1
|
Mittal M. Diagnosing Emergencies in Undifferentiated Acute Vertigo. Indian J Otolaryngol Head Neck Surg 2024; 76:2314-2319. [PMID: 38883510 PMCID: PMC11169370 DOI: 10.1007/s12070-024-04493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
Background: Patients with undifferentiated acute dizziness usually report with rapid onset of severe, often disabling illusion of movement with many other features. This accounts for roughly 50 to 100 million visits globally in emergencies annually. The causes may be numerous. Thus, the perplexed clinician needs to pursue advanced diagnostic imaging and unnecessary hospital admission in these patients. Aims and objectives: This study aims to assess the validity of HINTS Plus (head impulse test-nystagmus-test of skew + hearing assessment) test in diagnosing central causes of vertigo in patients with acute undifferentiated vertigo presenting within 72 h of onset of symptoms. The other objectives are to understand epidemiology and describe the assessment and management of these patients. Method: The data of 82 patients who visited the clinic within 72 h of the onset of symptoms as mentioned earlier during two years from August 2021 to 2023 at Ankush Hospital was stratified and analyzed. The outcome is reported here. Results: Among 82 patients, peripheral vestibular cause accounts for 84%. 12% were due to ischemic stroke and cardiovascular reasons. The sensitivity of HINTS Plus in isolating central acute vestibular vertigo was 100%, and the specificity was 95.6%. Conclusion: The risk for central and cerebrovascular causes of dizziness increases in the elderly with the presence of neurological signs and other comorbidities. The sensitivity and specificity of HINTS plus (4 Components) is very high in identifying central causes of undifferentiated acute vestibular in the first 72 h of onset of symptoms when undertaken by a trained clinician. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-04493-2.
Collapse
Affiliation(s)
- Mudit Mittal
- Director and ENT and Head Neck Surgeon, Ankush Medicare and Health Sciences, 2/1 Avantika parisar, lalghati, Bhopal, M.P. 462010 India
| |
Collapse
|
2
|
Doniselli FM, Zanardo M, Mazon M, Cuccarini V, Rovira A, Costa A, Sconfienza LM, Arana E. A Critical Appraisal of the Quality of Vertigo Practice Guidelines Using the AGREE II Tool: A EuroAIM Initiative. Otol Neurotol 2022; 43:1108-1115. [PMID: 36214510 DOI: 10.1097/mao.0000000000003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this review is to assess the methodological quality of guidelines for the management of vertigo and dizziness and to compare their recommendations, with specific focus on neuroimaging. DATABASES REVIEWED MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence database. METHODS In March 2022, a systematic search was performed to find practice guidelines of management of vertigo and dizziness. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool. We excluded from the results those guidelines that were not primarily focused on vertigo and dizziness, such as national/international guidelines in which vertigo and dizziness were only briefly mentioned. RESULTS Our strategy of literature search identified 161 studies, and 18 guidelines were selected for the appraisal. Only five guidelines reached the acceptance level in the overall result (at least 60%), with three of them reaching the highest scores (at least 80%). The highest scores were found in Domain 6 "Editorial Independence," Domain 1 "Scope and purpose," and Domain 4 "Clarity of presentation" (median value = 66%, 62%, and 61%, respectively). The remaining domains showed a low level of quality: Domain 2 "Stakeholder Involvement," Domain 3 "Rigor of development," and Domain 5 "Applicability" had median values of 27%, 27%, and 22%, respectively. The quality of these guidelines was very low, because of low involvement of multidisciplinary teams in writing guidelines recommendations. CONCLUSION Considering all guidelines, only three had a "high" overall score, whereas 13 of 18 (72%) of them were rated as of "low" quality. Future guidelines might take this into account to improve clinical applicability.
Collapse
Affiliation(s)
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano
| | - Miguel Mazon
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonella Costa
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico
| | | | | |
Collapse
|
3
|
Altıntaş M, Korkut S. Investigation of coronavirus anxiety, health anxiety, and anxiety symptom levels in vertigo patients during COVID-19 pandemic. Braz J Otorhinolaryngol 2022; 89:313-320. [PMID: 36504161 PMCID: PMC9684103 DOI: 10.1016/j.bjorl.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic adversely affects the mental health of vertigo patients. Thus, this study aimed to investigate the effects of coronavirus anxiety, health anxiety, anxiety symptom levels, and demographic variables on vertigo and its severity in vertigo patients during the pandemic. METHODS This cross-sectional study was conducted from May 15 to November 15, 2021. In total, 118 patients with vertigo and 82 healthy controls participated in the study. Besides demographic and clinical data, Coronavirus Anxiety Scale (CAS), Hospital Anxiety Depression Scale-Anxiety Subscale (HAD-A), and Short Health Anxiety Inventory (SHAI) were applied to all participants. Additionally, Vertigo Symptom Scale-Short Form (VSS-SF) was administered to vertigo patients. RESULTS According to the findings, vertigo patients experienced higher levels of coronavirus anxiety, health anxiety, and anxiety disorder compared to the healthy controls. In vertigo patients, the rate of coronavirus anxiety was 20.3%, and the rate of anxiety disorder was 32.2%. Majority of the patients (80.5%) were found to have severe-level vertigo. Additionally, most of the patients (82.1%) reported that the severity of vertigo during the pandemic was higher than before the pandemic. CONCLUSIONS The COVID-19 pandemic causes serious mental health problems in vertigo patients, and pathological levels of these problems increase the discomfort of vertigo. Therefore, psychological assessment should be considered in these patients, and required psychological support and guidance services should be provided.
