No se cual sea la frecuencia con que ustedes vean el vértigo
como motivo de consulta inicial cuando es intenso, posicional,
brusco y de aparición súbita con frecuencia le damos pase
"a la ventanilla de enfrente" y a veces el compañero de ORL
nos los rebota como todo un reto diagnóstico. Otras veces,
nos aparece la sorpresa de un gran meningioma en el ángulo
ponto-cerebeloso o una plaquita de desmielinazión en los
nucleos vestibulares. El vértigo podría no tener palabra de
honor.
No ví si en esta revisión hay una ruta crítica respecto al
manejo diagnóstico-terapéutico.
Esta a la amable consideración de ustedes.
Gustavo
PD. Estas revisiones serán "subidas" directamente al blog
para que ahí puedan marcarlas como favoritas y accederlas
si son de su interés.
-
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| PubMed Results |
| 1. | Clin Exp Otorhinolaryngol. 2011 Sep;4(3):113-7. Epub 2011 Sep 6.The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence.Do YK, Kim J, Park CY, Chung MH, Moon IS, Yang HS.SourceDepartment of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea. AbstractOBJECTIVES:Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. METHODS:We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient's symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. RESULTS:Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). CONCLUSION:Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence. |
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| 2. | Front Neurol. 2011;2:55. Epub 2011 Aug 30.Vestibular function and quality of life in vestibular schwannoma: does size matter?Wagner JN, Glaser M, Wowra B, Muacevic A, Goldbrunner R, Cnyrim C, Tonn JC, Strupp M.SourceDepartment of Neurology, Ludwig-Maximilians University Munich, Germany. AbstractObjectives: Patients with vestibular schwannoma (VS) frequently suffer from disabling vestibular symptoms. This prospective follow-up study evaluates vestibular and auditory function and impairment of quality of life due to vertigo, dizziness, and imbalance in patients with unilateral VS of different sizes before/after microsurgical or radiosurgical treatment. Methods: Thirty-eight patients with unilateral VS were included. Twenty-two received microsurgery, 16 CyberKnife radiosurgery. Two follow-ups took place after a median of 50 and 186.5 days. Patients received a standardized neuro-ophthalmological examination, electronystagmography with bithermal caloric testing, and pure-tone audiometry. Quality of life was evaluated with the Dizziness Handicap Inventory (DHI). Patient data was grouped and analyzed according to the size of the VS (group 1: <20 mm vs group 2: ≥20 mm). Results: In group 1, the median loss of vestibular function was +10.5% as calculated by Jongkees Formula (range -43 to +52; group 2: median +36%, range -56 to +90). The median change of DHI scores was -9 in group 1 (range -68 to 30) and +2 in group 2 (-54;+20). Median loss of hearing was 4 dB (-42; 93) in group 1 and 12 dB in group 2 (5; 42). Conclusion: Loss of vestibular function in VS clearly correlates with tumor size. However, loss of vestibular function was not strictly associated with a long-term deterioration of quality of life. This may be due to central compensation of vestibular deficits in long-standing large tumors. Loss of hearing before treatment was significantly influenced by the age of the patient but not by tumor size. At follow-up 1 and 2, hearing was significantly influenced by the size of the VS and the manner of treatment. |
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| 3. | Hellenic J Cardiol. 2011 Sep-Oct;52(5):466-8.Multiple cerebral mycotic aneurysms due to left atrial myxoma: are there any pitfalls for the cardiac surgeon?Baikoussis NG, Siminelakis SN, Kotsanti A, Achenbach K, Argyropoulou M, Goudevenos J.SourceCardiac Surgery Department, University Hospital, Ioannina School of Medicine, Ioannina, Greece. AbstractAcute cerebral embolism or cerebral aneurysm formation as a consequence of left atrial myxomas has been well documented, but the formation of multiple cerebral aneurysms resulting from atrial myxoma is a very rare neurological complication. We present the case of a 72-year-old-woman with a cardiac myxoma who suffered multiple cerebral mycotic aneurysms. After experiencing both vertigo and a sudden collapse accompanied by loss of consciousness, she underwent cerebral computed tomography (CT) and magnetic resonance imaging (MRI) examinations, which revealed multiple cerebral mycotic aneurysms of various dimensions and a large cyst, as a result of a previous haemorrhage. Embolisation was performed in large aneurysms of the circle of Willis but not in the one located in the periphery, and re-examination for a cardiac intervention a month later was indicated. The risk of cerebral haemorrhage was considered high; thus she was not operated on. Conservative treatment followed. Two years after the first diagnosis the patient remains healthy, suggesting that in such cases we should also consider conservative treatment. According to the literature, the risk is high when aneurysms are large, multiple and intractable. We propose that cerebral CT or MRI scan should be performed before operation in all patients with a cardiac myxoma, especially in those with left cardiac chamber localisation. |
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| 4. | J Med Case Reports. 2011 Sep 19;5:465.Lyme neuroborreliosis in HIV-1 positive men successfully treated with oral doxycycline: a case series and literature review.Bremell D, Säll C, Gisslén M, Hagberg L.SourceInstitute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden. daniel.bremell@infect.gu.se. AbstractABSTRACT: INTRODUCTION:Lyme neuroborreliosis is the most common bacterial central nervous system infection in the temperate parts of the northern hemisphere. Even though human immunodeficiency virus (HIV) -1 infection is common in Lyme borreliosis endemic areas, only five cases of co-infection have previously been published. Four of these cases presented with typical Lyme neuroborreliosis symptoms such as meningoradiculitis and facial palsy, while a fifth case had more severe symptoms of encephalomyelitis. All five were treated with intravenous cephalosporins and clinical outcome was good for all but the fifth case CASE PRESENTATIONS:We present four patients with concomitant presence of HIV-1 infection and Lyme neuroborreliosis diagnosed in Western Sweden. Patient 1 was a 60-year-old Caucasian man with radicular pain and cognitive impairment. Patient 2 was a 39-year-old Caucasian man with headaches, leg weakness, and pontine infarction. Patient 3 was a 62-year-old Caucasian man with headaches, tremor, vertigo, and normal-pressure hydrocephalus. Patient 4 was a 50-year-old Caucasian man with radicular pain and peripheral facial palsy. Patients one, two, and three all had subnormal levels of CD4 cells, indicating impaired immunity. All patients were treated with oral doxycycline with good clinical outcome and normalization of CSF pleocytosis. CONCLUSION:Given the low HIV-1 prevalence and medium incidence of Lyme neuroborreliosis in Western Sweden where these four cases were diagnosed, co-infection with HIV-1 and Borrelia is probably more common than previously thought. The three patients that were the most immunocompromised suffered from more severe and rather atypical neurological symptoms than are usually described among patients with Lyme neuroborreliosis. It is therefore important for doctors treating HIV patients to consider Lyme neuroborreliosis in a patient presenting with atypical neurological symptoms. All four patients were treated with oral doxycycline with a good outcome, further proving the efficacy of this regime. |
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| 5. | Front Neurol. 2011;2:51. Epub 2011 Sep 9.Large Genomic Deletions in CACNA1A Cause Episodic Ataxia Type 2.Wan J, Mamsa H, Johnston JL, Spriggs EL, Singer HS, Zee DS, Al-Bayati AR, Baloh RW, Jen JC; CINCH Investigators.SourceDepartment of Neurology, University of California, Los Angeles Los Angeles, CA, USA. AbstractEpisodic ataxia (EA) syndromes are heritable diseases characterized by dramatic episodes of imbalance and incoordination. EA type 2 (EA2), the most common and the best characterized subtype, is caused by mostly nonsense, splice site, small indel, and sometimes missense mutations in CACNA1A. Direct sequencing of CACNA1A fails to identify mutations in some patients with EA2-like features, possibly due to incomplete interrogation of CACNA1A or defects in other EA genes not yet defined. Previous reports described genomic deletions between 4 and 40 kb in EA2. In 47 subjects with EA (26 with EA2-like features) who tested negative for mutations in the known EA genes, we used multiplex ligation-dependent probe amplification to analyze CACNA1A for exonic copy number variations. Breakpoints were further defined by long-range PCR. We identified distinct multi-exonic deletions in three probands with classic EA2-like features: episodes of prolonged vertigo and ataxia triggered by stress and fatigue, interictal nystagmus, with onset during infancy or early childhood. The breakpoints in all three probands are located in Alu sequences, indicating errors in homologous recombination of Alu sequences as the underlying mechanism. The smallest deletion spanned exons 39 and 40, while the largest deletion spanned 200 kb, missing all but the first three exons. One deletion involving exons 39 through 47 arose spontaneously. The search for mutations in CACNA1A appears most fruitful in EA patients with interictal nystagmus and onset early in life. The finding of large heterozygous deletions suggests haploinsufficiency as a possible pathomechanism of EA2. |
