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Xing Y, Si L, Zhang W, Wang Y, Li K, Yang X. Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study. J Neurol 2024; 271:2446-2457. [PMID: 38231268 PMCID: PMC11055744 DOI: 10.1007/s00415-023-12166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The study aimed to determine the etiological characteristics of patients with dizziness/vertigo attending a neurological clinic according to the criteria of the International Classification of Vestibular Disorders (ICVD), hoping to provide a valuable reference for clinicians to diagnose and treat dizziness/vertigo. METHOD A total of 638 consecutive patients with a chief complaint of dizziness/vertigo who attended the vertigo clinic of our neurology department from January 2019 to January 2020 were included. Clinical data of patients, including baseline data, medical history, neurological, neuro-otological, and auxiliary examination results were collected. The etiologic distribution of dizziness/vertigo was determined by analyzing the diagnoses of patients. RESULTS Of the 638 patients with dizziness/vertigo, 38.8% were males, 61.2% were females, with a male: female ratio of 1:1.58 and a mean age of 52.9 ± 16.9 years. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness/vertigo in both female (38.9%) and male patients (25.5%). Subgroup analysis based on sex showed that vestibular migraine (VM) and probable autoimmune inner ear disease (p-AIED) were more prevalent in female patients (10.7% and 3.8%, respectively), while vascular vertigo/dizziness was more common in male patients (10.1%). Subgroup analysis based on age showed that the most common diseases were VM in patients aged 0-30 years (27.4%), BPPV in patients aged 31-60 years (27.1%) and 61-100 years (46.0%). Episodic vestibular syndrome (EVS) was the most commonly observed, accounting for up to 60.6% (389/638) of all patients, and the most common diagnoses were BPPV (55.3%, 215/389), VM (15.2%, 59/389), primary unilateral peripheral vestibular dysfunction (p-UPVD) of unknown etiology (11.8%, 46/389), p-AIED (4.4%, 17/389), and vascular vertigo/dizziness (2.8%, 11/389) in these patients. Chronic vestibular syndrome (CVS) was found in 14.0% (90/638) of the patients, and the most common diagnoses were persistent postural-perceptual dizziness (PPPD, 35.6%, 32/90), psychogenic dizziness (18.9%, 17/90), p-UPVD of unknown etiology (15.6%, 14/90), vascular vertigo/dizziness (15.6%, 14/90), and bilateral vestibulopathy (7.8%, 7/90). Acute vestibular syndrome (AVS) was observed in 8.4% (54/638) of the patients, and the most common diagnoses were p-UPVD of unknown etiology (31.5%, 17/54), vestibular neuritis (24.1%, 13/54), probable labyrinthine apoplexy (16.7%, 9/54), stroke (13.0%, 7/54), and psychogenic dizziness (11.1%, 6/54). 16.4% (105/638) of the patients were found to have other disorders, including 15.2% (16/105) of patients with internal diseases, and 84.8% (89/105) of patients with unknown causes. In terms of localization diagnosis, 56.1%, 17.0%, 10.0%, and 16.4% of the patients were diagnosed with peripheral vestibular disorder, central vestibular disorder, psychiatric and functional vestibular disorders, and other disorders, respectively. CONCLUSION (1) Dizziness/vertigo was more common in females, which was frequently caused by damage to the vestibular system. Non-vestibular or unknown etiologies were also seen in some patients; (2) VM was more prevalent in women than in men, vascular vertigo/dizziness was more commonly observed in men; (3) EVS was more common in patients with dizziness/vertigo. The most common causes of dizziness/vertigo were peripheral vestibular disorders in patients with AVS and EVS, PPPD and psychogenic dizziness in patients with CVS. The most common causes were BPPV and p-UPVD of unknown etiology in patients with a peripheral vestibular disorder, VM and vascular vertigo/dizziness in patients with central vestibular disorder, PPPD and psychogenic dizziness in patients with psychiatric and functional vestibular disorders.