Collapse
Affiliation(s)
- Mustafa Altıntaş
- Antalya Training and Research Hospital, Department of Otorhinolaryngology, Antalya, Turkey,Corresponding author
| | - Süleyman Korkut
- Antalya Training and Research Hospital, Department of Psychiatry, Antalya, Turkey
| |
Collapse
|
4
|
Bamiou DE, Kikidis D, Bibas T, Koohi N, Macdonald N, Maurer C, Wuyts FL, Ihtijarevic B, Celis L, Mucci V, Maes L, Van Rompaey V, Van de Heyning P, Nazareth I, Exarchos TP, Fotiadis D, Koutsouris D, Luxon LM. Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results. J Neurol 2022; 269:2584-2598. [PMID: 34669009 PMCID: PMC8527447 DOI: 10.1007/s00415-021-10829-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. METHODS Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (- DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the "gold standard" against which the + DSS, - DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. RESULTS One hundred ninety-four participants (age range 25-85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the - DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the - DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the - DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. CONCLUSION There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. TRIAL REGISTRATION NUMBER NCT02704819 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Doris-Eva Bamiou
- The Ear Institute, University College London, London, WC1X 8EE, UK.
- University College London Hospitals NHS Trust, London, UK.
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Dimitris Kikidis
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Thanos Bibas
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Nehzat Koohi
- The Ear Institute, University College London, London, WC1X 8EE, UK
- University College London Hospitals NHS Trust, London, UK
| | - Nora Macdonald
- University College London Hospitals NHS Trust, London, UK
| | - Christoph Maurer
- Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Floris L Wuyts
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Laboratory for Equilibrium Investigations and Aerospace, University of Antwerp, Antwerp, Belgium
| | - Berina Ihtijarevic
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Laura Celis
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Viviana Mucci
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- School of Science, Western Sydney University, Sydney, NSW, Australia
| | - Leen Maes
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Vincent Van Rompaey
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios Koutsouris
- Biomedical Engineering Laboratory, National Technical University of Athens, Athens, Greece
| | - Linda M Luxon
- The Ear Institute, University College London, London, WC1X 8EE, UK
- University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
5
|
Abstract
Dizziness is a common complaint in otolaryngology clinics and can present a diagnostic challenge. A thorough history including onset, duration, and exacerbating and alleviating factors, along with physician persistence, can help differentiate between otologic and nonotologic forms of dizziness. An otologic and neurotologic physical examination, including vestibulo-ocular reflex and cranial nerve function evaluation and postural examination, can shed further light on symptom etiology. Otologic forms of dizziness often result in vertigo and may be associated with unilateral symptoms of hearing loss, aural fullness, or tinnitus. Primary causes of dizziness are more often constant and insidious in onset.
Collapse
|
6
|
Towards Providing an Automated Approach to Differentiating the Nystagmus of Ménière's Disease, Vestibular Migraine, and Benign Paroxysmal Positional Vertigo. Otol Neurotol 2021; 42:890-896. [PMID: 33606464 DOI: 10.1097/mao.0000000000003083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The diagnosis of vertigo is challenging, particularly as patients usually present while asymptomatic. We have developed an ambulatory medical device that allows vestibular telemetry to record eye movements over a 30-day period to aid the diagnosis of vertigo. We have undertaken proof-of-concept work to identify unique properties of nystagmus that could be used to differentiate between three of the most common causes of vertigo: Ménière's disease, vestibular migraine, and Benign Paroxysmal Positional Vertigo. PATIENTS We analyze the nystagmus from patients with a diagnosis of Ménière's disease, vestibular migraine, and Benign Paroxysmal Positional Vertigo. INTERVENTIONS Our vestibular telemetry system includes a wearable, ambulatory monitor which continuously records horizontal and vertical eye-movements, as well as three-axis movements of the head. MAIN OUTCOME MEASURES Horizontal and vertical eye-movement data, and three-axis head positioning data. RESULTS Sixteen participants were enrolled onto the study and three reported experiencing rotatory vertigo during their 30-day trial, confirmed by the presence of nystagmus in their eye-movement traces. Vestibular telemetry revealed distinct differences between the nystagmus produced during an acute Ménière's attack, and attacks of vestibular migraine and Benign Paroxysmal Positional Vertigo. Attack frequency, nystagmus duration, whether the nystagmus onset was motion provoked, nystagmus direction, slow phase velocity, and slow phase duration were found to be discriminatory features that could be exploited to allow an automated diagnosis to be made. CONCLUSIONS The data provided by vestibular telemetry can be used to differentiate between different inner-ear causes of dizziness.
