Migraine-Related Vestibulopathy

1997 ◽  
Vol 106 (3) ◽  
pp. 182-189 ◽  
Author(s):  
Stephen P. Cass ◽  
Jennifer K. P. Ankerstjerne ◽  
Sertac Yetiser ◽  
Joseph M. Furman ◽  
Carey Balaban ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Physical Examination ◽  
Vestibular System ◽  
Symptomatic Relief ◽  
Vestibular Function ◽  
Clinical Findings ◽  
Response To Treatment ◽  
Vestibular Disorders ◽  
Vestibular Tests ◽  
Episodic Vertigo

Migraine has been associated with specific vestibular disorders, including benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. Migraine may also play a role in chronic nonspecific vestibulopathy. Because scant data exist that describe the clinical findings and vestibular function abnormalities in suspected migraine-related vestibulopathy, we reviewed the history, physical examination, vestibular tests (electronystagmography, rotational chair, posturography), and response to treatment of 100 patients with diagnoses of migraine-related vestibulopathy. Dominant clinical features included chronic movement-associated dysequilibrium, unsteadiness, space and motion discomfort, and occasionally, episodic vertigo as an aura prior to headache, or true vertigo without headache. Common vestibular test abnormalities included a directional preponderance on rotational testing, unilateral reduced caloric responsiveness, and vestibular system dysfunction patterns on posturography. Treatment was usually directed at the underlying migraine condition by identifying and avoiding dietary triggers and prescribing prophylactic anti-migraine medications. Symptomatic relief was also provided using anti-motion sickness medications, vestibular rehabilitation, and pharmacotherapy directed at any associated anxiety or panic disorder.

Recent Advances in Clinical Neurotology

1995 ◽  
Vol 5 (4) ◽  
pp. 231-252
Author(s):  
Robert W. Baloh ◽  
Joseph M.R. Furman ◽  
G. Michael Halmagyi ◽  
John H.J. Allum
Keyword(s):  
Vestibular System ◽  
Clinical Management ◽  
Basic Science ◽  
Neural Control ◽  
Vestibular Function ◽  
Diagnosis And Treatment ◽  
Vestibular Disorders ◽  
Anatomy And Physiology ◽  
Technological Developments ◽  
Neural Control Of Movement

In recent years, owing to significant technological developments and an increased number of investigators entering the field, there have been spectacular advances in our understanding of the basic anatomy and physiology of the vestibular system. Unfortunately, these advances in basic science are slow to impact the clinical management of patients. We have selected a few important advances in clinical neurotology that have impacted the diagnosis and treatment of patients with vestibular disorders. This material was originally presented at the “Mechanisms of Vestibular Function and Dysfunction” symposium of the 1994 Neural Control of Movement meeting in Waikoloa, Hawaii.

scholarly journals Vestibular migraine- a dilemma no more

2017 ◽  
Vol 3 (2) ◽  
pp. 312
Author(s):  
Renu Rajguru ◽  
Inderdeep Singh ◽  
Abhishek Gupta
Keyword(s):  
Vestibular System ◽  
International Headache Society ◽  
Clinical History ◽  
Clinical Findings ◽  
Vestibular Dysfunction ◽  
Vestibular Migraine ◽  
Vestibular Disorder ◽  
Episodic Vertigo ◽  
Vestibular Pathology ◽  
Asymptomatic Phase

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Vestibular migraine (VM) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of VM is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. Though in its earlier version International Headache Society recognized only adult onset VM in the setting of basilar migraine, but in its latest 3rd edition beta version in consensus with Barany Society (2013), VM is included in the International Headache Society classification of migraine in appendix 1. It does not figure in the main list because it is yet to be validated by scientific research. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The purpose of this study is to record and describe the spectrum of clinical findings of VM patients, to study the vestibular system and find out the site of vestibular dysfunction. In this study we studied 20 patients with acute VM in the symptomatic and asymptomatic phase.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Abnormal findings in the vestibular work up were present in all 20 VM patients (100%). Central pathology in the vestibular system was seen in 10 patients (50%), 6 patients had peripheral vestibular pathology (30%), and in 4 patients (20%) the site of vestibular dysfunction was indeterminate as they had features of both central and peripheral dysfunction and the exact site of dysfunction could not be determined with certainty. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Acute VM should be considered in the differential diagnosis of vertigo. It can present both as a central and a peripheral vestibular disorder. However there are no definitive signs to pin-point the diagnosis. A careful clinical history combined with clinical findings and exclusion of other causes of vertigo, is fundamental for assessing the profile of patients with vestibular migraine.</span></p>

scholarly journals Inter-examinerreliability study of physical examination procedures to assess the cervical spine