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Affiliation(s)
- Yue Xing
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Lihong Si
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Wanting Zhang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Yuru Wang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Kangzhi Li
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Xu Yang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China.
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Vertigo in the Elderly: A Systematic Literature Review. J Clin Med 2023; 12:jcm12062182. [PMID: 36983184 PMCID: PMC10058392 DOI: 10.3390/jcm12062182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii) the risk of falling. Due to population aging, particularly in wealthy nations, vertigo represents a growing issue and a serious public health concern. In order to approach the patient correctly and to offer the best treatment options, it is mandatory to identify vertigo’s underlying causes. The aim of this paper was to identify the different etiologies of vertigo and possibly their frequency in the elderly population, by reviewing the scientific literature of the last decade (2012–2022). Methods: A systematic review was performed according to PRISMA guidelines, searching the Medline database from January 2012 through to December 2022. The search identified 1025 candidate papers, but after the application of specific selection criteria, only five were considered for further analysis. Results: A total of 2148 elderly patients (60–90 y old) presenting with vertigo were reported in the selected papers. A total of 3404 conditions were identified as the cause of vertiginous symptoms, (some patients presented multiple etiologies). All major diagnoses were categorized into different subgroups: the most common origin of vertigo was represented by audio-vestibular disorders (28.4%), followed by cardiovascular (20.4%) and neurological diseases (15.1%). Furthermore, 9.1% of patients were diagnosed with psychiatric conditions, whilst ophthalmologic and musculoskeletal disorders accounted for 7.5% and 6.3% of the cases respectively. Medication adverse effects and metabolic-related diseases were also considered among the causes. For 3.4% of cases the etiology remains unclear. Conclusions: Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders.
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Tian R, Zhang Y, Pan Q, Wang Y, Wen Q, Fan X, Qin G, Zhang D, Chen L, Zhang Y, Zhou J. Calcitonin gene-related peptide receptor antagonist BIBN4096BS regulates synaptic transmission in the vestibular nucleus and improves vestibular function via PKC/ERK/CREB pathway in an experimental chronic migraine rat model. J Headache Pain 2022; 23:35. [PMID: 35260079 PMCID: PMC8903578 DOI: 10.1186/s10194-022-01403-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023] Open
Abstract
Background Vestibular symptoms are frequently reported in patients with chronic migraine (CM). However, whether vestibular symptoms arise through overlapping neurobiology of migraine remains to be elucidated. The neuropeptide calcitonin gene-related peptide (CGRP) and CGRP1 receptor play important pathological roles in facilitating central sensitization in CM. Therefore, we aimed to investigate whether CGRP1 receptor contributes to vestibular dysfunction after CM by improving synaptic transmission in the vestibular nucleus (VN). Methods A CM rat model was established by recurrent intermittent administration of nitroglycerin (NTG). Migraine- and vestibular-related behaviors were assessed. CGRP1 receptor specific antagonist, BIBN4096BS, and protein kinase C (PKC) inhibitor chelerythrine chloride (CHE) were administered intracerebroventricularly. The expressions of CGRP and CGRP1 receptor components, calcitonin receptor-like receptor (CLR) and receptor activity modifying protein 1 (RAMP1) were evaluated by western blot, immunofluorescent staining and quantitative real-time polymerase chain reaction in the vestibular nucleus (VN). Synaptic associated proteins and synaptic morphological characteristics were explored by western blot, transmission electron microscope, and Golgi-cox staining. The expressions of PKC, phosphorylated extracellular signal regulated kinase (p-ERK), phosphorylated cAMP response element-binding protein at serine 133 site (p-CREB-S133) and c-Fos were detected using western blot or immunofluorescent staining. Results The expressions of CGRP, CLR and RAMP1 were significantly upregulated in CM rats. CLR and RAMP1 were expressed mainly in neurons. BIBN4096BS treatment and PKC inhibition alleviated mechanical allodynia, thermal hyperalgesia and vestibular dysfunction in CM rats. Additionally, BIBN4096BS treatment and PKC inhibition markedly inhibited the overexpression of synaptic associated proteins and restored the abnormal synaptic structure in VN after CM. Furthermore, BIBN4096BS treatment dysregulated the expression levels of PKC, p-ERK and p-CREB-S133, and attenuated neuronal activation in VN after CM. Conclusions The present study demonstrated that CGRP1 receptor inhibition improved vestibular function after CM by reversing the aberrant synaptic transmission via downregulating PKC/ERK/CREB signaling pathway. Therapeutic interventions by inhibiting CGRP/CGRP1 signaling may be a new target for the treatment of vestibular symptoms in CM.