Collapse
|
7
|
Talebi RZ, Rezasoltani A, Khalkhalizavieh M, Manshadi FD, Baghban AA. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonography. J Phys Ther Sci 2020; 32:439-443. [PMID: 32753783 PMCID: PMC7344283 DOI: 10.1589/jpts.32.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
[Purpose] Cervical vertigo as a common complaint is associated with some
musculoskeletal disorders. However, to date, ultrasonographical parameters of cervical
muscles in patients with cervical vertigo have not been investigated. This study was
conducted to investigate size of cervical muscles in patients with cervical vertigo
compared to healthy controls. [Participants and Methods] Thicknesses of cervical flexor
and extensor muscles were evaluated through ultrasonography and results were compared
between the patients and healthy controls by Independent Samples t-test or Mann-Whitney U
nonparametric test. [Results] Results showed that, thickness of Longus Colli muscle was
significantly different between the patients and healthy controls. [Conclusion] According
to findings of the study, size of Longus Colli muscle is likely to be associated with
etiology of cervical vertigo.
Collapse
Affiliation(s)
- Ronak Zargar Talebi
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Asghar Rezasoltani
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Minoo Khalkhalizavieh
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Farideh Dehghan Manshadi
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran 161679, Iran
| |
Collapse
|
8
|
YILDIRIM M, DOĞAN MT, KEÇELİ AM. Çocuk nöroloji bölümüne baş dönmesi şikâyeti ile konsülte edilen hastaların retrospektif değerlendirmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.756284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
9
|
Vanderkam P, Blanchard C, Naudet F, Pouchain D, Vaillant Roussel H, Perault-Pochat MC, Jaafari N, Boussageon R. Efficacy of acetylleucine in vertigo and dizziness: a systematic review of randomised controlled trials. Eur J Clin Pharmacol 2019; 75:603-607. [PMID: 30613860 DOI: 10.1007/s00228-018-02617-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the efficacy of acetylleucine to improve or stop an attack of vertigo and dizziness (vertigo/dizziness). METHODS Systematic review by 2 independent reviewers. Consultation of the Medline, Cochrane and ClinicalTrials.gov databases until September 2018. Keywords used: Acetylleucine, Tanganil®, Acetyl-DL-leucine, Acetyl-leucine. Trial selection: randomised controlled trials (RCTs) comparing acetylleucine against placebo. RESULTS Up until 2018, no RCTs have been published on the efficacy of acetylleucine in vertigo/dizziness. CONCLUSION There is no solid evidence of the efficacy of acetylleucine in vertigo/dizziness. Given its frequent prescription and the cost generated for the French social security system, high-quality randomised trials should be carried out to assess its efficacy.
Collapse
Affiliation(s)
- Paul Vanderkam
- Department of General Medicine, University of Poitiers, 6 rue de la Milétrie, TSA 51115, 86073, Poitiers Cedex 9, France. .,Clinical Research Unit, Henri Laborit Hospital, 370 av. Jacques cœur, CS 10587, 86021, Poitiers, France.