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| 6. | Intern Med. 2011;50(18):2031-4. Epub 2011 Sep 15.Disseminated intracranial tuberculoma mimicking neurocysticercosis.Zhengqi L, Bingjun Z, Wei Q, Xueqiang H.SourceMultiple Sclerosis Centre, Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, China. AbstractIntracranial tuberculoma and neurocysticercosis (NCC) are the most frequent granulomatous infections in the central nervous system. Here we report a 41-year-old man with disseminated intracranial tuberculoma mimicking NCC. The patient complained of relapsing vertigo and vomiting consistent with Bruns syndrome. Serum antibodies against cysticercosis were positive. Magnetic resonance imaging (MRI) of the brain showed multiple disseminated ring-enhanced lesions. An initial diagnosis of NCC was made based on clinical signs and MRI. However, during antiparasitic treatment, the patient exhibited fever, meningitis signs, and positive cerebrospinal fluid findings for tuberculosis. The diagnosis was therefore corrected as tuberculoma. After three months of antituberculous treatment, the patient recovered clinically and on MRI. Our results highlight the importance of differential diagnosis of these two diseases in the early stage. |
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| 7. | J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):386-8.Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia.Chaturvedi A, Dash H.SourceDepartment of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India. AbstractCommon complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours. |
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| 8. | Ann Thorac Cardiovasc Surg. 2011;17(4):347-51.Complex reconstruction of supraaortic branches.Mirzaie M, Fatehpur S, Friedrich M, Sossalla S, Sohns C, Schoendube FA, Schmitto JD.SourceDepartment of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen, Goettingen, Germany. AbstractOBJECTIVE:The present paper exemplary describes several severe stenoses of supraaortic branches with its symptoms and operative treatments. METHODS:Eight patients, two female (68 ± 5 y), six male (73 ± 4 y), were retrospectively evaluated. Patients showed neurological signs as followed: recurring attacks of vertigo (80%), temporary paresis of extremity (20%), speech disorders (20%) and subclavian and/or carotic-steel-syndrome (15%). Seven patients have already been previously treated with revascularization of the supraaortic branches in the past. The surgical techniques used were thrombendarterectomy of the internal carotid artery, carotid-subclavian bypass and complex aorto-truncal, aorto-carotid and aorto-subclavian-bypass. RESULTS:One patient died nine days postoperatively due to myocardial infarction. Mean duration of stay on intensive care unit was 1.5 days. Mean duration of postoperative ventilation was six hours. Average duration of stay on normal ward was nine days. CONCLUSION:This study presents several complex reconstructions of supraaortic branches, which were indicated in cases with severe stenoses of supraaortic branches. Even though treatment strategies were complex the peri- and postoperative complication rates are quite low. These therapeutic strategies were necessary to avoid severe neurological complications in these patients. |
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| 9. | GMS Z Med Ausbild. 2011;28(3):Doc40. Epub 2011 Aug 8.Differential diagnosis in primary care: conception and implementation of a new elective seminar - An experience report.Bösner S, Celemin-Heinrich S, Mühlbauer S, Stibane T, Schönbauer A, Baum E.SourceUniversität Marburg, Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Marburg, Deutschland. boesner@staff.uni-marburg.de AbstractPrimary care is in a unique position to teach the broad spectrum of differential diagnoses. We developed and piloted a new elective seminar 'Differential Diagnosis in Primary Care'. With the help of simulation patients, training models, interactive small group work, and short lectures we addressed common complaints presented in the daily routine of primary care like vertigo, dyspnoea, chest or abdominal pain. We put a special focus on the diagnostic accuracy of history and physical examination. The final examination was conducted as an objective structured clinical examination. |
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| 10. | PLoS One. 2011;6(8):e23125. Epub 2011 Aug 9.Saccades and vergence performance in a population of children with vertigo and clinically assessed abnormal vergence capabilities.Bucci MP, Kapoula Z, Bui-Quoc E, Bouet A, Wiener-Vacher S.SourceLaboratoire de Psychologie et Neuropsychologie Cognitives, FRE 3292 CNRS IUPDP Université Paris Descartes, Boulogne Billancourt, France. maria-pia.bucci@parisdescartes.fr AbstractPURPOSE:Early studies reported some abnormalities in saccade and vergence eye movements in children with vertigo and vergence deficiencies. The purpose of this study was to further examine saccade and vergence performance in a population of 44 children (mean age: 12.3±1.6 years) with vertigo symptoms and with different levels of vergence abnormalities, as assessed by static orthoptic examination (near point of convergence, prism bar and cover-uncover test). METHODS:Three groups were identified on the basis of the orthoptic tests: group 1 (n = 13) with vergence spasms and mildly perturbed orthoptic scores, group 2 (n = 14) with moderately perturbed orthoptic scores, and group 3 (n = 17) with severely perturbed orthoptic scores. Data were compared to those recorded from 28 healthy children of similar ages. Latency, accuracy and peak velocity of saccades and vergence movements were measured in two different conditions: gap (fixation offset 200 ms prior to target onset) and simultaneous paradigms. Binocular horizontal movements were recorded by a photoelectric device. RESULTS:Group 2 of children with vergence abnormalities showed significantly longer latency than normal children in several types of eye movements recorded. For all three groups of children with vergence abnormalities, the gain was poor, particularly for vergence movement. The peak velocity values did not differ between the different groups of children examined. INTERPRETATION:Eye movement measures together with static orthoptic evaluation allowed us to better identify children with vergence abnormalities based on their slow initiation of eye movements. Overall, these findings support the hypothesis of a central deficit in the programming and triggering of saccades and vergence in these children. |
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| 11. | Int J Otolaryngol. 2011;2011:709469. Epub 2011 Aug 2.Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management.Riga M, Bibas A, Xenellis J, Korres S.SourceENT Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. AbstractBackground. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients. |
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| 12. | Int J Otolaryngol. 2011;2011:835671. Epub 2011 Jul 25.Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions.Hornibrook J.SourceDepartment of Otolaryngology, Head and Neck Surgery, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8011, New Zealand. AbstractBPPV is the most common cause of vertigo. It most often occurs spontaneously in the 50 to 70 year age group. In younger individuals it is the commonest cause of vertigo following head injury. There is a wide spectrum of severity from inconsistent positional vertigo to continuous vertigo provoked by any head movement. It is likely to be a cause of falls and other morbidity in the elderly. Misdiagnosis can result in unnecessary tests. The cardinal features and a diagnostic test were clarified in 1952 by Dix and Hallpike. Subsequently, it has been established that the symptoms are attributable to detached otoconia in any of the semicircular canals. BPPV symptoms can resolve spontaneously but can last for days, weeks, months, and years. Unusual patterns of nystagmus and nonrepsonse to treatment may suggest central pathology. Diagnostic strategies and the simplest "office" treatment techniques are described. Future directions for research are discussed. |
