting dexamethasone at room temperature and injecting it at body temperature. Patients were asked to report the vertigo they felt immediately, and at 15 min after the injection using the visual analogue scale (VAS) and the four-point categorical rating scale (CRS-4). RESULTS The level of vertigo immediately after injection was lower when the dexamethasone was injected at body temperature rather that at room temperature for both the VAS and CRS-4 (p < 0.05). However, no statistical differences in the VAS and CRS-4 self-report values between the two methods were found 15 min after the injection (p > 0.05). CONCLUSION Vertigo due to IT decreases within minutes. When the IT drugs are administered at body temperature, temporal vertigo due to injection is lower than when they are administered at room temperature.
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Affiliation(s)
- Nurdoğan Ata
- Department of Otorhinolaryngology, KTO Karatay University Medical Faculty, Medicana Konya Hospital, Konya, Turkey.
| | - Kayhan Öztürk
- Department of Otorhinolaryngology, KTO Karatay University Medical Faculty, Medicana Konya Hospital, Konya, Turkey
| | - Bahri Gezgin
- Department of Otorhinolaryngology, KTO Karatay University Medical Faculty, Medicana Konya Hospital, Konya, Turkey
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180
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Abstract
The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo lasting seconds to days that are accompanied by migraine symptoms. Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking. In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment still lacks solid evidence. It is targeted at the underlying migraine and comprises explanation and reassurance, lifestyle modifications, and drugs.
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Affiliation(s)
- Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Heubnerweg 2, Berlin 14059, Germany.
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181
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Zhang Y, Jiang L, Yang P, Zhang Y. Diagnostic Values of Neutrophil and Neutrophil to Lymphocyte Ratio in Distinguishing between Acute Cerebral Infarction and Vertigo. Clin Lab 2019; 65. [PMID: 31414750 DOI: 10.7754/clin.lab.2019.190208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vertigo and acute cerebral infarction (ACI) patients show similar symptoms such as dizziness and imbalance. This study was to investigate the diagnostic values of neutrophil counts and neutrophil to lymphocyte ratio (NLR) in distinguishing patients with ACI from those with vertigo. METHODS This retrospective study was performed and data were gathered from medical records of patients with vertigo symptoms from the Department of Emergency and Neurology Clinics who were admitted to the Fourth Affiliated Hospital Zhejiang University School of Medicine between August 2017 and January 2019. Of the 173 patients with vertigo symptoms, 111 non-ACI vertigo patients (vertigo group) and 62 cases diagnosed with ACI (ACI group) were enrolled in this study. The neutrophil counts, lymphocyte counts, platelet counts, NLR, and PLT to lymphocyte ratio (PLR) within 24 hours after admission were compared between the two groups. Student's t-test of independent samples was adopted for the comparison of the mean between two groups. The neutrophil counts and NLR were evaluated by comparing the areas under the receiver operating characteristic curve (AUC) in distinguishing patients with ACI from those with vertigo. Comparison of AUC was performed using the Z-test. RESULTS The neutrophil counts and NLR were significantly increased in the ACI group compared with the vertigo group (all p < 0.05), while there were no significant statistical differences of the lymphocyte counts, platelet counts, and PLR (all p > 0.05); moreover, AUC in distinguishing patients with ACI from those with vertigo was 0.647 (95% confidence interval (CI), 0.570 to 0.718) for neutrophil counts and 0.639 (95% CI, 0.562 to 0.710) for NLR, but there was no significant statistical difference (p > 0.05); finally, the cutoff values were 3.1 x 109/L in distinguishing patients with ACI from those with vertigo (specificity 41.44% and sensitivity 83.87%) for neutrophil counts and 2 (specificity 55.86% and sensitivity 67.74%) for NLR. CONCLUSIONS As easy-to-obtain inflammatory biomarkers, both neutrophil counts and NLR could demonstrate diagnostic values in distinguishing between ACI and vertigo.