| | - Clara Blanchard
- Department of General Medicine, University of Poitiers, 6 rue de la Milétrie, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 (Clinical Center of Investigation, Rennes), Univ Rennes, F-35000, Rennes, France
| | - Denis Pouchain
- Department of General Medicine, University of Tours, 10 boulevard Tonnelé, BP 3223, 37032, Tours Cedex 1, France
| | - Helene Vaillant Roussel
- Department of General Medicine and UPU ACCePPT, University of Auvergne Clermont-Ferrand Cedex 1, France28 place Henri Dunant, BP 38, 63001, Clermont-Ferrand Cedex 1, France
| | - Marie Christine Perault-Pochat
- Clinical Pharmacology and Awareness Department, University Hospital of Poitiers, 2 rue de la Milétrie, BP 577, 86021, Poitiers Cedex, France
| | - Nematollah Jaafari
- CNRS 3557, CIC-P 1402 and Clinical Research Unit, Henri Laborit Hospital, 370 av. Jacques cœur, CS 10587, 86021, Poitiers, France
| | - Rémy Boussageon
- University College of General Medicine and UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude-Bernard Lyon 1 University, CNRS, Lyon, 69622, France
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Shen Z, Kong D. Meta-analysis of the adverse events associated with extended-release versus standard immediate-release pramipexole in Parkinson disease. Medicine (Baltimore) 2018; 97:e11316. [PMID: 30142750 PMCID: PMC6112990 DOI: 10.1097/md.0000000000011316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [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
BACKGROUND In order to increase treatment choices for patients with Parkinson disease (PD), we performed a retrospective assessment of adverse events associated with a novel once-daily extended-release (ER) formulation versus the standard immediate-release (IR) of the nonergolinic dopamine agonist, pramipexole. METHODS The PubMed and Embase databases, as well as the foreign language medical information resource retrieval platform were searched from 2007 to 2017. The relative risks (RR) of various adverse events with 95% confidence intervals (95% CIs) were generated. The Modified Jadad score (MJs) was used to assess the quality of individual studies. Funnel plots were used to evaluate publication bias. RESULTS Three randomized controlled trials involving 1021 patients were included in this meta-analysis. We evaluated common adverse events associated with pramipexole in the gastrointestinal and nervous systems. These included the typical gastrointestinal symptom of nausea (RR = 0.96, 95% CI: 0.72-1.28; P = .80 > .05) and nervous system symptoms of somnolence (RR = 1.16, 95% CI: 0.95-1.43; P = .14 > .05), dizziness (RR = 1.11, 95% CI: 0.80-1.54; P = .54 > .05), and dyskinesia (RR = 0.87, 95% CI: 0.47-1.60; P = .66 > .05). CONCLUSION Patients with PD treated with 2 different pramipexole formulations (ER and IR) had similar incidences of common adverse events.
Collapse
|
12
|
Feil K, Feuerecker R, Goldschagg N, Strobl R, Brandt T, von Müller A, Grill E, Strupp M. Predictive Capability of an iPad-Based Medical Device (me dx) for the Diagnosis of Vertigo and Dizziness. Front Neurol 2018. [PMID: 29535671 PMCID: PMC5835100 DOI: 10.3389/fneur.2018.00029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. Objective In this study we examined the performance of the iPad based program medx in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. Patients and methods The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The “gold standard diagnosis” was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient’s case in the constellatory diagnostic system of medx based on an algorithm using all available clinical information. These diagnoses were compared to the “gold standard” by retrospective review of the charts of the patients. The accuracy provided by medx was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity), of being test negative when a disease was absent (specificity), of having the disease when the test is positive (positive predictive value) and of not having the disease when the test is negative (negative predictive value) for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by medx. Results A total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of medx in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%), Menière’s disease (77.8, 97.6, 87.0, and 95.3%), benign paroxysmal positional vertigo (61.7, 98.3, 86.6, and 93.4%), downbeat nystagmus syndrome (69.6, 97.7, 71.1, and 97.5%), vestibular migraine (34.7, 97.8, 76.1, and 88.3%), and phobic postural vertigo (80.5, 82.5, 52.5, and 94.6%). Conclusion This study demonstrates that medx is a new and easy approach to screen for different diagnoses. With the high specificity and negative predictive value, the system helps to rule out differential diagnoses and can therefore also lead to a cost reduction in the health care system. However, the sensitivity was unexpectedly low, especially for vestibular migraine. All in all, this device can only be a complementary tool, in particular for non-experts in the field.
Collapse
Affiliation(s)
- Katharina Feil
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Regina Feuerecker
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nicolina Goldschagg
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute for Clinical Neurosciences, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Eva Grill
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Strupp
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| |
Collapse
|
13
|
Papa L, Amodio A, Biffi F, Mandara A. Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. J Bodyw Mov Ther 2017; 21:866-872. [PMID: 29037641 DOI: 10.1016/j.jbmt.2017.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 11/30/2022]
Abstract
The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.
Collapse
Affiliation(s)
- L Papa
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy.
| | - A Amodio
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - F Biffi
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - A Mandara
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| |
Collapse
|
14
|
Ferreira LMDBM, Jerez-Roig J, Ribeiro KMOBDF, Moreira FSM, Lima KCD. Associação entre medicamentos de uso contínuo e tontura em idosos institucionalizados. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171937017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: associar medicamentos de uso contínuo com a presença de tontura em idosos institucionalizados. Métodos: trata-se de um estudo transversal realizado em 10 Instituições de longa permanência para idosos. Foram incluídos todos os idosos a partir de 60 anos que fossem capazes de deambular e que apresentassem bom nível cognitivo. Foram coletadas as medicações de uso contínuo e dados referentes à Instituição. Ao idoso, foi questionado se apresentou tontura no último ano. Para análise estatística, utilizou-se os testes do Qui-quadrado e Exato de Fisher para análise bivariada e regressão logística para análise múltipla stepwise forward, com nível de significância de 5%. Resultados: dos 92 idosos avaliados, 35 afirmaram terem apresentado tontura nos últimos 12 meses (23,8%). Foram associados à tontura os antiepilépticos (p=0,034, RR= 2,26, IC95% 1,06-4,78), anti-trombóticos (p=0,008, RR= 0,21, IC95% 0,07-0,67) e diuréticos (p=0,024, RR= 2,29, IC95% 1,11-4,70), ajustados pelos psicolépticos. Conclusão: a tontura nos idosos institucionalizados esteve associada ao uso crônico de anti-epilépticos e diuréticos.