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| 13. | Int J Otolaryngol. 2011;2011:687921. Epub 2011 Jul 26.About nystagmus transformation in a case of apogeotropic lateral semicircular canal benign paroxysmal positional vertigo.Vannucchi P, Pecci R.SourceDepartment of Surgical Sciences Oto-Neuro-Ophthalmology, Service of Audiology, University of Florence, Viale Morgagni 85 50100 Florence, Italy. AbstractTHERE ARE TWO FORMS OF LATERAL SEMICIRCULAR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO: geotropic and apogeotropic. When the pathophysiological mechanism of the apogeotropic form is that of canalolithiasis, we can observe a transformation from an apogeotropic nystagmus into a geotropic one. Usually, this phenomenon happens simultaneously on both sides, thus enabling us to observe a right-beating paroxysmal positional nystagmus when the patient lies on the right side and a left-beating paroxysmal positional nystagmus on the left side. We describe a case in which the transformation occurred gradually, so that, after three head rotations from side to side in supine position, there was a right nystagmus beating toward the ground (geotropic) with the patient on the right side and a right nystagmus beating away from the ground (apogeotropic) on the left side. However, after further rotations we observed the nystagmus transformation also on the left side, with a geotropic nystagmus on both sides. The phenomenon of gradual transformation could happen because initially only a part of the debris moved from the anterior to the posterior aspect of the canal during head rotations. |
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| 14. | Acta Otorhinolaryngol Ital. 2011 Feb;31(1):17-26.Hyperventilation-induced nystagmus in a large series of vestibular patients.Califano L, Melillo MG, Vassallo A, Mazzone S.SourceDepartmental Unit of Audiology and Phoniatrics, "G. Rummo" Hospital, Benevento, Italy. luigi.califano@tin.it AbstractThe Hyperventilation Test is widely used in the "bed-side examination" of vestibular patients. It can either activate a latent nystagmus in central or peripheral vestibular diseases or it can interact with a spontaneous nystagmus, by reducing it or increasing it. Aims of this study were to determine the incidence, patterns and temporal characteristics of Hyperventilation-induced nystagmus in patients suffering from vestibular diseases, as well as its contribution to the differential diagnosis between vestibular neuritis and neuroma of the 8(th) cranial nerve, and its behaviour in some central vestibular diseases. The present study includes 1202 patients featuring, at vestibular examination, at least one sign of vestibular system disorders or patients diagnosed with a "Migraine-related vertigo" or "Chronic subjective dizziness". The overall incidence of Hyperventilation-induced nystagmus was 21.9%. It was detected more frequently in retrocochlear vestibular diseases rather than in end-organ vestibular diseases: 5.3% in Paroxysmal Positional Vertigo, 37.1% in Menière's disease, 37.6% in compensated vestibular neuritis, 77.2% in acute vestibular neuritis and 91.7% in neuroma of the 8(th) cranial nerve. In acute vestibular neuritis, three HVIN patterns were observed: Paretic pattern: temporary enhancement of the spontaneous nystagmus; Excitatory pattern: temporary inhibition of the spontaneous nystagmus; Strong excitatory pattern: temporary inversion of the spontaneous nystagmus. Excitatory patterns proved to be time-dependent in that they disappeared and were replaced by the paretic pattern over a period of maximum 18 days since the beginning of the disorder. In acoustic neuroma, Hyperventilation-induced nystagmus was frequently observed (91.7%), either in the form of an excitatory pattern (fast phases towards the affected site) or in the form of a paretic pattern (fast phases towards the healthy side). The direction of the nystagmus is only partially related to tumour size, whereas other mechanisms, such as demyelination or a break in nerve fibres, might have an important role in triggering the situation. Hyperventilation-induced nystagmus has frequently been detected in cases of demyelinating diseases and in cerebellar diseases: in multiple sclerosis, hyperventilation inhibits a central type of spontaneous nystagmus or evokes nystagmus in 75% of patients; in cerebellar diseases, hyperventilation evokes or enhances a central spontaneous nystagmus in 72.7% of patients. In conclusion the Hyperventilation Test can provide patterns of oculomotor responses that indicate a diagnostic investigation through cerebral magnetic resonance imaging enhanced by gadolinium, upon suspicion of neuroma of the 8(th) cranial nerve or of a central disease. In our opinion, however, Hyperventilation-induced nystagmus always needs to be viewed within the more general context of a complete examination of the vestibular and acoustic system. |
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| 15. | Acta Otorhinolaryngol Ital. 2010 Dec;30(6):317-20.Multiple dehiscences of bony labyrinthine capsule. A rare case report and review of the literature.Manzari L.SourceDepartment of Experimental Medicine and Pathology, "La Sapienza" University "Posturology Master", Rome, Italy. leonardomanzari@virgilio.it AbstractMultiple semicircular canal dehiscences are clinical entities characterised by vestibular and cochlear symptoms induced by enhanced sensitivity of labyrinthine receptors due to a multiple bone defect of the otic capsule. The case is presented of a 38-year-old male with bilateral posterior semicircular canal dehiscence associated with unilateral (right) superior semicircular canal dehiscence. The man suffered from vestibular (recurrent Tullio Phenomenon or sound-induced vertigo) and cochlear symptoms (persistent aural fullness associated with mixed hearing loss and disabling tinnitus). |
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| 16. | Int J Otolaryngol. 2011;2011:278383. Epub 2011 Jul 21.Why Treat Apogeotropic BPPVs of the Horizontal Canal? About 30 Observations.Lorin P, Foubert F, Debaty M.SourceEar Nose Throat, Vertigo and Vestibular Rehabilitation Clinic Center, 15 rue Gougeard, 72000 Le Mans, France. AbstractBenign paroxysmal positional vertigo (BPPV), of the horizontal canal, in the apogeotropic form (AHBPPV) was described in 1995. Based on 30 observations of typical AHBPPVs of the horizontal canal, we endeavor to discuss the relevance of physiotherapy. Material and Method. Thirty observations of typical apogeotropic BPPVs of the horizontal canal treated with a 360° barbeque rotation on the BPPV side, reviewed in consultation at 1 and 3 weeks and reevaluated the following year. Results. Our cohort of 30 patients had an average age of 58.6 years. The apogeotropic BPPVs of the horizontal canal, which can be transformed into BPPVs of the posterior canal or into geotropic-type BPPVs of the horizontal canal do not recover more quickly. Patients who follow the positional advice do not recover more quickly than those who do not (P = 0.152). The 15 patients treated on average 13.73 days after the onset of the disease did not recover more quickly after the start of therapeutic treatment than those treated later (P = 0.032). Conclusion. Here, we demonstrate that the direction of rotation during the maneuvers is of no importance for the results. We show that transformability is not a guarantee of rapid recovery and that the therapist's effectiveness is limited when it comes to the short-term results. |
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| 17. | Turk J Gastroenterol. 2011;22(2):195-8.Leptomeningeal carcinomatosis of gastric adenocarcinoma.Bulut G, Erden A, Karaca B, Göker E.SourceEge University Faculty of Medicine, Department of Internal Medicine, İzmir, Bornova, Turkey. AbstractGastric cancer is the third most common malignancy among gastrointestinal malignancies. With the advance of new treatments, overall survival in gastric cancer is extending, and metastasis to atypical sites is seen more commonly. Leptomeningeal metastasis is one such atypical metastasis for gastric cancer. We report a case of gastric adenocarcinoma with leptomeningeal metastasis as an atypical involvement. A 39-year-old female, presenting with headache, vertigo, horizontal gaze palsy, visual disturbances, and seizures, was admitted to our hospital in August 2009. The funduscopic examination revealed the presence of bilateral papilledema. Magnetic resonance imaging of the brain showed diffuse leptomeningeal enhancement and biventricular dilatation. Cytological examination of the cerebrospinal fluid revealed malignant cells. These findings were consistent with leptomeningeal carcinomatosis. Six months before, she was diagnosed as having gastric cancer by upper gastrointestinal tract endoscopy, which was performed as a part of the diagnostic work-up to clarify the cause of her abdominal ascites. She received six cycles of docetaxel-cisplatin-5-fluorouracil for metastatic gastric cancer, and she developed the above-mentioned symptoms under chemotherapy. She was included in a craniospinal radiotherapy program and received intrathecal methotrexate treatment. We present this case report since leptomeningeal carcinomatosis of gastric cancers is a rare clinical entity, and treatment strategies remain challenging for clinicians. |