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182
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Affiliation(s)
- Vivien Li
- National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | | | - S Anand Trip
- National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
- Department of Neurology, Northwick Park Hospital, LNWUH NHS Trust, Harrow, UK
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183
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Flanagin VL, Fisher P, Olcay B, Kohlbecher S, Brandt T. A bedside application-based assessment of spatial orientation and memory: approaches and lessons learned. J Neurol 2019; 266:126-138. [PMID: 31240446 PMCID: PMC6722154 DOI: 10.1007/s00415-019-09409-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/05/2023]
Abstract
Spatial orientation and memory deficits are an often overlooked and potentially powerful early marker for pathological cognitive decline. Pen-and-paper tests for spatial abilities often do not coincide with actual navigational performance due to differences in spatial perspective and scale. Mobile devices are becoming increasingly useful in a clinical setting, for patient monitoring, clinical decision-making, and information management. The same devices have positional information that may be useful for a scale appropriate point-of-care test for spatial ability. We created a test for spatial orientation and memory based on pointing within a single room using the sensors in mobile phone. The test consisted of a baseline pointing condition to which all other conditions were compared, a spatial memory condition with eyes-closed, and two body rotation conditions (real or mental) where spatial updating were assessed. We examined the effectiveness of the sensors from a mobile phone for measuring pointing errors in these conditions in a sample of healthy young individuals. We found that the sensors reliably produced appropriate azimuth and elevation pointing angles for all of the 15 targets presented across multiple participants and days. Within-subject variability was below 6° elevation and 10° azimuth for the control condition. The pointing error and variability increased with task difficulty and correlated with self-report tests of spatial ability. The lessons learned from the first tests are discussed as well as the outlook of this application as a scientific and clinical bedside device. Finally, the next version of the application is introduced as an open source application for further development.
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Affiliation(s)
| | - Paul Fisher
- Neuro-Cognitive-Psychology, Department of Psychology, LMU, Munich, Germany
| | - Berk Olcay
- Computer Aided Medical Procedures, Technical University Munich (TUM), Munich, Germany
| | - Stefan Kohlbecher
- German Centre for Vertigo and Balance Disorders (DSGZ), Munich, Germany
| | - Thomas Brandt
- German Centre for Vertigo and Balance Disorders (DSGZ), Munich, Germany
- Hertie, University Hospital, LMU Munich, Munich, Germany
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184
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Abstract
Objective To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. Methods All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Results Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. Conclusion BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. Ebm Rating: C © 2005 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.
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Affiliation(s)
- Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
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185
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Numata K, Shiga T, Omura K, Umibe A, Hiraoka E, Yamanaka S, Azuma H, Yamada Y, Kobayashi D. Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey. PLoS One 2019; 14:e0213196. [PMID: 30845218 PMCID: PMC6405109 DOI: 10.1371/journal.pone.0213196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/16/2019] [Indexed: 12/19/2022] Open
Abstract
Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07-0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06-0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01-5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07-0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01-0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85-61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.
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Affiliation(s)
- Kenji Numata
- Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Mita hospital, Mita, Minato-ku Tokyo, Japan
- * E-mail:
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Nishi-shimbashi, Minato-ku, Tokyo, Japan
| | - Akiko Umibe
- Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya, Koshigaya city, Saitama, Japan
| | - Eiji Hiraoka
- Department of General Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan
| | - Shunsuke Yamanaka
- Department of Emergency Medicine, University of Fukui Hospital, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Hiroyuki Azuma
- Department of Emergency Medicine, Fukui prefectural hospital, Fukui, Fukui prefecture, Japan
| | - Yasuhiro Yamada
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, higashigaoka, meguro-ku, Tokyo, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, St. Luke’s International Hospital, Tokyo Japan
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186
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Abstract
Dizziness/vertigo is a common complaint in the emergency department (ED). We aimed to evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo.We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7-12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615-0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474-0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453-0.857).The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients.