Collapse
|
15
|
Rethorn Z, Barlow SJ, Gavlick E. Differential diagnosis of a patient referred to physical therapy for dizziness: a case report. Physiother Theory Pract 2017; 33:254-259. [PMID: 28339331 DOI: 10.1080/09593985.2017.1288281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Case report. BACKGROUND Dizziness is a common and debilitating condition across the lifespan. Patients with this complaint must be carefully examined to determine the cause of dizziness, rule out the presence of central nervous system dysfunction, and determine the appropriateness of physical therapy intervention. CASE DESCRIPTION A 90-year-old male was referred to physical therapy six months after the onset of dizziness. A thorough history was taken and examination was performed. Signs consistent with central nervous system dysfunction and peripheral vestibular dysfunction were observed. The patient was treated for the peripheral vestibular disorder and referred back to his physician for further testing. Imaging revealed that the patient had idiopathic normal pressure hydrocephalus. DISCUSSION This case illustrates the need for physical therapists to perform thorough examinations of patients with a primary complaint of dizziness and properly interpret positive central signs, indicating a potential need for referral to a physician or other healthcare provider when they appear.
Collapse
Affiliation(s)
- Zachary Rethorn
- a Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - Susan J Barlow
- a Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA.,b Siskin Hospital for Rehabilitation , Chattanooga , TN , USA
| | - Emily Gavlick
- b Siskin Hospital for Rehabilitation , Chattanooga , TN , USA
| |
Collapse
|
16
|
|
17
|
Exarchos T, Rigas G, Bibas A, Kikidis D, Nikitas C, Wuyts F, Ihtijarevic B, Maes L, Cenciarini M, Maurer C, Macdonald N, Bamiou DE, Luxon L, Prasinos M, Spanoudakis G, Koutsouris D, Fotiadis D. Mining balance disorders' data for the development of diagnostic decision support systems. Comput Biol Med 2016; 77:240-8. [DOI: 10.1016/j.compbiomed.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
|
18
|
Yu TY, Lee DH. Dizziness and Syncope Related with Diabetic Autonomic Neuropathy. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2016. [DOI: 10.18501/arrhythmia.2016.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
19
|
Chiu CW, Lee TC, Hsu PC, Chen CY, Chang SC, Chiang JY, Lo LC. Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:173. [PMID: 26055400 PMCID: PMC4459064 DOI: 10.1186/s12906-015-0704-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/29/2015] [Indexed: 12/04/2022]
Abstract
Background Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Pharmacological therapy is often applied for these symptoms, such as vestibular suppressants, anti-emetics and benzodiazepines. However, every medication is accompanied with unavoidable side-effects. There are several research articles providing evidence of acupuncture treating dizziness and vertigo but few studies of acupuncture as an emergent intervention in ED. We performed a pilot cohort study to evaluate the efficacy and safety of acupuncture in treating patients with dizziness and vertigo in ED. Methods A total of 60 participants, recruited in ED, were divided into acupuncture and control group. Life-threatening conditions or central nervous system disorders were excluded to ensure participants’ safety. The clinical effect of treating dizziness and vertigo was evaluated by performing statistical analyses on data collected from questionnaires of Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS) of dizziness and vertigo, and heart rate variability (HRV). Results The variation of VAS demonstrated a significant decrease (p-value: 0.001 and p-value: 0.037) between two groups after two different durations: 30 mins and 7 days. The variation of DHI showed no significant difference after 7 days. HRV revealed a significant increase in high frequency (HF) in the acupuncture group. No adverse event was reported in this study. Conclusion Acupuncture demonstrates a significant immediate effect in reducing discomforts and VAS of both dizziness and vertigo. This study provides clinical evidence on the efficacy and safety of acupuncture to treat dizziness and vertigo in the emergency department. Trial registration ClinicalTrials.gov ID: NCT02358239. Registered 5 February 2015
Collapse
|
20
|
Chimirri S, Aiello R, Mazzitello C, Mumoli L, Palleria C, Altomonte M, Citraro R, De Sarro G. Vertigo/dizziness as a Drugs' adverse reaction. J Pharmacol Pharmacother 2013; 4:S104-9. [PMID: 24347974 PMCID: PMC3853661 DOI: 10.4103/0976-500x.120969] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Vertigo, dizziness, and nausea encompass a spectrum of balance-related symptoms caused by a variety of etiologies. Balance is affected by many systems: Proprioceptive pathways and visual, cerebellar, vestibulocochlear, and vascular / vasovagal systems. Vertigo is a subtype of dizziness, in which a subject, as a result to a dysfunction of the vestibular system, improperly experiments the perception of motion. The most useful clinical subdivision is to categorize vertigo into true