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Karthik V. Hariharan ◽  
Michael G. Timko ◽  
Christopher G. Bise ◽  
Meenakshi Sundaram ◽  
Michael J. Schneider
Keyword(s):  
Cervical Spine ◽  
Physical Examination ◽  
Facet Joint ◽  
Physical Therapists ◽  
Clinical Status ◽  
Clinical Findings ◽  
Qualitative Assessment ◽  
Segmental Mobility ◽  
Convenience Sample ◽  
Pain Provocation

Abstract Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.

scholarly journals Proceedings of the GDR Vertige 2019 annual meeting devoted to endolymphatic hydrops

2021 ◽  
pp. 1-3
Author(s):  
Christian Chabbert ◽  
Anne Charpiot
Keyword(s):  
Annual Meeting ◽  
Research Group ◽  
Endolymphatic Hydrops ◽  
Clinical Manifestations ◽  
Vestibular Function ◽  
Therapeutic Strategies ◽  
Vestibular Disorders ◽  
Special Issue ◽  
Clinical Imaging ◽  
New Methods

The GDR Vertige is a federative research group gathering the different components of the French neuro-otology community. The annual meeting of the GDR Vertige is an opportunity for interactive exchanges between scientists, clinicians and industrialists, on basic issues related to vestibular function, as well as translational questions regarding the management of vestibular disorders. For its fifth edition, the annual meeting of the GDR Vertige, which took place in September 2019 in Marseille (France), was devoted to one of the most peculiar phenomena of neuro-otology: endolymphatic hydrops. For two days, international scientists and clinicians presented the most recent advances regarding the biophysical correlates of endolymphatic hydrops, the genetic and endocrine tableaux that favor its manifestation, new methods of clinical imaging, and current and upcoming therapeutic strategies to overcome the associated clinical manifestations. This special issue of the Journal of Vestibular Research aims at providing the proceedings of this meeting.

scholarly journals Postural control during dual task in adolescent cochlear implant users under on/off-device conditions

2021 ◽  
Author(s):  
Zahra Nadimi ◽  
Mansoureh Adel Ghahraman ◽  
Ghassem Mohammadkhani ◽  
Reza Hoseinabadi ◽  
Shohreh Jalaie ◽  
...  
Keyword(s):  
Postural Control ◽  
Cochlear Implant ◽  
Vestibular System ◽  
Dual Task ◽  
Cognitive Task ◽  
Normal Hearing ◽  
Hearing Impaired ◽  
Caloric Test ◽  
Vestibular Disorders ◽  
Control Performance

Background and Aim: Vestibular system has several anatomical connections with cognitive regions of the brain. Vestibular disorders have negative effects on cognitive performance. Hearing-impaired patients, particularly cochlear implant users, have concomitant vestibular disor­ders. Previous studies have shown that attention assigned to postural control decreases while per­forming a cognitive task (dual task) in hearing-impaired children. Since the vestibular system and postural control performance develop around 15−16 years of age, the aim of this study was to compare postural control performance during dual task in adolescent boys with normal hearing and cochlear implant (CI) users with congenital hearing-impairment. Methods: Postural control was assessed in twenty 16−19 year old cochlear implant boys and 40 normal hearing peers with force plate. The main outcomes were displacement in posterior- anterior and medial-lateral planes, and mean speed with and without cognitive task and under on/off-device conditions. Caloric test was per­formed for CI users in order to examine the peri­pheral vestibular system. Results: Ninety-five percent of CI users showed caloric weakness. There were no significant diff­erences in postural control parameters between groups. All performances deteriorated in the foam pad condition compared to the hard surface in all groups. Total mean velocity significantly increased during dual task in normal hearing group and in CI users with off-device. Conclusion: Although CI users had apparent vestibular disorders, their postural control in both single and dual-task conditions was identical to the normal peers. These effects can be attributed to the vestibular compensation that takes place during growing. Keywords: Balance; postural control; dual task; congenital hearing loss; cochlear implant

Arthroscopic shoulder assessment in Turkish amateur boxers

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 358-362
Author(s):  
Hüseyin Özkan ◽  
İbrahim Yanmış ◽  
Mustafa Kürklü ◽  
Ali Şehirlioğlu ◽  
Servet Tunay ◽  
...  
Keyword(s):  
Physical Examination ◽  
Clinical Findings ◽  
Subacromial Impingement ◽  
Shoulder Injuries ◽  
Pathological Findings ◽  
Glenoid Labrum ◽  
Arthroscopic Findings ◽  
Shoulder Region ◽  
Grade 3 ◽  
The Brain