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| 18. | Int J Otolaryngol. 2011;2011:483965. Epub 2011 Jul 14.Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A.SourceENT Department, Tzanio General Hospital of Piraeus, Afentouli 1 and Zanni, 18536 Piraeus, Greece. AbstractBenign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis. |
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| 19. | Exp Diabetes Res. 2011;2011:687624. Epub 2011 May 29.The ECG vertigo in diabetes and cardiac autonomic neuropathy.Voulgari C, Tentolouris N, Stefanadis C.SourceDepartment of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, 17 Saint Thomas Street, Athens 11527, Greece. c_v_24@yahoo.gr AbstractThe importance of diabetes in the epidemiology of cardiovascular diseases cannot be overemphasized. About one third of acute myocardial infarction patients have diabetes, and its prevalence is steadily increasing. The decrease in cardiac mortality in people with diabetes is lagging behind that of the general population. Cardiovascular disease is a broad term which includes any condition causing pathological changes in blood vessels, cardiac muscle or valves, and cardiac rhythm. The ECG offers a quick, noninvasive clinical and research screen for the early detection of cardiovascular disease in diabetes. In this paper, the clinical and research value of the ECG is readdressed in diabetes and in the presence of cardiac autonomic neuropathy. |
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| 20. | Acta Neurol Taiwan. 2011 Jun;20(2):101-6.The Relationship between Isolated Dizziness/Vertigo and the Risk Factors of Ischemic Stroke: A Case Control Study.Chang CC, Chang WN, Huang CR, Liou CW, Lin TK, Lu CH.SourceDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. AbstractPurpose: Dizziness/vertigo are important public heath care issues especially in elderly patients. Isolated dizziness/vertigo without neurological deficits has seldom been considered a symptom/sign due to vascular origin. Recently, some studies have suggested that vascular origin should be considered in cases of positional vertigo and isolated vertigo or dizziness when the etiology remains unclear. In this study, we tried to delineate the correlation of dizziness/vertigo and risk factors of stroke. Methods: We collected adult subjects receiving health screening of the brain at their own expense. All subjects had undergone brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and carotid duplex. The chief complaints, body height, body weight, waist circumference and blood pressure of all subjects were recorded. Most received blood tests including fasting sugar, total cholesterol, low density lipoprotein, high density lipoprotein (HDL), triglycerides, and uric acid (UA). The relationships between dizziness/vertigo and blood test data, blood pressure, body mass index (BMI), waist circumference, metabolic syndrome, carotid duplex, silent brain infarction, leukoaraiosis and MRA were analyzed. Results: After exclusion, a total of 170 out of 210 subjects were collected. The analysis revealed that dizziness/ vertigo had a significant correlation to age, UA , BMI, male HDL and female waist circumference. Among them, female waist circumference had the highest statistical significance (P = 0.001). Leukoaraiosis on brain MRI also had a close relationship with dizziness/vertigo. Conclusion: After careful examination and approach, a vascular origin should be considered in dizzy patients of unknown etiology. |
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| 21. | Acta Neurol Taiwan. 2011 Jun;20(2):75-6.Isolated dizziness/vertigo, vascular risk factors and stroke.Hsu LC.SourceDepartment of Neurology, Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine. AbstractDizziness is a common symptom encountered in everyday clinical practice, affecting about 20% to 30% of the general population (1).The number is even higher in the elderly. It is estimated that around 7.5 million patients with dizziness were seen in ambulatory care setting in the U.S. (2), making it the most common principal complaint in the emergency department. The term "dizziness' is very nonspecific, but may refer to vertigo, which is the sensation of spinning, lightheadedness, presyncope, or feeling of imbalance. It is often associated with depressed mood, poor self-rated health, falls, and a reduction in social activities (3). Most of the causes (over 75%) are peripheral vestibular disorders, such as benign paroxysmal positional vertigo, vestibular neuritis or labyrinthitis (4-5). Central causes account for less than 25% of the cases. The diagnosis of vertebrobasilar insufficiency (VBI) is obvious when the dizziness/vertigo is accompanied by other neurological symptoms, e.g. ataxia, diplopia, and nystagmus. However, when vertigo/dizziness occurs in isolation, it is difficult to differentiate vascular causes from other, more benign peripheral vestibular disorders. There have been conflict results in the estimate on the role of vascular insufficiency in patients with isolated dizziness/vertigo( 2, 6-12). In this issue, Chang and colleagues systemically evaluate 170 evaluated subjects receiving self-paid health check-up of the cerebrovascular system, including brain magnetic resonance imaging (MRI), serum biochemistry and vascular risk factors screening, to investigate the relationship between vascular risk factors and isolated dizziness/vertigo (13). Twenty-eight out of the 170 subjects complained of chronic isolated dizziness/ vertigo. They found that old age, obese female, higher uric acid level and MRI evidence of leukoaraiosis were significantly associated with chronic isolated dizziness/vertigo. Grad and Baloh found a high incidence of isolated episodes of vertigo during their course of disease in a retrospective review of 84 cases with VBI or brainstem infarction (7). Sixty-two percent of patients with VBI had at least one isolated episode of vertigo; in 19% VBI began with isolated episode of vertigo. Transient ischemic in the vestibular labyrinth ischemia was highly suspected in these cases. Similarly, Gomez et al. found a high incidence (6/29) of widespread vascular insufficiency in the VB system in patients with long-standing (> 4 weeks) isolated vertigo (10). In addition, these patients had multiple vascular risk factors in common. This was confirmed by a recent study (11). Moubayed and Saliba reviewed the morphologic results of vertebral arteries (VA) by magnetic resonance angiography (MRA) in 133 patients. Compared to normal VAs, those with VA stenosis or hypoplasia (61 cases) had higher frequency of isolated positional vertigo or dizziness (85.7% vs. 58%). Furthermore, those with VA abnor- Editorial Acta Neurol Taiwan 2011;20:75-76 malities had more stroke risk factors (≧3) than patients with normal VA. The results of Chang et al. study (13) essentially paralleled these previous studies, i.e. patients with isolated dizziness/vertigo of presumably vascular origin were older, had higher body mass index (BMI), metabolic derangement, and more stroke risk factors. The most frequent sites of pathology in patients with isolated dizziness/vertigo are brainstem and/or cerebellum. Yamasoba et al. reported on a high prevalence of lacunar infarcts in the hindbrain in aged patients with chronic dizziness (9). Chan et al. reported on a case of pontine infarction due to VA thrombosis presenting with chronic isolated vertigo (14). Colledge et al. found more white matter lesions especially in the midbrain in aged dizzy patients (≧65) compared to control subjects (6). These authors postulated that cerebral small vessel disease could cause dizziness in susceptible patients. The underlying mechanism of higher frequency of leukoaraiosis in Chang et al. study (13) might be the same. Given the high prevalence of isolated dizziness/vertigo in our everyday practice, additional researches are warranted to further delineate the role of vascular risk factors and cerebral small vessel disease in these patients. |
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| 22. | J Neurosci Rural Pract. 2011 Jan;2(1):109-10.Benign paroxysmal positional vertigo.Xiang-Dong G.SourceDepartment of Otolaryngology, the First Affiliated Hospital of Henan Traditional Chinese Medical College, Zhengzhou, China. AbstractBenign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes as may occur with looking up, turning over in bed, or straightening up after bending over. It is important to understand BPPV not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and effective in >90% of cases. The diagnosis of BPPV can be made based on the history and examination. Patients usually report episodes of spinning evoked by certain movements, such as lying back or getting out of bed, turning in bed, looking up, or straightening after bending over. At present, the generally accepted recurrence rate of BPPV after successful treatment is 40%-50% at 5 years of average follow-up. There does appear to be a subset of individuals prone to multiple recurrences. |