vertigo and pseudovertigo, whereas from a pathophysiological point of view, vertigo can be classified into central, peripheral, and psychogenic. It is not easy to identify the cause of vertigo since the patients often are not able to precisely describe their symptoms. An impressive list of drugs may cause vertigo or dizziness. MATERIALS AND METHODS The aim of the present study was to analyze the data extracted from the reporting cards of the ADRs (adverse drug reactions), received at our Pharmacovigilance Regional Center (Calabria, Italy) in 2012. In particular, the data concerning the occurrence of vertigo and dizziness, after taking certain classes of drugs, have been considered. RESULTS Our results show that, among the side-effects of different classes of drugs such as anti-convulsants, anti-hypertensives, antibiotics, anti-depressants, anti-psychotics, and anti-inflammatory, also vertigo or dizziness are included. CONCLUSIONS Spontaneous reports of vertigo or dizziness, as side-effect of certain drugs, received at our Pharmacovigilance Center, represented the 5% of all reports in 2012. Considering the high incidence of such an ADR for several drugs' classes, it can be speculated that under-reporting also affect vertigo and dizziness. Despite the fact that these ADRs might not represent a direct threaten for life, indirectly they can cause secondary damage to patients such as falls, fractures etc. Balance should be accurately monitored during drug use and particularly in fragile patients.
Collapse
Affiliation(s)
- Serafina Chimirri
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | - Rossana Aiello
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | - Carmela Mazzitello
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | - Laura Mumoli
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | - Caterina Palleria
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | | | - Rita Citraro
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Science of Health, School of Medicine, University of Catanzaro, Italy and Pharmacovigilance's Center Calabria Region, University Hospital Mater Domini, Catanzaro, Italy
| |
Collapse
|
21
|
|
22
|
Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neurol 2012; 3:169. [PMID: 23226141 PMCID: PMC3508265 DOI: 10.3389/fneur.2012.00169] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/08/2012] [Indexed: 11/13/2022] Open
Abstract
Objective: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient. Materials and methods: Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65 years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses. Results: Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (<65 year from 12.7 to 25.1%) and older patients (from 20.7 to 37.6%). Striking relative increases were found for the diagnoses multisensory dizziness in older patients (from 20.7 to 37.6%) and vestibular migraine in younger patients (1.8 to 20.2%). In both age groups, the proportion of patients with undetermined diagnoses was reduced by about 60% (younger: 69.8 to 9.8%; older: 69.2 to 12.4%) by the diagnostic procedures in the vertigo center. These changes were all significant (p < 0.05) in McNemar tests with continuity correction (2 × 2 tables: focused diagnosis vs. other diagnoses, referral vs. final). Conclusion: Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.
Collapse
Affiliation(s)
- Rebekka Geser
- Department of Neurology, University Hospital Zurich Zurich, Switzerland
| | | |
Collapse
|
23
|
Abstract
OBJECTIVE The study examines categorical responses to questions on a comprehensive dizziness questionnaire, to find the overall predictive power of the questionnaire, and to identify which question(s) are most predictive of each diagnosis. STUDY DESIGN Retrospective chart review. SETTING Specialized dizziness and balance center at a tertiary care hospital. PATIENTS A total of 619 patients (aged 19-89 yr, of whom 60% are women and 40% are men) diagnosed with 1 of 23 types of dizziness or postural instability. INTERVENTION All patients were administered a standard 163-item dizziness questionnaire (including 77 review of systems items). OUTCOME MEASURES Predicted diagnoses from the questionnaire, as determined by binary and multinomial logistic regressions, are compared with an ultimate clinical diagnosis made by an expert neurotologist based on full interview, examination, and clinical tests. RESULTS Significant question groupings exist for each of the main diagnoses. A subset of 47 questions under multinomial logistic regression gave high predictive accuracies for migraine (92%), benign paroxysmal positional vertigo (90%) and Ménière's disease (86%), and fair predictive power for vestibular neuritis (63%), contributing to an overall predictive accuracy of 84%. A smaller subset of 32 questions gave an overall predictive accuracy of 71%. CONCLUSION The capability of historical data to accurately predict the ultimate diagnosis for dizziness emphasizes the importance of a structured questionnaire in the evaluation of such patients. Future developments include the formulation of a computer-based program to generate a differential diagnosis for the practitioner to consider.