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Inal M, Bayar Muluk N, Asal N, Çelik EN. Peripheric smell regions in patients with semicircular canal dehiscence: An MRI evaluation. J Clin Neurosci 2021; 94:173-178. [PMID: 34863433 DOI: 10.1016/j.jocn.2021.10.019] [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: 05/05/2021] [Revised: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated the peripheric smell regions in patients with semicircular canal dehiscence (SCD) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 186 adult patients were included. Group 1 consisted of 83 adult patients with SCD. The control group (Group 2) consisted of 83 healthy subjects without central vertigo. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth were measured in all groups. RESULTS In group 1, SCD was detected on the right (33.7%), left (26.5%) sides and bilateral (39.8%). Localization of dehiscence was at superior SC (75.9%), posterior SC (21.7%), lateral SC (1.2%), and posterior + superior SCs (1.2%). OB volumes of the SCD group were significantly lower than the control group bilaterally (p < 0.05). There were no significant differences between OS depths of groups 1 and 2 (p > 0.05). In SCD group, there were positive correlations between OB volumes; OS depths; and OB volumes and OS depths (p < 0.05). In older patients, bilateral OS depth values got lower (p < 0.05). In females, left OB volume values were lower than males (p < 0.05). In right SCD (+) patients, left OS depth values got lower (p < 0.05). CONCLUSION We concluded that possible changes in CSF dynamics may cause the development of SCD at thin bone segments; and a decrease in the OB volume. CSF leaks into the perineural sheet of the olfactory bulb (OB) maybe responsible for the decrease in the OB volume. In addition, minor trauma, infection, and inflammation may also be responsible for both coexistences of SCD development and OB volume decrease.
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Affiliation(s)
- Mikail Inal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Neşe Asal
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Enes Nusret Çelik
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
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Matsumura Y, Ito T, Yamanaka T, Kitahara T. Posturographic Findings in Patients With Psychological Dizziness. Neurologist 2021; 27:11-13. [PMID: 34842571 DOI: 10.1097/nrl.0000000000000352] [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
BACKGROUND The diagnosis and treatment of patients with psychogenic vertigo (PSY) is difficult because of the lack of reliable objective findings for this condition. We examined the characteristics of foam posturography in patients with peripheral vestibular disorders (PVD) and those with PSY. In particular, we focused on the objective findings of foam posturography in PSY. METHODS Between January 2010 and December 2011, 2-legged stance tasks were conducted in patients with vertigo/dizziness under 4 conditions: eyes opened with/without foam rubber and eyes closed with/without foam rubber. In terms of the velocity of movement of the center of pressure, we examined Romberg ratios, that is, the ratios of changes in visual conditions under the fixed foam rubber conditions, and foam rubber ratios, that is, the ratios of changes in foam rubber conditions under fixed visual conditions. These ratios were compared among 3 groups: healthy controls (CONT) (n=195), PVD (n=178), and PSY (n=32). RESULTS Romberg ratios using foam rubber in the PVD group were significantly higher than those in the CONT group. Those in the PSY group were significantly lower. Likewise, the foam rubber ratios in the PVD group were significantly higher than those in the CONT group when the eyes were closed. Those in the PSY group were significantly lower. CONCLUSION Judging from scores in Romberg ratios using foam rubber and foam rubber ratios when eyes were closed, foam posturography might have the potential to differentiate PSY from PVD.