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| 23. | J Neurosci Rural Pract. 2011 Jan;2(1):80-3.Horizontal canal benign paroxysmal positional vertigo in a fighter pilot.Xie SJ, Wang JC, Ding L, Sun XQ.SourceDepartment of Aerospace Biodynamics, Fourth Military Medical University, Xi'an, Shaanxi, China. AbstractBenign paroxysmal positional vertigo (BPPV) is the most common disorder of the peripheral vestibular system, characterized by intense, positional provoked vertigo. BPPV is thought to occur due to canalithiasis of the posterior semicircular canal. Recently, a new entity of BPPV, known as horizontal canal (HC)-BPPV, has been recognized. Although only 3 to 8% of BPPV is due to horizontal canal involvement, HC-BPPV is not rare. We present a case of a naval fighter pilot who had an incident of HC-BPPV on the ground. The pilot aeromedical evaluation and considerations are discussed. |
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| 24. | J Korean Neurosurg Soc. 2011 May;49(5):290-1. Epub 2011 May 31.Diagnosis of persistent primitive olfactory artery using computed tomography angiography.Kim MS, Lee GJ.SourceDepartment of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. AbstractPersistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA. |
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| 25. | BMC Fam Pract. 2011 Jun 24;12:58.Newly diagnosed incident dizziness of older patients: a follow-up study in primary care.Sczepanek J, Wiese B, Hummers-Pradier E, Kruschinski C.SourceInstitute of General Practice, Hannover Medical School, Hannover, Germany. AbstractBACKGROUND:Dizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (≥65) with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs') initial diagnoses, referrals and revised diagnoses after six months. METHODS:An observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrollment and follow-up (after 1 month and 6 months). After six months, chart reviews and face-to-face interviews were also performed with the GPs. RESULTS:Mean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8%) showed a moderate or severe dizziness handicap, and 43 (62.3%) showed a certain disability in terms of quality of life at the time of enrollment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months) initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47) than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV). CONCLUSIONS:New-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as differential diagnosis. |
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| 26. | Ther Adv Neurol Disord. 2011 May;4(3):183-91.Management of vestibular migraine.Bisdorff AR.SourceCentre Hospitalier Emile Mayrisch, rue Emile Mayrisch, Esch-sur-Alzette, 4003 Luxembourg. AbstractVestibular migraine is considered to be the second most common cause of vertigo and the most common cause of spontaneous episodic vertigo. The duration of attacks varies from seconds to days, usually lasting minutes to hours, and they mostly occur independently of headaches. Long-lasting individual attacks are treated with generic antivertiginous and antiemetic drugs. Specific antimigraine drugs are unlikely to be very effective for rescue. The mainstay of the management of vestibular migraine is prophylactic medication. To date, there are no controlled trials available; the body of knowledge builds on case series and retrospective or observational studies. Most drugs are also used for the prevention of migraine headaches. The choice of medication should be guided by its side effect profile and the comorbidities of patients. Betablockers such as propanolol or metoprolol are preferred in patients with hypertension but in the absence of asthma. Anticonvulsants include topiramate when patients are obese, valproic acid and lamotrigine. Lamotrigine is preferred if vertigo is more frequent than headaches. Calcium antagonists include verapamil and flunarizine. If patients have anxiety, tricyclic antidepressants such as amitryptiline or nortryptiline or SSRIs and benzodiazepines such as clonazepam are recommended. Acetazolamide is effective in rare genetic disorders related to migraine-like episodic ataxia; however, its place in vestibular migraine is still to be established. Nonpharmacological measures such as diet, sleep, hygiene and avoidance of triggers are recommended as they are for migraine. Vestibular rehabilitation might be useful when there are complications such as loss of confidence in balance or visual dependence. |
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| 27. | PLoS One. 2011;6(5):e20498. Epub 2011 May 31.Matrix recruitment and calcium sequestration for spatial specific otoconia development.Yang H, Zhao X, Xu Y, Wang L, He Q, Lundberg YW.SourceVestibular Neurogenetics Laboratory, Boys Town National Research Hospital, Omaha, Nebraska, United States of America. AbstractOtoconia are bio-crystals anchored to the macular sensory epithelium of the utricle and saccule in the inner ear for motion sensing and bodily balance. Otoconia dislocation, degeneration and ectopic calcification can have detrimental effects on balance and vertigo/dizziness, yet the mechanism underlying otoconia formation is not fully understood. In this study, we show that selected matrix components are recruited to form the crystal matrix and sequester Ca(2+) for spatial specific formation of otoconia. Specifically, otoconin-90 (Oc90) binds otolin through both domains (TH and C1q) of otolin, but full-length otolin shows the strongest interaction. These proteins have much higher expression levels in the utricle and saccule than other inner ear epithelial tissues in mice. In vivo, the presence of Oc90 in wildtype (wt) mice leads to an enrichment of Ca(2+) in the luminal matrices of the utricle and saccule, whereas absence of Oc90 in the null mice leads to drastically reduced matrix-Ca(2+). In vitro, either Oc90 or otolin can increase the propensity of extracellular matrix to calcify in cell culture, and co-expression has a synergistic effect on calcification. Molecular modeling and sequence analysis predict structural features that may underlie the interaction and Ca(2+)-sequestering ability of these proteins. Together, the data provide a mechanism for the otoconial matrix assembly and the role of this matrix in accumulating micro-environmental Ca(2+) for efficient CaCO(3) crystallization, thus uncover a critical process governing spatial specific otoconia formation. |
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| 28. | Ann Indian Acad Neurol. 2011 Jan;14(1):12-8.Meniere's disease: Still a mystery disease with difficult differential diagnosis.Vassiliou A, Vlastarakos PV, Maragoudakis P, Candiloros D, Nikolopoulos TP.SourceNational Institute for the Deaf, Athens, Greece. AbstractOne hundred and forty-six years after its first description, the differential diagnosis of Meniere's disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere's disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus) is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere's disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere's disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems. |
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| 29. | J Can Chiropr Assoc. 2011 Jun;55(2):107-19.Attitudes of clinicians at the Canadian Memorial Chiropractic College towards the chiropractic management of non-musculoskeletal conditions.Parkinson J, Lau J, Kalirah S, Gleberzon BJ.SourceProfessor and Chair, Department of Applied Chiropractic, Canadian Memorial Chiropractic College, 6100 Leslie St. Toronto, ON M2H 3J1, E-mail: bgleberzon@cmcc.ca. AbstractOBJECTIVE:The objective of this study was to determine the attitudes of clinical faculty during the 2009-2010 academic year at the Canadian Memorial Chiropractic College towards the treatment of various non-musculoskeletal disorders. METHODS:A confidential survey was distributed to the clinical faculty via email. It consisted of several questions polling the demographic of the respondent such as years in clinical practice, and a list of 29 non-musculoskeletal conditions. Clinicians were asked to indicate their opinions on each condition on rating scale ranging from strongly agree to strongly disagree. RESULTS:Twenty of 22 clinicians responded. The conditions garnering the greatest positive ratings include: asthma, constipation, chronic pelvic pain, dysmenorrhea, infantile colic, and vertigo. The options regarding vertigo and asthma, while demonstrating an overall positive attitude towards the benefits of chiropractic care, were stratified amongst clinicians with varying years in clinical practice. CONCLUSION:This study suggests clinicians at this college are moderately open towards the chiropractic treatment of some non-musculoskeletal disorders. |