Collapse
|
24
|
Kulstad C, Hannafin B. Dizzy and confused: a step-by-step evaluation of the clinician's favorite chief complaint. Emerg Med Clin North Am 2010; 28:453-69. [PMID: 20709238 DOI: 10.1016/j.emc.2010.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article covers the general approach to patients who present to the emergency department with a complaint of dizziness or vertigo, and altered mentation. Patients' histories and physical examination findings are discussed first, then a pertinent differential diagnosis, ranging from neurological causes and poor perfusion states to toxicologic causes, is described along with the distinguishing features and potential diagnostic pitfalls of each problem. Case scenarios are presented and the treatment and disposition of patients from the emergency department are discussed.
Collapse
Affiliation(s)
- Christine Kulstad
- Department of Emergency Medicine, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA.
| | | |
Collapse
|
25
|
Osteopathic Manipulative Treatment and Vertigo: A Pilot Study. PM R 2010; 2:612-8. [DOI: 10.1016/j.pmrj.2010.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 03/17/2010] [Accepted: 04/05/2010] [Indexed: 11/18/2022]
|
26
|
Cunha LCM, Felipe L, Carvalho SA, Labanca L, Tavares MC, Gonçalves DU. Validade da prova calórica monotermal em comparação à estimulação bitermal. ACTA ACUST UNITED AC 2010; 22:67-70. [DOI: 10.1590/s0104-56872010000100013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 02/01/2010] [Indexed: 11/22/2022]
Abstract
TEMA: a estimulação calórica monotermal tem sido considerada como alternativa à prova calórica bitermal para triagem das assimetrias vestibulares. OBJETIVO: avaliar a confiabilidade da estimulação monotermal em relação à bitermal para o diagnóstico das assimetrias labirínticas. MÉTODO: avaliaram-se 389 resultados de vectoelectronistagmografia realizados entre 1998 e 2007. A estimulação monotermal de 30ºC e 44ºC com pontos de corte de predomínio labiríntico (PL) em 20% e em 25% foi comparada à bitermal com ponto de corte em 25% (padrão ouro). Na análise, interessou encontrar qual foi à prova monotemal (30°C ou 44°C) e com qual ponto de corte (20% ou 25%) que apresentou os valores mais elevados de sensibilidade e especificidade quando comparada à prova bitermal. RESULTADOS: a sensibilidade e especificidade da prova monotermal foram respectivamente de: 84% e 80%, a 30°C com PL em 20%; 78% e 90%, a 30°C com PL em 25%; 81% e 78%, a 44°C com PL em 20%; 76% e 85%, a 44°C com PL em 25%. CONCLUSÃO: a prova monotermal com estimulo a 30°C apresentou valores mais elevados de sensibilidade e especificidade quando comparada a bitermal. Contudo, não se observou diferença significativa em relação aos valores observados com estímulo a 44°C. Em todas as análises, a prova monotermal apresentou a limitação da baixa sensibilidade, de modo que testes alterados pela bitermal podem passar como normais pela prova monoternal. Ao se decidir pela realização da prova monotermal como triagem, deve-se realizá-la em indivíduos com menor probabilidade de estar com doença vestibular, a partir da história clínica.
Collapse
|
27
|
Schapiro RT. The symptomatic management of multiple sclerosis. Ann Indian Acad Neurol 2010; 12:291-5. [PMID: 20182577 PMCID: PMC2824957 DOI: 10.4103/0972-2327.58278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 03/30/2009] [Accepted: 07/06/2009] [Indexed: 11/26/2022] Open
Abstract
The management of multiple sclerosis (MS) revolves around disease management, symptom management, and person management. Of these, symptom management takes up the bulk of the time of the practicing physician. Some symptoms are easily managed whereas others are more difficult. Decisions have often to be made on whether to treat or to wait and watch. This article discusses the varied symptoms of MS and the approaches to management, which involves rehabilitation, pharmacological treatments, and surgical procedures. The skilled physician managing MS should be familiar with the multiple approaches to improving the quality of life of those with MS. After the diagnosis has been established and the decisions regarding treatment approaches have been made, the talk in a typical office appointment for MS usually turns to symptom management. Thus, the majority of management decisions made by the clinician revolve around that important topic. It is symptom management that will determine quality of life for those with MS, It is the basis for improving function, and, up until twenty years ago, it was the only basis for treating MS. Now, however, we can approach treatment by disease management, symptom management, and person management. The MS specialist must be well versed in all three areas.
