Cerebellar vermis lesions and tumours of the fourth ventricle in patients with positional and positioning vertigo and nystagmus

2006 ◽  
Vol 121 (2) ◽  
pp. 166-169 ◽  
Author(s):  
N Shoman ◽  
N Longridge
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Fourth Ventricle ◽  
Correct Diagnosis ◽  
Vestibular Dysfunction ◽  
Cerebellar Vermis ◽  
Positional Nystagmus ◽  
Common Presentation ◽  
Positional Vertigo ◽  
Benign Paroxysmal Positioning Vertigo

Positional and positioning vertigo and nystagmus syndromes are usually due to peripheral vestibular dysfunction. The most common form is benign paroxysmal positioning. In this paper, we discuss more serious aetiologies in the differential diagnosis for patients presenting with a history suggestive of benign paroxysmal positioning vertigo. We draw attention to the diagnosis of cerebellar vermis lesions and tumours of the fourth ventricle by presenting two cases of patients with positional nystagmus of so called benign paroxysmal type. We review the literature on positional nystagmus, highlighting key findings on history and physical examination to aid in the correct diagnosis of benign paroxysmal positioning vertigo, and to differentiate it from the rare yet sinister central aetiologies that can present with positional vertigo of the benign positional type. This is with the aim to avoid over-investigating a common presentation without missing a serious diagnosis.

Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis

1983 ◽  
Vol 59 (4) ◽  
pp. 660-663 ◽  
Author(s):  
Abelardo Salazar ◽  
Julio Sotelo ◽  
Hector Martinez ◽  
Francisco Escobedo
Keyword(s):  
Differential Diagnosis ◽  
Fourth Ventricle ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Large Cyst ◽  
Content Type ◽  
Surgical Exploration ◽  
Precise Diagnosis ◽  
The Central Nervous System ◽  
Radiological Procedures

✓ The fourth ventricle is frequently affected in patients with cysticercosis of the central nervous system, due either to a large cyst occluding the cavity or to granular ependymitis (ventriculitis) as a consequence of diffuse inflammation within the intraventricular and subarachnoid spaces. In some cases, the differential diagnosis between these two forms of neurocysticercosis is difficult to make, even after special radiological procedures. It is important to establish the correct diagnosis, since a surgical approach is beneficial only when the fourth ventricle is obstructed by a large cyst. In this paper, the clinical differences between fourth ventricle cysts and ventriculitis are presented in 16 patients with neurocysticercosis who were subjected to surgical exploration of the posterior fossa. Patients with a large cyst occluding the fourth ventricle had a short evolution of signs and symptoms, Bruns' syndrome, and discrete or no inflammatory reaction in the cerebrospinal fluid (CSF). Patients with ventriculitis generally had a longer duration of signs and symptoms, Parinaud's syndrome, a consistently positive complement fixation test to cysticerci, and more cells and proteins in the CSF. The clinical picture and ancillary studies can give the precise diagnosis in most patients before surgical exploration is performed.

scholarly journals Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants

2012 ◽  
Vol 4 (1) ◽  
pp. 25-40 ◽  
Author(s):  
Giacinto Asprella Libonati
Keyword(s):  
Differential Diagnosis ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Diagnosis And Therapy ◽  
Positional Vertigo ◽  
Peripheral Origin ◽  
Paroxysmal Positional Vertigo

ABSTRACT This article reviews the causes of positional vertigo and positional nystagmus of peripheral origin. Benign paroxysmal positional vertigo is described in all its variants, its diagnosis and therapy are highlighted. In addition, nonparoxysmal positional vertigo and nystagmus due to light/heavy cupula of lateral and posterior semicircular canal is focused on. The differential diagnosis between positional vertigo due to otolithic and nonotolithic causes is discussed. How to cite this article Asprella Libonati G. Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants. Int J Otorhinolaryngol Clin 2012;4(1):25-40.

Evaluation and Spectrum of Orbital Diseases

2011 ◽  
Author(s):  
Raymond S. Douglas ◽  
Robert A. Goldberg
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Laboratory Testing ◽  
Correct Diagnosis ◽  
Evaluation Process ◽  
Mass Effect ◽  
Clinical Presentations ◽  
Thyroid Associated Ophthalmopathy ◽  
Orbital Imaging ◽  
Orbital Disease