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Affiliation(s)
- Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung
| | - Yi-Syun Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung
| | - Charng-Yen Chiang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung
| | - E-Wai Zhang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung
- Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
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187
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Kikkawa Y, Suzuki K, Teranishi A, Tachikawa T, Kurita H. Ruptured intrameatal anterior inferior cerebellar artery aneurysm associated with obstructed internal auditory artery in a patient with sudden hearing loss and vertigo. Acta Neurochir (Wien) 2019; 161:403-406. [PMID: 30560376 DOI: 10.1007/s00701-018-3771-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intrameatal aneurysms arising from the meatal loop of the anterior inferior cerebellar artery (AICA) are extremely rare. CASE PRESENTATION We report a 60-year-old man presenting with severe vertigo and sudden left hearing loss associated with subarachnoid hemorrhage caused by rupture of a saccular aneurysm arising from the meatal loop of the AICA, which was entirely buried in the meatus. Intraoperatively, we identified the occluded internal auditory artery arising from the meatal loop of the AICA, where the aneurysm originated, and performed neck clipping. CONCLUSION These findings suggest that internal auditory artery occlusion is a potential cause of loss of auditory and vestibular functions.
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Affiliation(s)
- Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Akio Teranishi
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | | | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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Stroke and Vertigo Association of Chinese Stroke Association, Vertigo Professional Committee of Neurology Branch of Chinese Physicians Association. [Chinese multidisciplinary expert consensus on assessment and management of vestibular migraine]. Zhonghua Nei Ke Za Zhi 2019; 58:102-7. [PMID: 30704196 DOI: 10.3760/cma.j.issn.0578-1426.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vestibular migraine (VM) is a common disorder characterized by recurrent dizziness and/or vertigo, which involves a number of specialites and is easily misdiagnosed. The Stroke and Vertigo Association of Chinese Stroke Association and Vertigo Professional Committee of Neurology Branch of Chinese Physicians Association organized multi-disciplinary experts to discuss clinical issues of VM. The purpose of this consensus is to establish a standard framework for the diagnosis and management of VM in China.
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189
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Stroke and Vertigo Association of Chinese Stroke Association. Multidisciplinary experts consensus for assessment and management of vestibular migraine. Chin Med J (Engl) 2019; 132:183-9. [PMID: 30614869 DOI: 10.1097/CM9.0000000000000064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 01/03/2023] Open
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Abstract
This chapter is a brief overview of migraine associated vertigo (MAV), focusing on the points most relevant to the practicing clinician. We review the definition of MAV, theories regarding its underlying pathophysiology, clinical presentation, epidemiology, findings on physical examination and oto vestibular testing, differential diagnosis, management and prognosis.
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191
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Paviolo JP, Aranda Martínez A. [Susac syndrome, a rare cause of encephalopathy]. Medicina (B Aires) 2019; 79:204-207. [PMID: 31284256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Susac syndrome is a rare disorder caused by autoimmune-mediated occlusions of microvessels in the brain, retina and inner ear. These occlusions lead to a characteristic clinical triad of central nervous system dysfunction, visual disturbances and vestibule-cochlear deficits. The diagnosis is based on clinical manifestations and complementary studies, which demonstrate the involvement of three systems. There are different treatments that include various immunosuppressive drugs combinations such as corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, among others. We present the case of a 26-year-old woman with left hearing loss, tinnitus and episodes of recurrent vertigo, four weeks after bilateral blurred vision, cerebellar ataxia and encephalopathy. Magnetic resonance imaging of the brain showed multiple rounded hyperintense lesions in t2 and fluid-attenuated inversion recovery (FLAIR), hypointense in t1, at the middle level of the corpus callosum, internal capsule, cerebellum and right middle cerebellar peduncle. The audiometry evidenced bilateral perceptual hearing loss, predominantly in the left ear. Angiography by optical coherence tomography showed obstruction in the deep layer retina arteries. The Susac syndrome was diagnosed and treatment started with methylprednisolone pulses therapy, intravenously 1000 mg/day for 5 days, followed by maintenance with mycophenolate, which completely reversed the encephalopathy, with persistence of mild ataxia and hearing loss. It is important to know the clinical triad characteristic and the complementary studies necessary to arrive at the diagnosis, since immunosuppressive treatment can often be delayed. Our case had an excellent response to corticosteroids.