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| 30. | Neurol Med Chir (Tokyo). 2011;51(5):371-5.Trans-postpyramidal fissure approach for ventral vermian cavernous hemangioma.Nakaguchi H, Hoya K, Yamada S, Murakami M, Matsuno A, Yamazaki K, Ishida Y.SourceDepartment of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Japan. hnakaguti@gmail.com AbstractA 54-year-old man presented with a rare case of cavernous angioma located in the ventral vermis manifesting as sudden onset of vertigo, followed by cerebellar ataxia. T(1)-weighted magnetic resonance imaging revealed a 1.5-cm homogeneously enhanced lesion in the ventral vermis. The postpyramidal fissure was opened widely, and upward exploration through the incision enabled piecemeal removal of the lesion without deterioration of the symptoms. The histological diagnosis was cavernous hemangioma with ruptured enlarged varices. The trans-postpyramidal fissure approach allows visualization of the entire fourth ventricle and avoids damaging the cerebellar nuclei and major postoperative cerebellar dysfunction. |
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| 31. | Ochsner J. 2010 Spring;10(1):23-6.The heart of the matter.Zacharia G, Hart M, Vuppala S.AbstractA 65-year-old Hispanic man receiving peritoneal dialysis presented to the emergency department complaining of the sudden onset of numbness and tingling of the right side of his body and face with associated nausea, vomiting, vertigo, and blurry vision. Further testing revealed a large, mobile mass on his mitral valve, leading to a diagnosis of endocarditis with embolic phenomena. The presentation, diagnosis, and treatment of endocarditis are discussed here. |
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| 32. | Rev Neurol. 2011 Jun 16;52(12):751-8.[A new cause of structural vertigo: superior semicircular canal dehiscence]. [Article in Spanish] Crovetto-De la Torre MA, Whyte-Orozco J, Crovetto-Martínez R, Whyte-Orozco A, Obón-Nogués JA, Martínez-Rodríguez A.SourceServicio de Otorrinolaringología, Hospital de Basurto, Universidaddel País Vasco, España. macdlt@telefonica.net AbstractThe medical history of vertigo must be updated to accommodate current knowledge. In 1998 a new cause of vertigo associated with a structural anomaly was reported: superior semicircular canal dehiscence. This condition causes vestibular and auditory disorders, which are frequently associated, and a well-directed medical history allows a suspected diagnosis to be reached: the subject may suffer from vertigo triggered by loud sounds (Tullio's phenomenon) and by changes in pressure within the ear or in the intracranial space, when Valsalva's manoeuvres are performed or on pressing on the tragus (Hennebert's sign). It is not uncommon for subjects to suffer from a chronic imbalance that is exacerbated by the aforementioned precipitating factors. One frequent auditory symptom of superior semicircular canal dehiscence is autophony in the dehiscent ear, associated with hypoacusis of its transmission. This article outlines the questions that must be included in the medical history of vertigo in order to determine whether these dehiscences are present or not. The diagnostic procedures that are best suited to confirming it are also addressed. Superior semicircular canal dehiscence can be resolved satisfactorily by surgery. |
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| 33. | Tunis Med. 2011 May;89(5):471-5.Traumatic perilymphatic fistulae : About 13 cases.Kaffel N, Jlassi N, Selmi Z, Boulakbeche R, Lahiani R, Nejah D, Ben Saleh M, Hajri H, Ferjaoui M.AbstractBackground: Post-traumatic peri-lymphatic fistulas have been described following ear and temporal bone injury, particularly in the setting of temporal bone fractures. The symptoms and signs of perilymphatic fistulae (PLF) are very varied and frequently misleading. The diagnosis can be suspected on the bases of the clinical and the audiometrial findings. Indications for exploratory surgery in cases of trauma are vague and not well described. Aim: To assess the principal clinical and radiologic signs of PLF. Method: Study of 13 patients with different symptoms of posttraumatic peri-lymphatic fistulae. Results: Ten patients had vertigo, and 2 presented otoliquorreha. Two patients had tympanic perforation. Nine patients presented neurosensorinal hearing loss and 5 were completely deaf. A CT Scann was realized in 12 cases and showed the fracture in 10 cases (91%) with a pneumolabyrinth in 4 cases. Medical and postural treatment was indicated for all the patients then a surgery was indicated in all of them in an average wait of 4 months realizing an ear exclusion in one case and a filling-up for 12 patients. Vertigo improved in 10 cases and the hearing loss in 2cases. Conclusion: The diagnostic of perilymphatic fistulae is not easy. The trauma and the clinical signs can help but the confirmation is surgical. The indication of surgery and its timing are still discussed. |
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| 34. | Braz J Otorhinolaryngol. 2011 Mar-Apr;77(2):191-200.Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines. [Article in English, Portuguese] Silva AL, Marinho MR, Gouveia FM, Silva JG, Ferreira Ade S, Cal R.SourceUNISUAM - Rio de Janeiro - RJ. delandre@infolink.com.br AbstractBenign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. AIM:the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. METHOD:Study design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. RESULTS:Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. CONCLUSIONS:Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality. |
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| 35. | Turk Neurosurg. 2011;21(2):249-53. doi: 10.5137/1019-5149.JTN.2869-09.0.Primary fourth ventricular meningioma: case report and review of the literature.Alver I, Abuzayed B, Kafadar AM, Muhammedrezai S, Sanus GZ, Akar Z.SourceAcibadem Bakirkoy Hospital, Department of Neurosurgery, Istanbul, Turkey. AbstractPrimary fourth ventricle meningiomas are extremely rare, and they are defined as meningiomas arising from the choroid plexus and lying strictly within the fourth ventricle. In this report we present a 61-year-old man with progressive worsening vertigo and gait disturbance, and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis, horizontal nystagmus, and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion in the fourth ventricle with brain stem compression, and obstructive hydrocephalus. The patient was operated in the prone position with suboccipital craniotomy and splitting the lower vermis. Total resection of the tumor was achieved with no intra- or post-operative complications. Histopathologic examination revealed fibroblastic type meningioma (WHO grade I). |
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| 36. | Zhong Xi Yi Jie He Xue Bao. 2011 Apr;9(4):395-401.[Three preparations of compound Chinese herbal medicines for de-adaptation to high altitude: a randomized, placebo-controlled trial]. [Article in Chinese] Shi ZF, Zhou QQ, Xiang L, Ma SD, Yan CJ, Luo H.SourceThe 68303 Troop Hospital of People's Liberation Army, Wuwei 733004, Gansu Province, China. AbstractBACKGROUND:With the increase of troops entering the plateau for a variety of missions, the occurrence of de-adaptation increased significantly when the army returned to the plains, however, until now, there has been no effective treatment for de-adaptation to high altitude. OBJECTIVE:To observe the interventional effects of compound Chinese herbal preparations (Sankang Capsule, Rhodiola Rosea Capsule and Shenqi Pollen Capsule) on de-adaptation to high altitude, and provide scientific evidence for appropriate treatment methods in the army health care for future missions. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: A randomized, single-blind, placebo-controlled trial design was used. Soldiers of a returning army unit who exhibited de-adaptation response symptoms were selected for observation after participating in earthquake relief at high altitude. A total of 543 soldiers were divided into a Sankang Capsule group, a Rhodiola Rosea Capsule group, a Shenqi Pollen Capsule group and a placebo group for drug intervention and administered with corresponding drugs. The course of treatment was 15 days. A self-evaluation scale for de-adaptation to high altitude was used to measure the signs and symptoms exhibited by the soldiers. Main outcome measures: Effective rate of signs and symptoms of de-adaptation to high altitude was analyzed after a 15-day treatment and the differences of improvement rate of symptoms between groups were compared to evaluate the efficacy of the drugs. RESULTS:All three drugs improved the symptoms of de-adaptation to high altitude. Compared with the placebo group, symptoms of de-adaptation to high altitude in the drug-treated groups were remitted (P<0.05). Compared with placebo, Sankang Capsule mainly had well-marked effects on dizziness, fatigue, palpitations, cough, sputum and sore throat (P<0.05); Rhodiola Rosea Capsule significantly reduced the symptoms of fatigue, drowsiness, chest tightness, palpitations, vertigo, lack of attention and memory loss (P<0.05); Shenqi Pollen Capsule significantly reduced the symptoms of dizziness, fatigue, weakness, chest tightness, palpitations, cough, sputum, sore throat, memory loss, unresponsiveness and limb numbness (P<0.05). The symptom improvement rate of Shenqi Pollen Capsule was significantly higher than those of the other two drugs. CONCLUSION:All the three drugs played an evident role in ameliorating symptoms of de-adaptation, and the use of Shenqi Pollen Capsule was more effective than Rhodiola Rosea Capsule and Sankang Capsule. |