AbstractThe most common injuries reported in the literature regarding the sport of boxing are to the brain, eyes, kidneys and hands. Shoulder injuries have not been fully reported in the literature until recently, as a result we aimed to present our arthroscopic findings in amateur boxers. Ten amateur boxers with complaints of pain in the shoulder region and decreased performance during sportsplay were enrolled. They were evaluated by physical examination, radiology and arthroscopy. There were no clinical findings of instability. One patient was found to have subacromial impingement; six had crepitation at various degrees during shoulder movements. At arthroscopy, all patients had a variety of pathological findings. Five patients had Grade 1, three had Grade 2, and two had Grade 3 chondropathy. Various degrees of fraying of the anterosuperior and posterosuperior regions of the glenoid labrum were noted in all cases. Three patients had superior labrum anterior and posterior lesions, one patient had a posterior labroligamentous lesion, and one had chondral erosion in the anterosuperior portion of the humeral head. In conclusions, although the injury mechanism of the shoulder during boxing is unknown, this study shows that shoulder complaints in boxers should be considered as possible indicators of serious intra-articular lesions.

Extremity Injuries in Children: Predictive Value of Clinical Findings

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 803-807
Author(s):  
Frederick P. Rivara ◽  
Ruth Ann Parish ◽  
Beth A. Mueller
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Clinical Findings ◽  
Clinical Predictors ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Extremity Injuries ◽  
Physical Findings ◽  
Upper Extremity Fracture ◽  
Point Tenderness

This study sought to identify clinical predictors of extremity fracture in children with trauma. There were 189 children 1 to 15 years of age with 209 extremity injuries seen during a 9-month period. Gross deformity and point tenderness were the best predictors of upper extremity fracture; these two findings correctly identified 81% of children with fractures and 82% of these without fractures. Gross deformity and pain on motion best predicted lower extremity fracture, with 97% of children with fractures correctly identified. The study showed that physical examination is predictive of fractures in extremity injuries of children, regardless of age. In the absence of the specific physical findings identified by the study, the probability of diagnosing a fracture by roentgenographic findings is low.

scholarly journals Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans

2020 ◽  
Vol 5 (2) ◽  
pp. 23
Author(s):  
Felix Haxby ◽  
Mohammad Akrami ◽  
Reza Zamani
Keyword(s):  
Vestibular System ◽  
Postural Sway ◽  
Vestibular Function ◽  
Vestibular Stimulation ◽  
Significant Heterogeneity ◽  
Vestibular Loss ◽  
Ocular Reflex ◽  
Gait Characteristics ◽  
Vestibulo Ocular Reflex ◽  
Meta Analyses

The vestibular system is located in the inner ear and is responsible for maintaining balance in humans. Bilateral vestibular dysfunction (BVD) is a disorder that adversely affects vestibular function. This results in symptoms such as postural imbalance and vertigo, increasing the incidence of falls and worsening quality of life. Current therapeutic options are often ineffective, with a focus on symptom management. Artificial stimulation of the vestibular system, via a vestibular prosthesis, is a technique being explored to restore vestibular function. This review systematically searched for literature that reported the effect of artificial vestibular stimulation on human behaviours related to balance, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique. A total of 21 papers matched the inclusion criteria of the literature search conducted using the PubMed and Web of Science databases (February 2019). The populations for these studies included both healthy adults and patients with BVD. In every paper, artificial vestibular stimulation caused an improvement in certain behaviours related to balance, although the extent of the effect varied greatly. Various behaviours were measured such as the vestibulo-ocular reflex, postural sway and certain gait characteristics. Two classes of prosthesis were evaluated and both showed a significant improvement in at least one aspect of balance-related behaviour in every paper included. No adverse effects were reported for prostheses using noisy galvanic vestibular stimulation, however, prosthetic implantation sometimes caused hearing or vestibular loss. Significant heterogeneity in methodology, study population and disease aetiology were observed. The present study confirms the feasibility of vestibular implants in humans for restoring balance in controlled conditions, but more research needs to be conducted to determine their effects on balance in non-clinical settings.

scholarly journals 084 Separating stroke from vestibular neuritis by vestibular function test parameters

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.1-A27
Author(s):  
Zeljka Calic ◽  
Benjamin Nham ◽  
Rachel Taylor ◽  
Allison Young ◽  
Craig Anderson ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Vestibular Function ◽  
Vestibular Neuritis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Saccade Amplitude ◽  
Vestibular Tests ◽  
Acute Vestibular Syndrome ◽  
Significant Difference ◽  
Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

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