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Affiliation(s)
- Juan Pablo Paviolo
- Servicio de Neurología, Hospital SAMIC Eldorado, Misiones, Argentina. E-mail:
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192
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Abstract
Following the initial description of HINTS to diagnose acute vestibular syndrome (AVS) in 2009, there has been significant interest in the systematic evaluation of HINTs to diagnose stroke and other less common central causes of AVS. This trend increased with availability of the video head impulse test (video-HIT). This article reviews the original papers and discusses the main publications from 2009 to 2017. Many authors use video-HIT in the diagnosis of patients with AVS; this paper focuses on the major publications on the topic featuring nystagmus, manual and video-HIT, and skew deviation. Twenty-five papers provide a summary of the last 8 years' application of HINTS, the video-HIT added quantitative information to the early clinical observations. Further research will undoubtedly provide specific combination of abnormalities with high degree of lesion localisation and aetiology. In a short time following the original description, neurotologist and neurologists in the evaluation of AVS use the HINTS triad. The introduction of the video-HIT added greater understanding of the complex interaction between the primary vestibular afferents, brainstem and cerebellum. In addition, it permits evaluation of the angular vestibulo-ocular reflex in the plane of all six semicircular canals, with accurate peripheral versus central lesion localisation often corroborated by brain imaging.
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Affiliation(s)
- Jorge C Kattah
- Department of Neurology, University of Illinois College of Medicine, Peoria, Illinois, USA
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193
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Abstract
Dizziness can be due to pathology from multiple physiologic systems, the most common being vestibular. Dizziness may be categorized as vertigo, disequilibrium, lightheadedness, or oscillopsia. Vertigo is an illusion of motion often caused by asymmetrical vestibular input to the brainstem. To evaluate vertigo, it is essential to include the symptom's quality, timing, frequency, trigger, influence from positional changes, and other associations from the history. Oculomotor, otologic, balance testing, positional testing, and nystagmus testing are equally important components of the examination. Two of the most common diagnoses are readily treated with canalith repositioning maneuvers and vestibular rehabilitation exercises.
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Affiliation(s)
- Sharmeen Sorathia
- Ziauddin University College of Medicine, 4/B, Shahrah-e-Ghalib, Block 6, Clifton, Karachi 75600, Pakistan; Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.
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194
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Abstract
The patients with sudden sensorineural hearing loss (SSNHL) may complain of vertigo. Although there have been many reports on SSNHL with vertigo (SSNHL_V), changes in the pattern of nystagmus have not been studied as yet. This study is a retrospective study and aims to investigate the characteristic changes in type of nystagmus and clinical features in patients with SSNHL_V who experienced a change in their nystagmus pattern during follow-up. Among 50 patients with SSNHL_V between January 2012 and December 2015, we identified 15 patients with SSNHL_V whose pattern of nystagmus changed. Initial nystagmus was classified into 5 subgroups: paretic type, irritative type, persistent geotropic direction-changing positional nystagmus (PG-DCPN), persistent apogeotropic direction-changing positional nystagmus (PA-DCPN), and posterior semicircular canal benign paroxysmal positional vertigo. The most common pattern of initial nystagmus was PG-DCPN (n = 7). The change of initial nystagmus pattern occurred on day 2 to 75 from symptom onset, and 2 (of 15) patients showed further conversion. The most common pattern of final nystagmus was PA-DCPN (n = 9). Hearing improvement after treatment was not significantly different (P = .59) between SSNHL_V patients with nystagmus change (25 ± 17 dB, n = 15) and those without nystagmus change (28 ± 18 dB, n = 35). In conclusion, clinician's attention is required in evaluating the vertigo symptom in patients with SSNHL_V because the initial patterns of nystagmus can be converted to another type of nystagmus. The presence of nystagmus change during follow-up may not be a prognosticator for hearing recovery in patients with SSNHL_V.