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Affiliation(s)
- Yachiyo Matsumura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
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Liu P, Ma S, Du G, Sun S, Zhang X, Tang P, Hou C, Liu Y, Zhao J, Zhang X, Chen L, Gu C, Zhang L, Chong L, Yang X, Li R. Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China. J Gen Intern Med 2021; 36:3064-3070. [PMID: 33501533 PMCID: PMC8481407 DOI: 10.1007/s11606-020-06475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN Retrospective before-after study. PARTICIPANTS Sample of 29,793 patients with vertigo/dizziness as primary complaint. MEASURES Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.
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Affiliation(s)
- Peng Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Shaolin Ma
- Clinic for Vertigo and Dizziness, Xinyuan Hospital of Yulin, Yulin, 719000 Shaanxi People’s Republic of China
| | - Guixiang Du
- Clinic for Vertigo and Dizziness, The First Municipal Hospital of Weinan, Weinan, 714000 Shaanxi People’s Republic of China
| | - Shengde Sun
- Otorhinolaryngology Head and Neck Surgery, Wuwei People’s Hospital, Wuwei, 733000 Gansu People’s Republic of China
| | - Xin Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Peng Tang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chen Hou
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Yue Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Jiaxing Zhao
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xiaohui Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chen
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chaochao Gu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Lina Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chong
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Aerospace Clinical Medical College of Peking University, Beijing, 100049 People’s Republic of China
| | - Rui Li
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
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Wang W, Zhang Y, Pan Q, Liu J, Zhu Y, Tan G, Zhan Q, Zhou J. Central nystagmus plus ABCD 2 identifying stroke in acute dizziness presentations. Acad Emerg Med 2021; 28:1118-1123. [PMID: 34014605 DOI: 10.1111/acem.14295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to explore the ability of head impulse-nystagmus-test of skew (HINTS) combined with ABCD2 score to identify cerebrovascular causes of dizziness. MATERIALS AND METHODS We prospectively recruited 85 patients with acute onset of dizziness from September 2016 to December 2018 and analyzed their clinical characteristics, ABCD2 scores, HINTS, and neuroimages data. RESULTS Acute stroke was identified by MRI in 21 of 85 patients. The mean ± SD ABCD2 scores were significantly higher among patients with acute stroke than those without acute stroke (4.0 ± 0.8 h vs. 2.5 ± 0.7 h, p < 0.01). The majority (71.4%) of patients with cerebrovascular causes had central pattern of nystagmus at the initial 48 h from symptoms onset. The sensitivity and specificity of HINTS were 100% and 87% for the presence of stroke in patients with nystagmus. When combined central pattern of nystagmus and ABCD2 ≥ 4, the sensitivity increased to 100% for identifying cerebrovascular causes. Nystagmus were absence at time of examination in 16.5% of our patients, and ABCD2 scores in patients who had cerebrovascular diagnoses were all ≥ 4. CONCLUSION HINTS examinations could efficiently differentiate stroke from nonstroke under the condition that patients remaining symptomatic, including spontaneous or gaze-evoked nystagmus. It is more practical to apply the combination of central pattern of nystagmus and ABCD2 ≥ 4 in ED setting. If patients were absence of central nystagmus at admission, cerebrovascular event should be a priority diagnosis when their ABCD2 ≥ 4.