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| 37. | Case Rep Oncol. 2011 Feb 25;4(1):106-14.Hodgkin's Lymphoma and Paraneoplastic Phenomena in the Central Nervous System: A Case Report and Review of the Literature.Vetter M, Tzankov A, Engert A, Mehling M, Herrmann R, Rochlitz C.SourceDepartment of Medical Oncology, University Hospital Basel, Basel, Switzerland. AbstractA 25-year-old male patient presented to our Ear, Nose and Throat clinic with a history of nausea, vomiting, headache, vertigo and weight loss of 5 kg over the preceding 3 months. An enlarged cervical lymph node was detected at clinical examination. Lymph node biopsy showed nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL, nodular paragranuloma). Because of the neurological symptoms a cerebral MRI scan was performed and revealed an intense perivascular, bilateral, contrast-medium enhancing lesion of the temporal lobes suggestive of cerebral vasculitis. Cerebrospinal fluid analysis showed an increased number of mononuclear cells, but there was no indication for neurotropic viral or bacterial infections. EEG revealed a left temporal epileptic focus, and anti-epileptic therapy was initiated. NLPHL was treated with 2 cycles of ABVD chemotherapy and 20 Gy involved-field radiotherapy. Steroid therapy (prednisone 100 mg q.d.) for the presumed paraneoplastic neurological manifestation was started 1 week before chemotherapy and led to the rapid disappearance of complaints. Because of renewed onset of nausea and vertigo after 3 weeks of treatment with ABVD chemotherapy and 4 weeks of treatment with steroids, a follow-up brain MRI and EEG were performed and demonstrated complete disappearance of the 'vasculitic' changes without additional pathologic findings. Five months after therapy, the patient is without neurological symptoms and a PET-CT showed a complete remission. This case is a unique example of paraneoplastic central nervous system (CNS) involvement in a patient with newly diagnosed NLPHL. We present a review of the literature on paraneoplastic CNS symptoms in Hodgkin's lymphoma. |
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| 38. | J Neurol. 2011 Jul;258(7):1207-22. Epub 2011 Apr 2.Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus.Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ.SourceDepartment of Neurology, University of Munich, Munich, Germany. AbstractWe review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine. |
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| 39. | World J Surg Oncol. 2011 Mar 23;9:36.Cystic cavernous malformation of the cerebellopontine angle: case report and literature review.Huang H, Xu K, Qu L, Li Y, Yu J.SourceDepartment of Neurosurgery, The First Hospital of Jilin University, Changchun, PR China. AbstractBACKGROUND:Cavernous malformations (CMs) in the cerebellopontine angle (CPA) are rare, and most of such CMs reported to date are solid and extend from the internal auditory canal into the CPA. In contrast, cystic CMs that arise in the CPA and do not involve the internal auditory canal and dura of the skull base are extremely rare. CASE PRESENTATION:A 50-year-old man presented with vertigo and progressive hearing loss in the right ear. MRI examination revealed a lesion in the CPA with solid and cystic components. Surgery was performed. Well-circumscribed adhesion to cranial nerves, the cerebellum, or the brain stem was noted during surgery. The lesion was totally resected. Pathological examination suggested the lesion to be a CM. At 1-year follow-up, the symptoms at presentation had resolved and no complications had occurred. CONCLUSION:Although cystic CMs of the CPA have no established imaging features, a diagnosis of CMs may be suspected when a cystic lesion is present in the CPA and does not involve internal acoustic meatus or dura mater of the skull base. Skillful microsurgical techniques and monitoring of cranial nerves will secure good outcomes for patients with cystic CMs in the CPA. |
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| 40. | Ann Acad Med Singapore. 2011 Jan;40(1):59-6.15th Yahya Cohen Memorial Lecture - the relationship between the air-bone gap and the size of superior semicircular canal dehiscence.Yuen HW, Boeddinghaus R, Eikelboom RH, Atlas MD.SourceEar Science Institute Australia, Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia. heng_wai_yuen@cgh.com.sg AbstractINTRODUCTION:This study aimed to examine the relationship between the air-bone gap (ABG) and the size of the superior semicircular canal dehiscence (SSCD) as measured on a computed tomography (CT) scan. MATERIALS AND METHODS:The study design was a case series with chart review. Twenty-three patients (28 ears) from a tertiary referral centre were diagnosed with SSCD. The size of the dehiscence on CT scans and the ABG on pure-tone audiometry were recorded. RESULTS:The size of the dehiscence ranged from 1.0 to 6.0 mm (mean, 3.5 ± 1.6 mm). Six ears with a dehiscence measuring less than 3.0 mm did not have an ABG (0 dB). The remaining 18 ears showed an average ABG at 500, 1000, and 2000 Hz (AvABG(500-2000)) ranging from 3.3 to 27.0 dB (mean, 11.6 ± 5.7 dB). The analysis of the relationship between the dehiscence size and AvABG(500-2000) revealed a correlation of R(2) = 0.828 (P <0.001, quadratic fit) and R(2) = 0.780 (P <0.001, linear fi t). Therefore, the larger the dehiscence, the larger the ABG at lower frequencies on pure-tone audiometry. CONCLUSION:In SSCD patients, an ABG is consistently shown at the low frequency when the dehiscence is larger than 3 mm. The size of the average ABG correlates with the size of the dehiscence. These findings highlight the effect of the dehiscence size on conductive hearing loss in SSCD and contribute to a better understanding of the symptomatology of patients with SSCD. |
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| 41. | Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet].EditorsSourcePortland (OR): Oregon Health & Science University; 2010 May. Drug Class Reviews. ExcerptAntihistamines inhibit the effects of histamine at H1 receptors. They have a number of clinical indications including allergic conditions (e.g., rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia. First-generation antihistamines are highly lipophilic and therefore readily cross the blood-brain barrier, contributing to adverse central nervous system effects, including sedation, drowsiness, and decreased cognitive processing. Newer antihistamines were developed to decrease the adverse effects of first generation drug. "Second generation" antihistamines have higher specificity for binding to H1 receptors, lower affinity for non-histamine receptors, and are lipo-phobic (thus have poor penetration of the blood brain barrier). Third generation antihistamines are natural metabolites of first generation drugs, developed with the goal of improving clinical efficacy and minimizing side-effects. The purpose of this review was to compare the efficacy, effectiveness, and adverse effects of newer antihistamines in both adult and pediatric populations. Copyright © 2010 by Oregon Health & Science University, Portland, Oregon 97239. All rights reserved. |
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| 42. | Drug Class Review: Newer Antihistamines: Final Report [Internet].EditorsOregon Evidence-based Practice Center. SourcePortland (OR): Oregon Health & Science University; 2006 Apr. Drug Class Reviews. ExcerptAntihistamines inhibit the effects of histamine at H1 receptors. They have a number of clinical indications including allergic conditions (e.g., rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia. First-generation antihistamines are highly lipophilic and therefore readily cross the blood-brain barrier, contributing to adverse central nervous system effects, including sedation, drowsiness, and decreased cognitive processing. Newer antihistamines were developed to decrease the adverse effects of first generation drug. "Second generation" antihistamines have higher specificity for binding to H1 receptors, lower affinity for non-histamine receptors, and are lipo-phobic (thus have poor penetration of the blood brain barrier). Third generation antihistamines are natural metabolites of second generation drugs, developed with the goal of improving clinical efficacy and minimizing side-effects. The purpose of this review was to compare the efficacy, effectiveness, and adverse effects of newer antihistamines in both adult and pediatric populations. The following key questions guided this review: 1. For outpatients with seasonal or perennial allergic rhinitis or urticaria, do newer antihistamines differ in effectiveness? 2. For outpatients with seasonal or perennial allergic rhinitis or urticaria, do newer antihistamines differ in safety or adverse effects? 3. Are there subgroups of patients based on demographics (age, racial groups, gender), other medications (drug-drug interactions), comorbidities (drug-disease interactions), or pregnancy for which one newer antihistamine is more effective or associated with fewer adverse effects? Copyright © 2006, Oregon Health & Science University, Portland, Oregon |