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195
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Abstract
BACKGROUND Post-traumatic vertigo, dizziness and balance disorders following head trauma range from 15% to 78% in the general population. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in such patients. OBJECTIVES The aim of the study was to assess the occurrence of BPPV in patients with mild traumatic brain injury (MTBI) and determine the outcome of treatment. MATERIAL AND METHODS A group of 179 patients, with a mean age of 45.2 years, complaining of vertigo/ /dizziness and balance instability after MTBI, was enrolled into the study. All these patients were diagnosed and treated in the Department of Otolaryngology (Medical University of Lodz, Poland) between the years 2012 and 2014. Anamnesis and otoneurological examination were conducted in each patient. The diagnosis was based on the medical history, the Dix-Hallpike test or the rollover test. The treatment comprised the Epley, barbecue and particle repositioning (RM) maneuvers. RESULTS Nineteen patients (10.6%) complained about attacks of vertigo elicited by positional changes. The diagnosis of BPPV was confirmed in 9 (47.4%) patients: 8 cases with a positive Dix-Hallpike test and 1 with the roll test. In 10 cases, a high probability of BPPV was diagnosed based on the medical history. Eight patients were treated by a single Epley maneuver and 1 patient by the barbecue roll. In 4 (44.4%) patients, the maneuvers were repeated. On the follow-up examination, the patients were not found to have vertigo. CONCLUSIONS Benign paroxysmal positional vertigo should be diagnosed and treated successfully in patients after head trauma.
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Affiliation(s)
| | - Anna Pajor
- Department of Otolaryngology, Medical University of Lodz, Poland
| | - Wojciech Skóra
- Otolaryngology Department, The Stanisław Rybicki Memorial Regional Hospital, Skierniewice, Poland
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Kovacs E, Stephan AJ, Phillips A, Schelling J, Strobl R, Grill E. Pilot cluster randomized controlled trial of a complex intervention to improve management of vertigo in primary care (PRIMA-Vertigo): study protocol. Curr Med Res Opin 2018; 34:1819-1828. [PMID: 29565189 DOI: 10.1080/03007995.2018.1456413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Vertigo and dizziness are highly prevalent symptoms in primary care, frequently misdiagnosed. Based on a thorough need assessment, INDICORE (INform, DIagnose, COmmunicate, REfer), an evidence-based complex intervention has been developed to transfer knowledge of specialized tertiary clinics to primary care providers (PCPs), improve the referral process and, ultimately, improve the functioning and quality of life of patients with vertigo/dizziness. The main objective of the PRIMA-Vertigo pilot study is to examine whether the INDICORE intervention is feasible and sufficiently promising to warrant a larger trial. METHODS We plan to perform a single-blind, pragmatic cluster-randomized controlled pilot study with an accompanying process evaluation. PCPs will be the cluster units of randomization. Patients who consult these PCPs because of vertigo/dizziness symptoms will be included consecutively and considered the units of analysis. The intervention will be multi-faceted training on diagnostics targeted at the PCPs, supported by patient education material and a newly developed tool to structure the referral process. To balance the influence of non-specific effects, all clusters will receive generic communication training. EXPECTED RESULTS The process evaluation aims to provide results on the acceptability and feasibility of the INDICORE intervention components to PCPs and patients. Additionally, this study will provide a first estimate of the likely effectiveness of the intervention on patients' quality of life, functioning and participation. CONCLUSIONS The PRIMA-Vertigo pilot study will allow further tailoring of the INDICORE intervention to stakeholder needs before its effectiveness is evaluated in a large-scale main study.
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Affiliation(s)
- Eva Kovacs
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Anna-Janina Stephan
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Amanda Phillips
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Jörg Schelling
- c Ludwig-Maximilians-Universität München, University Hospital - Institute for General Practice and Family Medicine , Germany
| | - Ralf Strobl
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Eva Grill
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
- d Ludwig-Maximilians-Universität München - Munich Center of Health Sciences , Germany
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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198
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Wu V, Beyea MM, Simpson MT, Beyea JA. Standardizing your approach to dizziness and vertigo. J Fam Pract 2018; 67:490-498. [PMID: 30110495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
First, determine whether the sensation the patient is experiencing is dizziness or true vertigo. Then eliminate ominous causes from the array of benign ones.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology, Queen's University School of Medicine; Hotel Dieu Hospital, Kingston, Ontario, Canada
| | - Michael M Beyea
- Department of Emergency Medicine & Critical Care Medicine, Victoria Hospital London Health Sciences Centre, London, Ontario, Canada
| | - Matthew Tw Simpson
- Department of Family Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Jason A Beyea
- Department of Otolaryngology, Queen's University School of Medicine, Kingston, Ontario, Canada.