Although orbital disorders are not frequently encountered in the comprehensive ophthalmologist’s practice, it is essential to be able to diagnose patients with orbital disease and manage them accordingly. Various disease processes can affect the orbit. This chapter endeavors to provide a thoughtful, stepwise, and logical approach to the evaluation of orbital disease. The discussion begins with differential diagnosis, adds an intelligent history-taking and physical examination, and then focuses on efficient use of diagnostic tests to finally arrive at the correct diagnosis. The staging and management of two common orbital disorders, orbital inflammation and thyroid-associated ophthalmopathy, will also be discussed. The differential diagnosis of orbital disease is extensive, and most listings of orbital disease divide the causes between histopathologic and mechanistic categories. This type of grouping is intellectually sound and scientifically useful but does not provide a framework that the clinical practitioner can easily grasp and directly use in sorting through the differential diagnosis of any given patient. In broad terms, orbital disease can be considered in terms of location, extent, and biologic activity. The classification used in this chapter is broken down along clinical lines and takes advantage of the fact that the orbit has a somewhat limited repertoire of ways that it can respond to pathologic conditions. Orbital disease can be categorized into five basic clinical patterns: inflammatory, mass effect, structural, vascular, and functional. Although many cases cross over into several categories, the vast majority of clinical presentations fit predominantly into one of these patterns. As the clinician walks through each step of the evaluation process—history, physical examination, laboratory testing, orbital imaging—a conscious effort should be made to categorize the presentation within this framework. If the practitioner approaches orbital disease with this framework of discrete patterns of clinical presentation, then at every step of the diagnostic pathway (history, physical examination, orbital imaging studies, and special tests), he or she can draw from a defined set of differential diagnoses that characterize each pattern of orbital disease and use that information to efficiently and confidently orchestrate diagnosis and management.

Acute Dizziness

2019 ◽  
Vol 39 (01) ◽  
pp. 027-040 ◽  
Author(s):  
Jonathan Edlow ◽  
Kiersten Gurley
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Traditional Approach ◽  
Diagnostic Testing ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome ◽  
Associated Symptoms ◽  
Ischemic Attack ◽  
Dizzy Patient ◽  
Paroxysmal Positional Vertigo

AbstractDizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Currently, misdiagnoses are frequent and diagnostic testing costs are high. This partly relates to use of an outdated diagnostic paradigm. This commonly used traditional approach relies on dizziness “symptom quality” or “type” (vertigo, presyncope, disequilibrium) to guide inquiry. It does not distinguish benign from dangerous causes and is inconsistent with current best evidence. A better approach categorizes patients into three groups based on timing and triggers. Each category has its own differential diagnosis and targeted bedside approach: (1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; (2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and (3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. The “timing and triggers” diagnostic approach for the acutely dizzy derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreasing diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.

scholarly journals Positional Vertigo and Nystagmus of Central Origin

1981 ◽  
Vol 8 (2) ◽  
pp. 133-137 ◽  
Author(s):  
P. Watson ◽  
H.O. Barber ◽  
J. Deck ◽  
K. Terbrugge
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Central Nervous System Disease ◽  
Positional Nystagmus ◽  
Posterior Fossa Tumors ◽  
System Disease ◽  
Positional Vertigo ◽  
Central Origin

SUMMARY:Four cases are described illustrating the clinical features of positional vertigo and nystagmus due to posterior fossa tumors and a case of obstructive hydrocephalus. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. One case of subependymoma of the fourth ventricle and one with hydrocephalus had characteristic symptoms of benign positional vertigo; each showed positional nystagmus of the benign paroxysmal type.

Stapedotomy and post-operative benign paroxysmal positional vertigo

2005 ◽  
Vol 15 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Giuseppe Magliulo ◽  
Mario Gagliardi ◽  
Giuseppe Cuiuli ◽  
Alessandra Celebrini ◽  
Donato Parrotto ◽  
...  
Keyword(s):  
Physical Examination ◽  
Prospective Study ◽  
Benign Paroxysmal Positional Vertigo ◽  
The Other ◽  
Positional Nystagmus ◽  
Positional Vertigo ◽  
Vestibular Symptoms ◽  
Paroxysmal Positional Vertigo

In our experience some patients subjected to stapedotomy presented vestibular symptoms characterized by brief episodes of vertigo that only lasted 10 to 20 seconds, accompanied by rapid paroxysmal nystagmus similar to that found in benign paroxysmal positional vertigo (BPPV). For this study, 141 otosclerotic patients were enroled and underwent stapedotomy following the Fisch and Dillier's technique. Twelve out (8.5%) of all the patients under study complained of post-operative vertigo and the physical examination of the positional nystagmus confirmed the presence of paroxymal positional vertigo. The percentage seems particularly high and does not agree with the data reported in literature. The onset of the vestibular symptoms appeared between the 5th and 21st day after surgery. To our knowledge, this is the first prospective study existing in literature on the incidence of BPPV after surgery of the stapes. It must also be stressed that the patient should be informed beforehand during the consultation phase of the possibility of post-stapedotomy BPPV together with the other causes of post-operative vertigo.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

scholarly journals Differential Diagnosis of Azoospermia in Men with Infertility

2021 ◽  
Vol 10 (14) ◽  
pp. 3144
Author(s):  
Danilo L. Andrade ◽  
Marina C. Viana ◽  
Sandro C. Esteves
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Detailed Analysis ◽  
Clinical Management ◽  
Semen Analysis ◽  
Testicular Biopsy ◽  
Nonobstructive Azoospermia ◽  
Sperm Cryopreservation ◽  
Imaging Studies ◽  
Detailed Medical History

The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.

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