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| 43. | Rev Neurol. 2011 Mar 1;52(5):275-82.[Linear accelerator radiosurgery for the treatment of vestibular schwannoma]. [Article in Spanish] Rodriguez-Mena R, Gallego-Sanchez JM, Gonzalez-Bonet LG, Goig-Revert F, Barcia-Marino C, Rosello-Ferrando J.SourceServicio de Neurocirugia, Consorcio Hospital General Universitario de Valencia. Avda. Tres Cruces, 2. E-46014 Valencia, Espana. ruben.rod@gmail.com AbstractINTRODUCTION AND AIM:Radiosurgery is among the treatment options for patients with vestibular schwannoma. We present the experience in our institution in the treatment of this disease with this technique. PATIENTS AND METHODS:A retrospective study was made including 20 patients (11 women and 9 men; median age: 55.15 years-old) with vestibular schwannoma who received linear accelerator radiosurgery treatment since April 2005 until December 2008. Follow-up period was between 12 and 42 months, considering clinical examination of cranial nerves VII (House-Brackmann scale) and VIII (Gardner-Robertson scale) as well as radiological findings (considering tumor volume). For statistical analysis, the Fisher's exact test and logistic regression test were used. RESULTS:Certain worsening of hearing function was present in 25% of the patients. Five patients had large tumors at the moment of the treatment (equal or larger than 3.5 cm3), from which four deteriorated from headache, unsteady gait, dizziness/vertigo, facial numbness and tinnitus, with statistical significance (p < 0.05). From the first year of treatment on, there was a tumor volume decrease tendency, with no tumor growth in the medium/long term follow-up, achieving a local control rate of 100%. CONCLUSIONS:Radiosurgery has become an alternative in the treatment of patients with vestibular schwannoma of appropriate size, with high safety level, using low radiation doses, low rate of complications and good tumor control rate in the medium term follow-up. |
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| 44. | Ulus Travma Acil Cerrahi Derg. 2011 Jan;17(1):75-8.Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.Ozkan Arat Y, Volpi J, Arat A, Klucznik R, Diaz O.SourceDepartment of Ophthalmology, University of Wisconsin, Madison, WI, USA. yoncaozkan@hotmail.com AbstractWe present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides. |
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| 45. | CMAJ. 2011 Mar 22;183(5):E301-5. Epub 2011 Feb 7.An atypical presentation of giant cell arteritis.Zwicker J, Atkins EJ, Lum C, Sharma M.SourceDivision of Neurology, The Ottawa Hospital, Ottawa, Ont. jczwicker@yahoo.com |
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| 46. | J Med Case Reports. 2011 Feb 3;5(1):47.Superior canal dehiscence in a patient with three failed stapedectomy operations for otosclerosis: a case report.Lehmann M, Ebmeyer J, Upile T, Sudhoff HH.SourceDepartment of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Münster University, Münster, Germany. holger.sudhoff@rub.de. AbstractINTRODUCTION:This case illustrates that superior semicircular canal dehiscence syndrome can be associated with a "pseudo"-conductive hearing loss, a symptom that overlaps with the clinical appearance of otosclerosis. CASE PRESENTATION:We present the case of a 48-year-old German Caucasian woman presenting with hearing loss on the left side and vertigo. She had undergone three previous stapedectomies for hearing improvement. Reformatted high-resolution computed tomographic scanning and the patient's history confirmed the diagnosis of concurrent canal dehiscence syndrome. CONCLUSION:Failure of hearing improvement after otosclerosis surgery may indicate an alternative underlying diagnosis which should be explored by further appropriate evaluation. |
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| 47. | Fabry disease and the ear [Internet].AuthorsEditorsSourceFabry Disease: Perspectives from 5 Years of FOS. Oxford: Oxford PharmaGenesis; 2006. Chapter 25. ExcerptOtological symptoms are common in patients with Fabry disease. Although they are not life threatening, they may severely affect quality of life. Data from FOS – the Fabry Outcome Survey – show that most patients experience hearing loss during their lifespan and that this hearing loss exceeds that of the normal population, as seen in ISO 7029 (International Institute of Standardization). The majority suffer from sensorineural hearing loss, with only a minority having mixed or conductive losses. Slowly progressive hearing loss predominates but the frequency of sudden hearing loss is elevated compared with the general population. About 85% of male patients over 50 years of age and 75% of female patients over 60 years of age suffer from hearing loss severe enough to justify the use of hearing aids. Preliminary data suggest that enzyme replacement therapy has a small beneficial effect in patients with mild or moderate hearing loss. Tinnitus is also much more frequent in patients with Fabry disease than in the normal population. About half of the male patients over 50 years of age and half of the female patients over 60 years of age suffer from tinnitus, as recorded in the FOS sign and symptom checklist. The FOS database provides little information on vertigo, however, as, until recently, it has not differentiated true vertigo from other forms of dizziness. Vestibular dysfunction does occur in Fabry disease but appears to be much less frequent than the 'vertigo' documented in the FOS sign and symptom checklist. The prevalence of non-specific dizziness appears to increase with age, with a smaller difference between genders than is the case for hearing loss. Copyright © 2006, Oxford PharmaGenesis™ |
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| 48. | Acta Otorhinolaryngol Ital. 2010 Aug;30(4):224.Converting apogeotropic into geotropic lateral canalolithiasis by headpitching manoeuvre in the sitting position.Califano L. |
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| 49. | Acta Otorhinolaryngol Ital. 2010 Aug;30(4):222.Lateral semicircular canal benign paroxysmal positional vertigo diagnostic signs.Asprella-Libonati G. |
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| 50. | Acta Otorhinolaryngol Ital. 2010 Aug;30(4):217.Case reports on two patients with episodic vertigo, fluctuating hearing loss and migraine responding to prophylactic drugs for migraine. Menière's disease or migraine-associated vertigo?Teggi R, Fabiano B, Recanati P, Limardo P, Bussi M.SourceENT Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy. teggi.roberto@hsr.it AbstractRecent reports have focused on a possible association between migraine and Menière's disease; patients suffering from Menière's disease present a higher rate of migraine. In some cases, the clinical features of migraine-associated vertigo may mimic the presentation of Menière's disease. The present report focuses on two cases of females with recurrent episodes of rotational vertigo, fluctuating hearing loss and tinnitus lasting from a few minutes to several hours; both cases also presented migrainous attacks. As a result of repeated cochleovestibular attacks, both patients presented a permanent low frequency sensorineural hearing loss. Preventive therapies for Menière's disease did not reduce vertigo attacks, while topiramate and acetylsalicylic acid treatment resulted in a significant reduction of both migraine and vertigo. Both the diagnosis of Menière's disease and of migraine-associated vertigo rely on clinical history and both disorders lack a specific diagnostic test. In the early stages, differential diagnosis between Menière's disease and migraine-associated vertigo is often very difficult; previous investigations focused on the possibility that subjects with migraine may experience all symptoms of Menière's disease, including sensorineural fluctuating hearing loss. In conclusion, a trial with prophylactic drug treatment for migraine might be suggested in patients with clear symptoms of migraine and recurrent cochleovestibular disorders. |
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