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Affiliation(s)
- Weiheng Wang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
- Department of Neurology Chongqing Renji HospitalUniversity of Chinese Academy of Sciences Chongqing China
| | - Yixin Zhang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Qi Pan
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Juan Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yinglin Zhu
- Program of Osteopathic Medicine Kansas City University Joplin Missouri USA
| | - Ge Tan
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Qunling Zhan
- Department of Neurology Chongqing Renji HospitalUniversity of Chinese Academy of Sciences Chongqing China
| | - Jiying Zhou
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Dyukova GM, Kryukov AI, Makarov SA, Guseva AL, Olimpieva SP. [A method for prediction functional dizziness after benign paroxysmal positional vertigo]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:120-125. [PMID: 34184487 DOI: 10.17116/jnevro2021121051120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify risk factors for functional vertigo (FV) in patients with benign paroxysmal positional vertigo (BPPV) based on the analysis of emotional and personality disorders at the time of the occurrence of BPPV and to develop a method for predicting its development. MATERIAL AND METHODS The study included 93 people, 81 women (87.1%), with benign paroxysmal positional vertigo (BPPV), aged 18 to 65 years, mean age 50 [41.5; 59]). After successful treatment with repositioning maneuvers, patients were re-examined 1 month later. Fifty-three patients underwent a semi-structured interview to identify a history of panic attacks (PA) using DSM-5 diagnostic criteria. After successful BPPV treatment, patients completed the following scales and questionnaires: Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short form (VSS-SF), Numeric analog scale of fear (from 0 to 10), Depersonalization-Derealization Inventory (DDI), PHQ-9, GAD-7, PHQ-15, Holmes-Rahe Stress Inventory, Anxiety Sensitivity Index (ASI). RESULTS The cohort was divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=76) of complaints for dizziness 1 month after BPPV. The frequency of PA history in group 1 was higher than in group 2 (80 vs 29.3%). Patients from group 1 had higher rates in all scales: DHI (57 vs 49, p=0.048), subscale DHI-E (18 vs 12, p=0.006), and subscale A VSS-SF (9 vs 5, p=0.03); DDI (18 vs 11, p=0.01), GAD-7 (13 vs 4), p=0.0002), Numeric analog scale of fear (10 vs 5, p<0.00005), ASI (55.5 vs 36.5, p<0.005). We developed a predictive method for diagnosis FD after BPPV, which sensitivity is 78.9% (95% CI 67.80-86.94) and specificity 94.12% (95% CI 71.31-99.85). CONCLUSION The likelihood of developing FV after BPPV can be predicted using the proposed predictive method. Early screening for FV can be used to prevent persistent postural-perceptual dizziness.
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Affiliation(s)
- G M Dyukova
- Loginov Moscow Clinical Scientific and Practical Center Moscow, Russi, Loginov Moscow Clinical Scientific and Practical Center Moscow, Russia
| | - A I Kryukov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - S A Makarov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S P Olimpieva
- Pirogov Russian National Research Medical University, Moscow, Russia
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Li C, Guo D, Ma X, Liu S, Liu M, Zhou L. The Impact of Coronavirus Disease 2019 Epidemic on Dizziness/Vertigo Outpatients in a Neurological Clinic in China. Front Neurol 2021; 12:663173. [PMID: 33995259 PMCID: PMC8116702 DOI: 10.3389/fneur.2021.663173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) epidemic on dizziness/vertigo outpatients in a neurological clinic in China. Methods: Against the background of the COVID-19 epidemic, the data of patients who visited the neurological clinic of Beijing Chaoyang Hospital West Branch during the pandemic (February 1-May 30, 2020) and the corresponding period in 2019 (February 1-May 30, 2019) were analyzed, and patients with dizziness/vertigo from these two periods were compared to discover their demographic features and etiologic distribution according to their age and sex. Result: The absolute number of neurological outpatients decreased from 14,670 in 2019 to 8,763 in 2020 (-40.3%), with a corresponding decline in dizziness/vertigo patients (2019: n = 856; 2020: n = 1,436, -40.4%). Dizziness/vertigo was more common in women than men in these two periods (2019: women = 63.6%; 2020: women = 63.1%, p = 0.82). The overall etiology distribution was different among all disorders between the two periods (p < 0.001). There was an increase in benign paroxysmal positional vertigo (BPPV) (2019 vs. 2020: 30.7 vs. 35%, p < 0.05) and psychogenic/persistent postural perceptual dizziness (PPPD) (2019 vs. 2020: 28.5 vs. 34.6%, p < 0.05) while a decrease in vascular vertigo during the epidemic (2019 vs. 2020: 13 vs. 9.6%, p < 0.05). During the epidemic, the top three causes of dizziness/vertigo were BPPV (35%), psychogenic/PPPD (34.6%), and vascular vertigo (9.6%). A female predominance was observed in BPPV (women = 67.7%, p < 0.05) and psychogenic/PPPD (women = 67.6%, p < 0.05). In addition, the etiology ratio of different age groups was significantly different (p < 0.001). The most common cause for young and young-old patients was BPPV, and the most common cause for middle-aged and old-old patients was psychogenic/PPPD. Conclusion: The absolute number of outpatients with dizziness/vertigo during the COVID-19 pandemic was reduced during the early period of the COVID-19 outbreak. BPPV and psychogenic/PPPD were more abundant, and vascular vertigo was less frequent. Based on those data, health-care management policy for dizziness/vertigo and mental disorder should be developed during the outbreak of COVID-19 and other infective diseases.