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199
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Abstract
BACKGROUND Otitis externa secondary to irritant or chemical exposure is well documented; however, specifically secondary to jet fuel exposure and its associated toxicology is not. Over 2 million military and civilian personnel per year are occupationally exposed to aviation fuels. CASE REPORT An aircraft maintainer presented with noninfectious acute otitis externa secondary to external ear canal exposure to JP-5 jet fuel. Proper exposure guidelines were followed, but it was not realized that the external ear canal was involved. The first symptoms to emerge were vertigo, dizziness, and disequilibrium; however, on physical exam it appeared that there was no middle ear involvement. DISCUSSION Otitis externa normally does not present with vestibular symptoms as the pathology affects the external ear canal dermal tissue. Upon review of JP-5's toxicology profile, dermal absorption is a route of entry and can cause general neurological symptoms, including loss of coordination. This case highlights potential deficiencies in the standardized safety data sheets that are used after exposure. Without mention of possible auricular exposure one may focus on the logical protection of the eyes, mouth, and visible skin. This is concerning due to potential delayed exposure symptoms, dermal absorption, high level of dermal destruction, and the close proximity to the sensory system. The goal of this case report is to improve the knowledge of providers caring for personnel who may be exposed and to suggest possible revisions to the Safety Data Sheets for jet fuel.Long RJ, Charles RA. Aviation fuel exposure resulting in otitis externa with vertigo. Aerosp Med Hum Perform. 2018; 89(7):661-663.
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Han J, Wang T, Xie Y, Cao D, Kang Z, Song X. Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm: A case report. Medicine (Baltimore) 2018; 97:e11192. [PMID: 29924039 PMCID: PMC6024476 DOI: 10.1097/md.0000000000011192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Study reported an extremely rare case of trigeminal neuralgia, vestibular paroxysmia, and hemifacial spasm successively occurring in a patient with vertebrobasilar dolichoectasia (VBD). PATIENT CONCERNS A 66-year-old female patient presented with episodic vertigo for 20 days before she was admitted to our hospital. Vertigo suddenly occurred when the patient rotated her head 20 days ago, the symptoms of vertigo were improved after continuous 1 to 3 seconds, and similar symptoms were repeated in sleep and rest, with a frequency of 30 to 40 times per day. The patient had a history of hypertension with poor blood pressure control for more than 20 years. DIAGNOSES The final diagnosis was vertebrobasilar dolichectasia, right trigeminal neuralgia, and vestibular paroxysmia. INTERVENTIONS Vitamin B1 (10 mg), methylcobalamin (0.5 mg), and carbamazepine (0.1 g) were given orally 3 times a day to relieve the symptoms. OUTCOMES On the seventh day of drug treatment, the symptoms of paroxysmal vertigo and trigeminal neuralgia were completely relieved, but occasional episodes occurred during the follow-up period. Five months after discharge, right hemifacial spasm appeared in the patient, which did not affect the quality of life of the patient, so the patient did not choose further treatment. Six months after discharge, the patient was lost to follow-up. LESSONS Comprehensive treatment to control VBD risk factors, delay the progression of VBD, and improve clinical symptoms may have a better effect on such patients. However, further research is needed.
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Affiliation(s)
- Jingzhe Han
- Department of Neurology, Harrison International Peace Hospital, Hengshui
| | - Tingting Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui
| | - Yanan Xie
- Department of Angiocardiopathy, The Second Hospital of Hebei Medical University, Shijiazhuang
| | - Duanhua Cao
- Department of Neurology, Harrison International Peace Hospital, Hengshui
| | - Zhilei Kang
- Department of MRI, Harrison International Peace Hospital, Hengshui
| | - Xueqin Song
- Department of Neurology, The Second Hospital of Hebei Medical University
- Institute of Cardiocerebrovascular Disease
- Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, China
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