Collapse
Affiliation(s)
- Randall T Schapiro
- The Schapiro Multiple Sclerosis Advisory Group and Clinical Professor of Neurology, University of Minnesota, USA
| |
Collapse
|
28
|
Lim HW, Chae SW. Evaluation and treatment of the patient with acute dizziness in primary care. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.10.898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyun Woo Lim
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung Won Chae
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Nørregaard AR, Lauridsen HH, Hartvigsen J. Chiropractic management of a patient with benign paroxysmal positional vertigo: a case report. J Manipulative Physiol Ther 2009; 32:387-90. [PMID: 19539122 DOI: 10.1016/j.jmpt.2009.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 03/09/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article describes and discusses the case of a patient with benign paroxysmal positional vertigo (BPPV) characterized by severe vertigo with dizziness, nausea, and nystagmus, treated without the use of spinal manipulation by a doctor of chiropractic. CLINICAL FEATURES A 46-year-old woman presented for care with complaints of acute vertigo and dizziness. INTERVENTION AND OUTCOME The patient was examined and diagnosed with left posterior canalolithiasis by means of the Dix-Hallpike maneuver. She was treated successfully with the Epley maneuver once and subsequently discharged without further treatment. CONCLUSION This case demonstrates the importance of correctly identifying patients with BPPV. This case also demonstrates the successful treatment of BPPV.
Collapse
Affiliation(s)
- Anette R Nørregaard
- Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | | | | |
Collapse
|
30
|
Felipe L, Cunha LCM, Cunha FCM, Cintra MTG, Gonçalves DU. [Presbyvertigo as a cause of dizziness in elderly]. ACTA ACUST UNITED AC 2009; 20:99-103. [PMID: 18622517 DOI: 10.1590/s0104-56872008000200005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 05/09/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND dizziness is a frequent complaint in the geriatric population and has a negative impact in the life quality of these individuals. AIM to correlate the types of dizziness and alterations in the caloric test and to verify the frequency of presbyvertigo in an elderly population with dizziness. METHOD The records of 132 patients aged over 60 and with balance disturbance were reviewed. These patients were evaluated in the Otoneurology Service of the Clinical Hospital of the Federal University of Minas Gerais between the years of 1998 and 2007. The variables considered for analysis were: epidemiologic data, clinical history, associated diseases and the result of the caloric test. Patients with positional and central vertigo were excluded from the analysis. RESULTS The research sample consisted of 120 patients, with an average age was of 70 years, being 71% (n=87) of sample women. Vertigo with the duration of a few minutes and of a daily frequency was the most frequent type of dizziness. In relation to the caloric test, normal results were observed in 73% of the sample. Altered results included unilateral weakness (14%), bilateral weakness (10%) and hyperactive caloric response (3%). Correlating the caloric test with the type of dizziness, bilateral weakness was associated with postural instability (p=0.006; IC=2 - 419). CONCLUSION dizziness in elderly has many causes. Bilateral weakness of the vestibular function can be related to presbyvertigo and must be considered in aged individuals who present unbalance. Metabolic, psychiatric, disautonomic, orthopedic, visual and proprioceptive disturbances may be the cause of dizziness in aged individuals who present normal vestibular evaluation.
Collapse
|
31
|
Scheenstra RJ, Rijntjes E, Tavy DL, Kingma H, Heijerman HG. Vestibulotoxicity as a consequence of systemically administered tobramycin in cystic fibrosis patients. Acta Otolaryngol 2009; 129:4-7. [PMID: 18607923 DOI: 10.1080/00016480801968534] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION The reported prevalence of vestibulotoxicity (30.4%) in cystic fibrosis (CF) patients supports vestibulotoxicity screening in CF patients during or after tobramycin exposure. Prospective longitudinal investigation is required for a more specific evidence-based proposal. OBJECTIVE To investigate the prevalence of tobramycin-induced vestibulotoxicity in CF patients, as it had not been investigated before. PATIENTS AND METHODS In this observational cohort study, 23 CF patient volunteers from the Haga Teaching Hospital Adult CF centre who had been exposed to at least one treatment with systemically administered tobramycin were included. Subjective feelings of dizziness were measured using validated questionnaires and vestibular symptoms were assessed by physical examination. Electronystagmography (ENG) with caloric irrigation was used as the gold standard. RESULTS Peripheral vestibular loss was found in seven patients (7/23 = 30.4%). Central vestibular loss was found in one patient. Analysis of the 19 completed questionnaires showed that 12 patients (12/19 = 63.2%) did not experience dizziness and 3 patients (3/19 = 15/8%) experienced specific vestibular symptoms. The results of the questionnaire could not predict the results of ENG with caloric irrigation. Physical examination showed no abnormalities in any patients. No age- or dose-related predictive factors were found.
Collapse
|
32
|
|
33
|
Abstract
Vertigo is a common balance deregulation symptom among elders. Its etiology may be peripheral vestibular disease or a central vestibular disorder. Symptom onset, severity, and duration are distinguishing characteristics. The majority of peripheral vestibular disorders include benign paroxysmal positional vertigo, vestibular neuronitis, Meniere's disease, and perilymph fistula. Medication regimen review is necessary to identify possible drug-induced etiology. Treatment options include pharmacotherapy, canalith repositioning procedures, surgery, vestibular rehabilitation therapy, and dietary interventions.
Collapse
Affiliation(s)
- Guido R Zanni
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | |
Collapse
|