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Affiliation(s)
- Changqing Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dongsheng Guo
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangke Ma
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Siwei Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingyong Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lichun Zhou
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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杨 丽, 吴 梅, 唐 亮. [Etiological analysis of 1027 patients with vertigo in Xinjiang Autonomous Region]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:1024-1026. [PMID: 33254324 PMCID: PMC10133128 DOI: 10.13201/j.issn.2096-7993.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Indexed: 06/12/2023]
Abstract
Objective:To analysis the etiological characteristics of patients with vertigo in Xinjiang Uygur Autonomous Region. Method:The data of 1027 patients with vertigo and dizziness were collected and the etiology was analyzed. Result:The patients aged 51-60 years accounted for 27.95% of the total, followed by those aged 61-70 years accounted for 20.16% and those aged 41-50 years accounted for 17.33% s. There were 363 males and 664 females with a ratio of 1∶1.8. Benign paroxysmal positional vertigo (BPPV) was the most common cause in 233 cases (22.69%), followed by vestibular migraine (VM) in 184 cases (17.92%), Meniere's disease (MD) in 139 cases (13.53%), sudden deafness with vertigo in 132 cases (12.85%), and unknown cause in 114 cases (11.10%). Conclusion:Among vertigo patients, women are significantly more than men. BPPV, VM, MD, and SHL are the most common vertigo causes. There are still some patients haven't received definite diagnosis.
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Affiliation(s)
- 丽 杨
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 梅 吴
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 亮 唐
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
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Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope 2020; 131:E1308-E1314. [PMID: 32809223 DOI: 10.1002/lary.29024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1308-E1314, 2021.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sophie Lipson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Tufts School of Medicine, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Meghan Corcoran
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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Zhang Y, Zhang Y, Tian K, Wang Y, Fan X, Pan Q, Qin G, Zhang D, Chen L, Zhou J. Calcitonin gene-related peptide facilitates sensitization of the vestibular nucleus in a rat model of chronic migraine. J Headache Pain 2020; 21:72. [PMID: 32522232 PMCID: PMC7288551 DOI: 10.1186/s10194-020-01145-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022] Open
Abstract
Background Vestibular migraine has recently been recognized as a novel subtype of migraine. However, the mechanism that relate vestibular symptoms to migraine had not been well elucidated. Thus, the present study investigated vestibular dysfunction in a rat model of chronic migraine (CM), and to dissect potential mechanisms between migraine and vertigo. Methods Rats subjected to recurrent intermittent administration of nitroglycerin (NTG) were used as the CM model. Migraine- and vestibular-related behaviors were analyzed. Immunofluorescent analyses and quantitative real-time polymerase chain reaction were employed to detect expressions of c-fos and calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis (TNC) and vestibular nucleus (VN). Morphological changes of vestibular afferent terminals was determined under transmission electron microscopy. FluoroGold (FG) and CTB-555 were selected as retrograde tracers and injected into the VN and TNC, respectively. Lentiviral vectors comprising CGRP short hairpin RNA (LV-CGRP) was injected into the trigeminal ganglion. Results CM led to persistent thermal hyperalgesia, spontaneous facial pain, and prominent vestibular dysfunction, accompanied by the upregulation of c-fos labeling neurons and CGRP immunoreactivity in the TNC (c-fos: vehicle vs. CM = 2.9 ± 0.6 vs. 45.5 ± 3.4; CGRP OD: vehicle vs. CM = 0.1 ± 0.0 vs. 0.2 ± 0.0) and VN (c-fos: vehicle vs. CM = 2.3 ± 0.8 vs. 54.0 ± 2.1; CGRP mRNA: vehicle vs. CM = 1.0 ± 0.1 vs. 2.4 ± 0.1). Furthermore, FG-positive neurons was accumulated in the superficial layer of the TNC, and the number of c-fos+/FG+ neurons were significantly increased in rats with CM compared to the vehicle group (vehicle vs. CM = 25.3 ± 2.2 vs. 83.9 ± 3.0). Meanwhile, CTB-555+ neurons dispersed throughout the VN. The structure of vestibular afferent terminals was less pronounced after CM compared with the peripheral vestibular dysfunction model. In vivo knockdown of CGRP in the trigeminal ganglion significantly reduced the number of c-fos labeling neurons (LV-CGRP vs. LV-NC = 9.9 ± 3.0 vs. 60.0 ± 4.5) and CGRP mRNA (LV-CGRP vs. LV-NC = 1.0 ± 0.1 vs. 2.1 ± 0.2) in the VN, further attenuating vestibular dysfunction after CM. Conclusions These data demonstrates the possibility of sensitization of vestibular nucleus neurons to impair vestibular function after CM, and anti-CGRP treatment to restore vestibular dysfunction in patients with CM.
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Affiliation(s)
- Yun Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Ke Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunfeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoping Fan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qi Pan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Guangcheng Qin
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dunke Zhang
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lixue Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
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Bedel C, Korkut M. The relationship of clinical and laboratory factors with acute isolated vertigo and cerebellar infarction. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_14_20] [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]
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Zhu RT, Van Rompaey V, Ward BK, Van de Berg R, Van de Heyning P, Sharon JD. The Interrelations Between Different Causes of Dizziness: A Conceptual Framework for Understanding Vestibular Disorders. Ann Otol Rhinol Laryngol 2019; 128:869-878. [DOI: 10.1177/0003489419845014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:According to population-based studies that estimate disease prevalence, the majority of patients evaluated at dizziness clinics receive a single vestibular diagnosis. However, accumulating literature supports the notion that different vestibular disorders are interrelated and often underdiagnosed.Objective:Given the complexity and richness of these interrelations, we propose that a more inclusive conceptual framework to vestibular diagnostics that explicitly acknowledges this web of association will better inform vestibular differential diagnosis.Methods:A narrative review was performed using PubMed database. Articles were included if they defined a cohort of patients, who were given specific vestibular diagnosis. The interrelations among vestibular disorders were analyzed and placed within a conceptual framework.Results:The frequency of patients currently receiving multiple vestibular diagnoses in dizziness clinic is approximately 3.7% (1263/33 968 patients). The most common vestibular diagnoses encountered in the dizziness clinic include benign paroxysmal positional vertigo (BPPV), vestibular migraine, vestibular neuritis, and Ménière’s disease.Conclusions:A review of the literature demonstrates an intricate web of interconnections among different vestibular disorders such as BPPV, vestibular migraine, Ménière’s disease, vestibular neuritis, bilateral vestibulopathy, superior canal dehiscence syndrome, persistent postural perceptual dizziness, anxiety, head trauma, and aging, among others.
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Affiliation(s)
- Richard T. Zhu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymond Van de Berg
- Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jeffrey D. Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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