scholarly journals The diagnosis of central vestibular disorder based on the complementary examination of the vestibulospinal reflex

2021 ◽  
Author(s):  
Stefani Maihoub ◽  
András Molnár ◽  
László Tamás ◽  
Ágnes Szirmai
Keyword(s):  
Vestibular Disorder ◽  
Vestibulospinal Reflex ◽  
Complementary Examination ◽  
Central Vestibular Disorder

scholarly journals Opinion and Special Articles: Remote Evaluation of Acute Vertigo

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. 34-38
Author(s):  
Kemar E. Green ◽  
Jacob M. Pogson ◽  
Jorge Otero-Millan ◽  
Daniel R. Gold ◽  
Nana Tevzadze ◽  
...  
Keyword(s):  
Inner Ear ◽  
Head Impulse Test ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Diagnostic Challenge ◽  
Clinical Interpretation ◽  
Clinical Dilemma ◽  
Key Steps ◽  
Central Vestibular Disorder ◽  
Remote Evaluation

Patients with acute vestibular disorders are often a diagnostic challenge for neurologists, especially when the evaluation must be conducted remotely. The clinical dilemma remains: Does the patient have a benign peripheral inner ear problem or a worrisome central vestibular disorder, such as a stroke? The use of a focused history and the virtual HINTS (head impulse test, nystagmus evaluation, and test of skew) examination are key steps towards correctly diagnosing and triaging the acute vertiginous patient. When looking for signs of vestibulo-ocular dysfunction, there are important technological and practical considerations for an effective clinical interpretation.

scholarly journals Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic

2021 ◽  
Vol 25 (01) ◽  
pp. e141-e149
Author(s):  
Renato Gonzaga Barreto ◽  
Darío Andrés Yacovino ◽  
Lázaro Juliano Teixeira ◽  
Mayanna Machado Freitas
Keyword(s):  
Disease Transmission ◽  
Benign Paroxysmal Positional Vertigo ◽  
Good Clinical Practice ◽  
Relevant Information ◽  
Remote Access ◽  
Vestibular Disorder ◽  
Face To Face ◽  
Positional Vertigo ◽  
Video And Audio ◽  
Paroxysmal Positional Vertigo

Abstract Introduction Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing. Objectives The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic. Methods Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context. Results Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV. Conclusion Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.

scholarly journals Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

2021 ◽  
pp. 194173812097051
Author(s):  
Alicia Wang ◽  
Guangwei Zhou ◽  
Kosuke Kawai ◽  
Michael O’Brien ◽  
A. Eliot Shearer ◽  
...  
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Pediatric Patients ◽  
Head Injuries ◽  
Vestibular Disorder ◽  
Symptom Scale ◽  
Level Of Evidence ◽  
Pediatric Concussion ◽  
Positional Vertigo ◽  
Level 3 ◽  
Paroxysmal Positional Vertigo

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

scholarly journals Videonystagmography

2012 ◽  
Vol 4 (1) ◽  
pp. 17-24
Keyword(s):  
Clinical Evaluation ◽  
Therapeutic Modality ◽  
Weak Links ◽  
Functional Abilities ◽  
Vestibular Disorder ◽  
Vestibular Evoked Myogenic Potential ◽  
Dynamic Posturography ◽  
Computerized Tests ◽  
Balance Disorder ◽  
The Individual

ABSTRACT The goals of any test that evaluates balance function are manifold; primarily to determine the presence of a true balance disorder and to topographically locate it. Secondarily, to determine the extent of residual functional abilities of the patient as regards the ‘deficit’ caused by the disorder, and evaluate the possibility of recovery. Thirdly, and most importantly, to determine whether the individual is likely to benefit from some therapeutic modality, whether single or combined, based on the results of the tests. Testing for vertiginous patients involves eliciting a detailed history, followed by a clinical evaluation. Investigations include the audiological, radiological and computerized tests. Computerized vestibular testing includes various computerized modules, such as: Electronystagmography (ENG), videonystagmography (VNG), rotational testing, computerized dynamic posturography (sensory organizational test—SOT; motor control testing—MCT) and vestibular evoked myogenic potential (VEMP) testing. VNG is thus only one of the computerized tests and should always be interpreted in conjunction with the others mentioned above. This, however, does not mean that VNG should be performed in all patients complaining of vertigo. It is thus, prudent to understand the indications and possible information that may be obtained from a VNG evaluation and its application to clinical science. Analysis is often carried out by a technician and the results presented to the surgeon or physician. The analysis is often carried out automatically, or at least semi-automatically by a computer, where the automatic artefact rejection is usually poor, or in the least, suboptimal. These potentially ‘weak links’ in the chain can often mislead the clinician, and lead to errant diagnosis, such as ‘central vestibular disorder’, either due to an artifactual recording, or poor interpretation! It is thus, extremely important, that the ENG/VNG results are correlated with the clinical evaluation of the same tests, which may be done with the naked eye or in the least, using Frenzel's glasses. How to cite this article Hathiram BT, Khattar VS. Videonystagmography. Int J Otorhinolaryngol Clin 2012;4(1): 17-24.

Effect of using smart phones on balance functions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
N Hazzaa ◽  
DM Hassan ◽  
Sh Mahmoud
Keyword(s):  
Healthy Subjects ◽  
Smart Phone ◽  
Balance Function ◽  
Visual Fatigue ◽  
Vestibular Disorder ◽  
Dynamic Posturography ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Composite Scores

Abstract Objective To investigate the effect of visual fatigue caused by smart phone on the balance function. Subjects and Methods Forty subjects divided into 2 groups were included in the present study . Group I, twenty normal healthy subjects with mean age of 28.8 years. Group II, twenty subjects with a clinical diagnosis of peripheral vestibular disorder with mean age of 38.85years. They were subjected to a computer vision syndrome questionnaire (CVS-Q) , occulomotor tests of videonystagmography (VNG) and sensory organization test (SOT) of computerized dynamic posturography (CDP) before and after visual fatigue induction. Results Significant differences existed between C5, 6 and composite scores in group I and in C4 and composite scores in group II after visual fatigue induction. However, there was no significant difference between occulomotor tests in both groups after visual fatigue induction. Conclusions The smart phone use can affect the balance function in healthy subjects and augment the deficit in those with balance problem. Reducing visual fatigue should be considered through various procedures as taking proper rest, adjusting the brightness of screen, avoid any wrong posture and using filters if possible.

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